Most people are familiar with how depression can completely weigh down a person’s life and change daily living. Images might come to your mind of a person unable to get out of bed who eventually is fired or someone who is unable to keep up with any relationships or someone consistently contemplating suicide. You have likely known someone who has struggled with this degree of depression, likely Major Depressive Disorder (MDD), or perhaps you have at some point in your life. MDD is real, can change a person’s life drastically, and can be deadly.
What is persistent depressive disorder?
However, there is another face of depression that is less recognized and less conspicuous but is prevalent, especially among intelligent, young professionals. It can be hidden to the point that you might not be able to detect if your coworker or good friend is suffering. You might have even struggled with identifying this depression in your own life. Persistent depressive disorder (PDD), formerly known as dysthymia, is a low-grade, persistent depression that has been present for at least two years in adults (or 1 year in youth below age 18.) People often refer to PDD as “high-functioning depression,” meaning that a person suffering from it can often hold a demanding job, engage in personal and intimate relationships, and even cover it up to the point that those around them would classify them as “happy” or “energetic.” The reality is that those experiencing PDD are often physically and emotionally exhausted, feel sad or hopeless frequently, tend to question themselves, are easily irritated, and are more likely to struggle with regular, healthy sleep and/or eating patterns.
Why do people hide their depression?
A person might hide their experiences with depression for many reasons, and part of me feels like I’m simplifying the issue by attempting to categorize something that is so complex. As a psychotherapist, I have sat with many, many individuals suffering from all intensities of depression, and despite many shared experiences that occur within the context of depression, each person’s individual experience with depression is always highly nuanced, personal, and influenced by so many individual factors. Given that caveat, here are some of the general reasons that people with PDD in particular might want to or feel pressured to hide their suffering.
1. They don’t want their depression to hold them back professionally.
Many careers and workplaces are very competitive and performance based, and for someone who is motivated to continue advancing, revealing signs of persistent depression at work could be detrimental. There are so many highly intelligent young professionals diagnosed with PDD, and many are able to muster up the energy to be present at work and even to thrive. Even if they struggle with self doubt and low self esteem, their perfectionism and desire to please can be enough to succeed in a working environment. It can be very challenging for someone with PDD to take care of oneself outside of work when they are in a very demanding professional environment.
2. They don’t want their loved ones to worry about them.
As mentioned prior, people with PDD can be highly intelligent and insightful. Some studies indicate that those who identify as a Highly Sensitive Person (HSP) are more likely to experience depression or anxiety. This may be because the same sensitive awareness that can lead to beautiful creativity and highly developed connections and conclusions can also lead to feeling overwhelmed and hopeless in the face of so much suffering in the world. For someone who is incredibly sensitive to others’ emotions and reactions, telling a loved one that you are struggling can be very painful and even scary. They likely do not want to feel responsible for causing pain or worry. For many, it might feel easier to carry this burden alone.
3. They are worried others would not understand (because they often don’t.)
There is significant stigma around depression — what it looks like, how a person “gets it,” and how a person can rid themselves of it. It is fairly common for even those close to a person with PDD to be surprised when the individual shares of their struggles with depression; it is also common for invalidating experiences to follow. “How can you be depressed? You seem happy and smile a lot.” “You are really successful though, so it’s not like your depression affects you.” “Just be positive and don’t focus on the sad stuff. You don’t have to feel this way.” You have likely either heard such statements or maybe have even said something similar and well-intentioned but misled to a friend struggling with depression. When you are struggling with depression and a loved one has an invalidating response, it can reinforce feelings of being alone, defective, and not good enough.
4. They don’t want to acknowledge it themselves.
This is where PDD and MDD often differentiate. When a person is experiencing MDD, the effects on daily life are often too apparent to ignore; however, if someone struggling with PDD does not want to acknowledge the ways in which life has become more difficult, he or she might turn their focus elsewhere. In short, they might attempt to distract themselves from the pain. This could include working harder, immersing themselves in new social relationships, partying, using substances, or incessant gaming. For some, admitting the presence of depression or voicing what is ultimately underneath the depression might be the most painful part of all the journey.
When people can hide their depression, is it really affecting them?
The short answer? YES. While PDD might not have the immediate urgency of many episodes of MDD as far as risk of suicidality, being nearly unable to eat or sleep, or the major financial impact of not being able to hold a job, a person with PDD can gradually move into these more detrimental areas if he or she does not receive needed support. Don’t underestimate the effects of having lowered energy and consistently feeling “down” and inadequate for multiple years. This can take a toll not just on the person but on the health of their relationships as well. It can also inhibit a person from reaching particular goals or from experiencing the joy they believe they should feel when they do reach their goals.
Support for those struggling with depression
If you or a loved one is struggling with persistent depressive disorder, there is absolutely hope! Therapy is a great support for expressing the difficult feelings and experiences connected to depression, exploring and building your sense of self, exploring how to find and experience joy and meaning, and discerning how to manage your depression to the best of your abilities — physically, mentally, and emotionally. Have a conversation with your primary care physician or a psychiatrist about the potential pros and cons of medication for depression to see if medication would be a helpful support for alleviating symptoms of your depression. Lifestyle changes are often especially helpful in mitigating depression including regular exercise, a healthy diet, good sleep hygiene, setting boundaries with sources of stress in your life (such as work or toxic people), mindfulness practices, and integrating in spiritual practices or activities that are life-giving and point you to what gives you meaning. It is also so important to have at least a few people in your life that you can be real with about your struggles. Of course, they need to be people that you trust and feel safe with. Vulnerability can be so difficult to practice, especially if you have become accustomed to hiding or minimizing the difficult, uncomfortable stuff in your life or if you don't have relationships currently that foster trust. Therapy can be helpful in beginning your journey into vulnerability in a confidential setting and as time goes on, exploring what this can look like in your natural support system.
If you are interesting in seeking therapy for your depression, please contact me here. I would love to discuss how I could be a support in your journey.