perfectly hidden depression

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Community Voices

Every day i walk through my door ,go to school , eating lunch with my friends,go back home like a normal person and yet every time i across something looks dangerous i would stuck in my daydream thinking if that could kill me and if it's does what would happen after i die , what if I fail to die and they saw my suicide note already , I'm really scared if they know the real me , i'm really scared of my family , friends and everyone reaction .
Please do not tell me I should tell them or "they will understand " because one word they say could affect what I'm about to do

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Community Voices
Community Voices

An Unhappy Achiever

This article describes me completely. I am nothing without my achievements. When I fail, or am not the best at something important to me, I feel like nothing. This article made me realize that my entire self worth is tied to my achievements. I don’t know how to be confident in myself without putting so much pressure on myself to be the best at everything. It’s to the point where I’m ready to give up. I can’t keep living like this.. #perfectionist #Anxiety #PerfectlyHiddenDepression #misunderstood

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Community Voices
Community Voices

Seeing Stars

I was just diagnosed with a depression that I never knew I had. A depression I’ve had my whole life. When you don’t know any different, how do you know what you feel is a symptom of a mood disorder or just what you thought was normal? I just thought I was a pessimistic introvert prone to irritability, anxiety, hopelessness, anhedonia, and suicidal ideation with a hint of disillusionment. This has been me for so long, I don’t know who I am anymore. I have astigmatism. I see stars. I thought everyone saw stars. #Hopeforme #Ididntwanttoknow #whoami #Brokenbrain #denial #Fooledmyself #Lifewasted #Fooledeveryone #PerfectlyHiddenDepression #PersistentDepressiveDisorder

