Imagine someone who seems to be living a perfect life. She has a great job, a loving and supportive partner, and plenty of fun outside of work. Getting to the office on time is no problem, and she is one of the most productive employees at her company.
There’s one problem, though: she is miserable, unable to derive happiness from much of anything. Because she lives with high-functioning depression, it is difficult for people to understand how anything could be wrong.
Defining High-Functioning Depression
Like many illnesses, depression exists on a spectrum, with degrees of severity ranging from mild to debilitating. Mental health professionals usually measure the impact of the condition by evaluating level of functioning. On the lowest end is what many therapists and sufferers refer to as “crippling depression,” a state where one cannot hold down a job, maintain basic hygiene, get out of bed, or commit to any relationship.
The opposite parameter is high-functioning depression, a form of the illness that is not intense enough to noticeably affect the ability to perform daily responsibilities such as work and home duties. Nonetheless, high-functioning depression can carry some of the same symptoms as any other form of the disorder, including:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Feeling restless or having trouble sitting still
- Appetite and/or weight changes
- Thoughts of death or suicide
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause
People with high-functioning depression are sometimes adept at hiding these symptoms, said Talkspace therapist Samantha White. These sufferers worry about others discovering their illness.
High-Functioning Depression vs. Dysthymia
People with mental illness often invent unofficial terms to describe their experiences. Sometimes these new phrases overlap with established diagnoses.
“In my opinion as a psychotherapist, high-functioning depression is a pop psychology term for what’s clinically known as dysthymia,” Annie Wright wrote in an article on The Mighty. Psychiatric associations have also referred to both dysthymia and high-functioning depression as persistent depressive disorder or chronic depression.
Despite many similarities, it is not yet clear if dysthymia and high-functioning depression are exactly the same. People are still fleshing out the definition of the latter.
High-Functioning Depression’s Correlation With Success, Ambition, and Perfectionism
The label of “high-functioning depression” does not stipulate a thriving career or additional mental health issues. People with this type of depression, however, are likely to be successful, ambitious, perfectionistic, lonely, or anxious. These traits are often related to depressive thinking and behavior. Wright offered some examples in her piece about high-functioning depression:
- Relentless self-criticism and doubt
- Feeling of guilt and worry over the past and future
- Seeking perfection in work and life
- Inability to rest and slow down
- Upset by small issues
When people are ambitious and expect a great deal from themselves, they can feel depressed when they fall short of unreasonable goals. Such is the nature of perfectionism. Nothing feels like enough. There is an anxiety about whether they will be able to obtain everything they want — or if they are good enough to deserve their desires. Career-driven lifestyles can breed loneliness and frustration.
Therapist Erika Martinez described an amalgam of clients with high-functioning depression as successful professionals who feel empty and unfulfilled.
“They come home late to an empty house or a family that’s already gone to bed,” Martinez said. Stress and burnout and can contribute to this type of depression.
The Challenge of Living With High-Functioning Depression
Despite their ability to maintain relationships, it can be difficult for people with high-functioning depression to receive support. Because their symptoms are not significantly affecting behavior, friends, coworkers, and family members often don’t understand or even believe a serious illness is present.
“Because I can work full-time and do well, own my own home and take care of everything myself, people underestimate just how deeply I struggle and how hard it is to function some days,” said Christine Dolan, a member of the Huffington Post lifestyle community who opened up about her condition. “It’s hard enough holding it together, but it’s even harder when you know people are misjudging you and not giving you credit just for getting out of bed.”
Sometimes people like Dolan face stigma that makes them feel as if their disorder is not legitimate. It is easy to dwell on behavior and overlook subtle patterns in emotion and thought.
Why High-Functioning Depression Can Be More Difficult to Treat Than Other Forms
At first glance it seems like high-functioning depression would — by definition — be more treatable than severe forms of the disorder. Nonetheless, therapists often face unique challenges when working with chronically depressed clients.
It is easier for mental health professionals to make progress with lower-functioning depressed clients, said therapist Asta Klimaite, because the goals tend to be simple and concrete. If a client with crippling depression has been unable to leave his apartment, he can make significant strides by going to a grocery store. But what about an accomplished executive whose desire is to “be happy?” With such a vague outcome in mind, it can be difficult for counselors and clients to set specific, actionable goals.
People with dysthymia are less likely to seek treatment. They sometimes do not realize their symptoms are from a mental illness. Others understand the situation but do not want help or think their disorder does not warrant concern.
Origin of the Term and Rise in Popularity
Internet users have entered the phrase, “high-functioning depression,” as early as 2004, according to data from Google Trends. The date of its first in-person use is unknown, but both clients and mental health professionals likely mentioned the label well before 2004.
The term’s popularity spiked in April, 2016 and has since become common.
“I believe it’s probably because there’s been more media use of the term, ‘high-functioning,’ in blogs, social media posts and videos,” Martinez theorized. “It really resonates and speaks to what many young adults in their 20s and early 30s are experiencing in their current phase of life.”
How the ‘High-Functioning Depression’ Label Helps People Cope With Stigma
Because there is still a stigma attached to mental illness, including depression, those afflicted sometimes do not feel comfortable with official diagnoses such as “clinical depression” or “major depressive disorder.” Using terms like “high-functioning depression” can be preferable because such labels do not sound as burdensome or serious.
“I think having unofficial diagnoses actually helps take the stigma away from mental illness,” said therapist Kimberly Hershenson. “Some clients like terms such as ‘chronic worrier’ instead of having ‘anxiety,’ for example, because they feel they are just struggling with an issue instead of being mentally ill.”
Regardless of labels or distinction, what matters is people with any form of depression understand they don’t have anything to be ashamed of. High-functioning or not, anyone with a mental health issue deserves professional help and support from loved ones.
Note: Check out Engadget’s report on texting therapy that includes coverage of Talkspace.