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Community Voices
Matt Sloan

Signs You Grew Up With 'Hidden' Depression

Being a child or a teenager can be an extremely confusing time. Hormonal changes aside, we sometimes feel isolated and alone, particularly where mental health is concerned. How are we to explain what’s going through our minds when we don’t understand it ourselves? What’s “normal” and what isn’t? While more parents these days are taking the time to teach their children about good mental health practices, chances are you might have grown up at a time when society wasn’t as aware of the need. Many of us grew up struggling in silence, dealing with depressive and suicidal thoughts without the knowledge necessary for dealing with or even talking about them. If you grew up hiding your depression, then you aren’t alone. That’s why we asked our mental health community what they realize, in hindsight, were signs of  “hidden” depression. Remember: you don’t have to fight this alone. Here’s what our community had to say: 1. “I failed to maintain personal hygiene. I didn’t bathe. I just didn’t have the energy. I also lost considerable weight and didn’t speak very often. Nobody ever checked to see what was up. My family, teachers and staff at school… just nobody. As an adult, I’ve received therapy and the help I needed, but as a teenager, I felt isolated, outcast and rejected, because I perceived myself as being absolutely alone. I often wonder how different my life would’ve been had I gotten help earlier. I sometimes feel like I’ve wasted my life, or that it was stolen. Everyone thought I was just being a ‘weird’ teen, but the truth was, I was struggling to breathe.” — Emily B. 2. “ Always said ‘sorry’ for everything, always asking ‘am I bugging?’ Constantly worried if I was wanted or not, so that led to being alone or not social. And now I do a lot of things by myself.” — Keisi G. 3. “My room was always a mess; as my mom said, ‘It looked like a tornado had gone through it.’ I was just too tired to deal with the mess and got overwhelmed by it, so it stayed like that. I’m a perfectionist, I love to clean and organize, but my depression halts me in my tracks.” — Stephanie R. 4. “I lacked motivation and concentration through school, so I found it extremely hard to do the work and revise for exams. Essays and exam revision were the worst because I couldn’t sit for 10 minutes before I was fighting to keep myself on track. It lead to a lot of sleepless nights and crying.” — Rachel W. 5. “Getting irritated at everything and everyone. My parents just thought it was because of puberty, but I was beyond puberty mood swings.” — Katlin W. 6. “I had a hard times making friends, especially in school. I was mostly very quiet and didn’t fit into any group, which led to me getting bullied a lot (worsening the depression). I’d daydream about being alone somewhere else to the point I didn’t pay attention.” — Tia M. 7. “In high school, I rarely hung out with friends outside of school. The very few times I did was for birthdays or if we had a school project we needed to work on. It wasn’t because I wasn’t allowed to see my friends or that I had no time for it; I just never made the effort. I’d miss days and sometimes weeks of proper hygiene. I remember washing and brushing my hair one night and a friend had asked me the next day what I did to make my hair look so nice. I told her I brushed it and she laughed; she didn’t think I was being serious.” — Reyna D. 8. “I stopped drawing and I can’t get back into it. This is the last thing I managed to sit and was able to draw; I really miss it.” — Rebecca C. 9. “Acting out at school. I used to get into fights all the time in high school — physical fights, because I was so angry that I didn’t understand what was going on inside my own head and didn’t feel like I could talk to anyone. I even dropped out of high school. After I dropped out, I started going to therapy. I was diagnosed with depression and generalized anxiety disorder when I was 16. As an adult, I continue therapy and have been on medication to help. Now I am a mother who is working on getting her bachelor’s degree in communications.” — Alyssa L. 10. “Sleeping all the time. I’d wake up early for school, come home and take a nap, eat dinner, go to soccer, take another nap and then do my homework. Once I was done with my homework, I’d go to bed. Also the avoidance aspect. I avoided my friends when it got really bad. I didn’t want to hang out or do anything other than sleep.” — Cherish I. 11. “I stopped caring. My grades plummeted from As to Fs. I slept a lot or ran myself ragged trying to stay busy. I hid behind a smile insisting nothing was wrong, yet inside trying to figure out what was wrong with me. I lashed out at everyone who tried to help.” — Viki C. 12. “I didn’t make friends and when I did, I would constantly question their motives. I would sleep all day and all night to the point my mother thought I had a thyroid condition. I lost motivation in school — I used to excel but couldn’t be bothered to the point where I barely graduated.” — Sam T. 13. “This may be odd, but I was the ‘overachiever.’ I needed to get good grades. I needed to be involved in every extracurricular activity during school. I volunteered everywhere I could. Every year, I got highest academic or student of the year. I graduated with a 90 percent grade average, valedictorian and received three scholarships. I was the ‘role model’ in my community. Now that I am in my early 20s, I recognize I needed to be valued. I needed to feel like I was something in the world, because I felt like I was nothing. I needed to be reassured that I was doing good, because no matter what I did, it never felt like enough. I needed someone to be proud of me, because I know I never was proud of myself.” — Lauren P. 14. “When I was quite young (like 7 years old) and just started using a computer, I would often listen to ‘ Lonely ‘ by Akon. It was one of my favorite songs at the time. Now that I’m a grown up, I realize how sad that song actually is and what it talks about.” — Anahita H. 15. “Extreme anger. I didn’t know how to express myself properly, and it always came out as anger. Reminders for me to do ‘normal’ things like bathe and tidy when I had no energy to do so led to extreme arguments, irrational anger and outbursts. I didn’t care about anything anymore and the only emotion I couldn’t suppress was my anger at everything: my situation, my past and myself.” — Allie S. 16. “Smiling when in public but then going back home to sit alone and never wanting to go back out. I acted like everything was fine, but really I felt lonely and empty.” — Abi T. 17. “I didn’t like celebrating my birthday because I didn’t see living for another year as something to celebrate. I’ve never really liked my birthday, but I didn’t connect the dots that it was connected to my depression until one really intense therapy session about a year ago.” — Katie H. 18. “Starting when I was around 10 or 11, I would sometimes fantasize about getting off the world for a little while. I didn’t want to be dead, just take a break from being a person.” — Ella B. Did you grow up with “hidden” depression? Let us know in the comments. Photo by Annie Spratt on Unsplash

Traits Of Perfectly Hidden Depression

I’ve been writing for three years now about a syndrome called  perfectly hidden depression (PHD). These are people who are inwardly struggling with depression — at times severe depression — but others would never guess they were. They can act both intentionally, but also unconsciously, to deny and avoid pain or suffering. And they do it quite well. In fact, perfectly. But what’s a syndrome? Here’s what the dictionary  offers: “ Pathology, Psychiatry. a group of symptoms that together are characteristic of a specific disorder, disease, or the like.” In PHD, it’s a set of behaviors, thought patterns and emotions (or lack thereof) that are often found together in someone. If you see one, you may be likely to see the other. Like red hair and freckles. Or salt and pepper. Here are ten characteristics of perfectly hidden depression. They’re not all present in every person who might recognize themselves in PHD, but they’re fairly consistent. They were created from hundreds of email stories and interviews with people identifying with PHD. 1) Perfectionism with a constant, critical inner voice. Having a perfectionistic streak is one thing. You try to do your best. “If it’s worth doing, it’s worth doing well,” is a favorite motto. Yet people with PHD silently berate themselves if they’re not at the top at all times. They may allow themselves one area where they’re not proficient, laughing and saying they couldn’t skate if their life depended on it. Or they can’t tell a joke. But if it’s an activity or a pursuit that is meaningful to them, it needs to be perfect — being a perfect mom, an accomplished lawyer, head of the class or a fantastic best friend. 2) Heightened or excessive sense of responsibility. People with PHD can be very aware of duty, obligation and loyalty. They can be counted on in a crunch. They can be the first to notice when something is going wrong, and look for solutions. They’re good leaders although perhaps not the best delegators. This sense of responsibility can also be painful, as people with PHD will readily blame themselves, rather than taking a moment to understand the entire picture. This can be manipulated by those who rarely take responsibility. 3) Difficulty with accepting and expressing painful emotions. I know when I’m sitting in front of someone, and they’re talking about a loss or a disappointment as they smile brightly at me, I may have discovered someone else who’s hiding. The avoidance or actual denial of regret, shame or any real vulnerability sticks out like a sore thumb. Anger is typically avoided. Sadness is banished to the back of the closet. Disappointment is for whiners. A PHD person, or PHDP, may not even have the words to express these emotions, and in more severe cases they may have trouble expressing emotions at all. The PHDP stays in his or her head most of the time, rather than connecting with their heart — analyzing, decoding and thinking through things. 4) Worry/Need for control over herself and her environment. The PHDP isn’t someone who can stay easily in the present. If she does yoga, she may hate the final position where you’re supposed to breathe and relax. He may love to cook, but has a very hard time sitting with his diners and enjoying the meal. The need for control is strong, and so a lot of time is spent worrying about the things that might occur to interrupt that control. It’s important to hide that worry, however. So it might not be obvious that the anxiety exists. Someone with PHD may look as if they do things easily and without effort. But the worry is hidden, right under the smile. 5) Intense focus on tasks, using accomplishment as a way to feel valuable. “You’re only as good as your last success.” That’s what a PHDP may strongly believe. They do, all the time, and count on activity and accomplishment to hide their inner insecurities and fears. We all do this to a certain extent. If you’re having a bad day, it feels good to get something done that perhaps you’ve been putting off. Or you get a promotion at work. Or someone emails you about how your kindness was so meaningful to them. There’s value in purpose and effort. Someone with PHD may carry it too far. They may not know how to express what they like about themselves, what brings them a sense of esteem, except for those accomplishments and tasks. That’s the problem. 6) Active concern for the well-being of others, while not allowing anyone into their inner world. This is not fake concern. It’s not pretend or insincere. It’s real, and it can be intense. Caring for others is what people with PHD do very well. However, they don’t let others sense their own vulnerability. They don’t reveal pain from their past to others. Their spouse might know, but it’s not discussed. There’s a wall up against anyone discovering they are lonely or fatigued, empty or overwhelmed. This can be especially frightening when suicidal ideation is present. And he can’t let anyone in. Or if he does, he may not be believed. “What, you? Depressed? You’ve got everything in the world going for you.” That response could be devastating. 7) Discounts or dismisses hurt or abuse from the past, or the present. Compartmentalization is a skill. It’s the ability to be hurt, sad, disappointed, afraid or angry about something and put those feelings away until a time when you can deal with them better. Healthy people do it all the time. You can even do it with joy or happiness. Sometimes it’s not the time to burst out singing. People with PHD over-compartmentalize. They have developed very strong boxes they habitually lock painful feelings in, and shove them back into the dark recesses of their minds. This allows them to discount, deny or dismiss the impact of life experiences that caused pain in the past or the present. One woman identifying with PHD emailed recently that she had been diagnosed with post-traumatic stress disorder (PTSD), and she totally dismissed it. “What happened to me was no big deal,” she wrote. “Much worse things have happened to other people.” That’s a very typical kind of belief system used in PHD. 8) Has accompanying mental health issues, involving control or escape from anxiety. People with PHD live their lives in a very controlled fashion. So, you’ll find eating disorders and obsessive-compulsive disorder (OCD) traits are likely. Alcohol or sedative medications could be used to escape anxiety as well. 9) A strong belief in “counting your blessings” as the foundation of well-being. I believe in counting your blessings. You bet. It’s healthy. It can keep you optimistic and grateful. A person with PHD feels guilt or even shame if he shows compassion toward himself, and allows himself to realize that not all things in his life are good. In fact, some are really hard. And it’s OK to feel that. 10) Intimate relationships may be difficult, but are accompanied by professional success. The vulnerability that is linked with true intimacy is hard for someone with PHD. Although driven to be productive and achieve, and often finding great success, she isn’t likely to be someone who can easily relate on an intimate level. Someone with PHD may likely choose a partner, in fact, who doesn’t know how to be vulnerable either, or doesn’t have that capability. Their relationship will be based primarily on what they do for each other, rather than who they are for each other. The focus may be on the family and the children. If you have these characteristics, you don’t have to hide. There’s no shame in being human. You can take  this questionnaire  to see how you score. You can listen to these  two podcasts to find out what to do about it. You can realize that there are  many others , like you, who are hiding and keeping secrets. If someone you love has these characteristics, please send them this post. They will hopefully feel seen and loved. It could be the catalyst that would allow them to start a journey that might save their life. If you’re a therapist, please realize depression doesn’t always look the same. People don’t always present with depressed mood and anhedonia. You have to listen and look carefully. You can hear more about Perfectly Hidden Depression and many other topics by listening to Dr. Margaret’s new podcast, SelfWork with Dr. Margaret Rutherford , or join her on her website . We want to hear your story. Become a Mighty contributor here . Thinkstock photo via jitloac

The Voices of Perfectly Hidden Depression

It has been almost three years since I wrote my first post on “Perfectly Hidden Depression.” Since then, I’ve received hundreds of emails from people from all over the world. They’ve taken the questionnaire, they’ve listened to my podcast or want to help with my research. I’d have to stop seeing patients myself to have the time to talk to each and every one. What is Perfectly Hidden Depression or PHD? I thought you might like to hear the answer from the people who’ve written to me. Their words are no longer my words, describing a syndrome or condition I’ve called PHD. These are actual people who are creating a facade of the perfect life while hiding loneliness, exhaustion and despair. Some are well aware of what they’re doing. Others are beginning to realize, perhaps for the first time, that they are growing more weary of keeping the secrets that haunt them. The stories I chose aren’t the most dramatic examples I’ve heard, where people have described considering some way of killing themselves before they finally reached out for help. Yet these wonderful people speak clearly of the vast difference between what the world believes and what they know, in their quietest of times, about themselves. I found them compelling in their simplicity. (I’ve also changed the details to maintain their anonymity.) From Casey, a woman in her 30s: I am almost embarrassed to be depressed. I feel like if I went to a therapist it would be wasting their time — there are people out there carrying much heavier burdens than I am, certainly. But I am starting to think I need help. My sadness is sort of a constant thing that I deal with (like a low-grade headache that you can forget about sometimes) and some days I feel great. But then something will happen to tip the balance and I am lost. Ever since my dad passed away in July it’s been so much harder. I want to sleep all the time. I don’t want to take care of my house (but I do since I don’t want anyone to see it messy). I don’t want to go out with friends (but I do so they don’t think I’m ignoring them). I even feel angry a lot over silly stuff — I have never, ever been an angry person. But I don’t want anyone to know it (I almost can’t make myself not be happy around others, if that makes sense?). I feel like I am wearing a mask when I’m out in public. I work with high school students and most of them spend a lot of time in my office because I’m really good at letting people talk (no judgment or advice, just an ear). I think most of my friends and family like me for just that reason. They like Casey the Listener, Casey the Sympathizer, Casey Who Doesn’t Make Fun of You. But they have no idea how there is this constant ache in the pit of my stomach or how tears are right there behind my eyes. I don’t think they would even want to hear about my problems… they like to talk about themselves and 99% of the time I am ok with that. From Jordan, a man in his late-40s: It’s like a constant undercurrent, invisible to most casual observers. It doesn’t seem to characterize me. I’m a smart-ass life-of-the-party and all that. But it’s still there. And when it comes out from time to time, people around me are shocked. I’ve achieved far more in life than I expected. I’m 47. I was the first member of my family to graduate from college. Two failed marriages. Both were results of hidden despair. I mean the marriages themselves were the byproduct of my despair. I wasn’t emotionally close to either wife. I thought I could be successfully married while managing the relationship in some rational way that would let me remain strong. Or at least seem strong. And I didn’t want to be alone. I wanted the negative to go away. I denied it. I have secrets I’ve kept from everyone. I’ve never trusted anyone enough to fully confide in them.  I keep myself distracted with adrenaline feeds from triathlon training. I t’s still there. This thing. Always I find I need to constantly shift my focus away from death. I’m fixated on it as a target. I don’t plan to hasten its arrival, but I’m not doing much to keep it away, either. And in my darkest moments, I realize I’m not that special. I believe there are millions more just like me. From Robin, currently a student: So you know a little of my past. I am the daughter of a drug addict. My mother did pills all of my childhood, and it was what many would say very traumatizing. I still have a problem believing this because I always seen this as “normal” and would tell myself things were not that bad and I was just being sensitive, and went on with my life. I always worked hard in school to have straight As. I also have a habit of caring for others and trying to make sure they accept me and think I’m great. As irrational as it is anything less than perfection makes me hate myself. Yes, I’m the student who got a 104 on a biology exam and was upset that I missed one bonus question. I would cry in my bathtub over getting a B on a math exam, and even hit myself when I got a low B on a statistics exam. If I’m not excelling in school I feel worthless, pointless, and frustrated. I can honestly say at this point in my life I don’t love myself. I love only the part of me that is capable of achieving great success, the part of me that is responsible and can take care of others, the part of me that is put together. You may know these people. Maybe she’s your kid’s teacher, your buddy, or your classmate. Maybe you are just like them. Maybe you also hide by trying to look put together, focusing on others, avoiding painful emotions or vulnerability, and being the person who is successful at whatever you try to do. You don’t have to. The people above wrote to me because they felt understood. They were either thanking me for writing about PHD or wanting to help in some way — so others wouldn’t have to live the life they were living. During one interview, I was laughing a bit and describing the difficulty of trying to get my ideas published. The woman had been calm and engaging, and suddenly, I heard her voice crack. I realized she was crying. “Please don’t give up.” I’ve worked with too many people just like Casey and Jordan and Robin to give up. Their real stories need to be heard. Their wounds need to be healed. And if you have PHD, maybe it’s time for you to reach out — and be known. If you’d like to take the PHD questionnaire yourself, it’s appeared here on The Mighty. Click here. You can now listen to Dr. Margaret as she talks about PHD (Episodes 3 and 4) and many other topics on her new podcast, SelfWork with Dr. Margaret Rutherford. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 o r text “START” to 741-741 . We want to hear your story. Become a Mighty contributor here . Thinkstock photo by jazzmxx

Talking About Painful Feelings You Hid as a Child

I’ve been interviewing people who have identified with what I term “perfectly hidden depression. They’ve read one of my posts on perfectly hidden depression (PHD). Or they’ve taken my questionnaire on PHD (which you can take if interested, just head here.) And they’ve reached out. First, we email. We talk about arranging a phone call for later to talk about their experience with hiding their depression. A few get cold feet and pull out. They’re not quite ready to be that vulnerable. I get it. Right before I make each call, I’m aware I want to make the person on the other end of the line as comfortable as I can as quickly as I can. Because I recognize how hard it is for them to share their story — to tell me, a stranger, things they may not have not told anyone. Ever. Then we start talking. When asked, “Why did you reach out to me?”  the answer has consistently been, “ Because I’ve never seen this anywhere — and because I don’t want anyone else to have to live this way. It’s incredibly lonely.” The 40 or so interviewees thus far have fallen into a spectrum. They’ve ranged from people who have never whispered a word to anyone, not even their spouse, that they have thoughts of wanting to die or secrets from their past and present that have remained shamefully untold, to people who hide mostly within their professional world but have a close friend or partner who know their struggles. Most of the people I’ve interviewed belong to the first group. They’re in their car or out in the backyard where no one can hear them talking to me. A few have already sought therapy. But others have told me, “ I am hoping that by talking to you, it will help me take the next step. I’m so tired of living this way.” Everyone is describing themselves as people who take lots of responsibility, push themselves constantly, rarely feel they do enough, keep a thumb in their back — and yet never feel satisfied completely with what they’ve accomplished. All of that, of course, is what makes them not look depressed. They’re active, involved, engaged. But there is one question on the questionnaire that 39 out of 40 people have answered unequivocally “yes,” that keeps jumping out at me. Did you grow up in a family where feelings of sadness or pain were avoided, or where you were criticized or punished for expressing them? Yes______ No______ This is poignant to me. Because this is how I began wondering about PHD in the first place. I was trying to treat people who couldn’t express or connect strongly with feelings of sadness or pain. They could have other feelings but not much compassion for themselves. Very little to none. Here are quotes from some of the interviews: “ I was never told I was loved. I was raised by grandparents who gave me things to show their love.” “I was adored. But I kept feelings secret if they didn’t please my mom. I was her best friend.” “My mom died and all the pictures of her disappeared. We weren’t allowed to ask questions about her.” “If I needed to cry, I hid. If you couldn’t be engaged appropriately with the family, you were punished.” “If I was sad, I was told ‘those things happen.’ The only feeling that was allowed was anger. Not mine, my parent’s.” “How can you be sad, and not know it? But that’s how it felt.” “My mom had severe postpartum depression, like sometimes she thought about killing all of us, but dad wouldn’t do anything. All he did was criticize and be abusive.” “I was the star of the family. They would drive hours to take me to athletic events. Everything was about practice and more practice. I was competitive. All we talked about was winning.” These families were stunted. Parents or grandparents strictly or abusively controlled the emotional environment at home. There were huge gaps in the emotional experiences they were offering the children who were being raised within them. If you imagine emotions as colors on a palette, only certain colors were allowed. There were no dark hues — no grays, mauves, or dark greens — nothing that would express fear, sadness, confusion or grief. Only yellows and oranges — “happy” colors. The only emotional world that could exist was one that suited those in charge. If you don’t grow up knowing how to access and soothe more painful feelings — how to “paint” in those colors — it’s very difficult as an adult to learn how. But it can be done. Because they’re there. You feel them in the pit of your stomach. You can catch them when someone is unexpectedly kind to you. Maybe you feel them when you’re taking a shower and you notice how exhausted you are.  Or when you get quiet at night. You can reengage with practice as you divorce yourself from the irrational rules you learned as a child. So… no, there’s not one factor that determines the presence of perfectly hidden depression. But if you struggle to feel sad… if you cringe at thinking about being a bit vulnerable… if you don’t even know how… you might think about it. You can break free. You can be vulnerable. You don’t have to be lonely. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255 . We want to hear your story. Become a Mighty contributor here . Thinkstock photo by Katarzyna Bialasiewicz