“High-functioning depression”: what it means and symptoms to look for
“High-functioning depression” is not a clinical diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a manual used by medical professionals. It’s a colloquial term that has gained popularity in recent years, although some experts have mixed feelings about its usage.
The sentence highlights “a really important point that people can be mentally ill and still seem capable of functioning or not appear mentally ill to an outside observer,” said Rebecca Brendel, president-elect of the American Psychiatric Association. .
But, Brendel added, the term could exacerbate shame and misunderstanding about mental health and depression. “Saying someone is functioning well even though they have a mental illness per se increases the stigma associated with mental illness.”
Here’s what some mental health experts think about this increasingly common phrase.
What is “high-functioning depression” and why might this term be useful?
Broadly speaking, “high-functioning depression” is a non-medical term that can be used to describe some people who meet the criteria for a clinical diagnosis of depression, but manage to function day-to-day in a way that their mental state probably isn’t obvious to others or even to themselves, said Jameca Woody Cooper, a psychologist and adjunct professor at Webster University in Missouri.
And while “high profile” can be associated with “high profile” individuals or public figures, that’s not always the case, Woody Cooper said.
“It can be a teacher, it can be someone who works in a daycare, it can be a fast food worker,” she said. “Anyone from any background can have major depression, and anyone from any background can look or present themselves as someone with high-functioning depression.”
Clinical depression is diagnosed on a spectrum that takes into account a person’s ability to function. But the phrase “high-functioning depression” can be illuminating for those with and without depression.
People “often carry this image of individuals who are crying, who are stuck in bed, who are suicidal,” Woody Cooper said. “Whereas in fact it looks totally different in people who work every day.”
Montrella Cowan, a Washington, DC-based relationship therapist, speaker, and author, agreed. Understanding “high-functioning depression” can help raise awareness that it’s possible for a person “to be productive, to earn six figures, to have the biggest house, a nice car, and to be depressed,” she said.
It can also help someone know they’re not alone, Cowan said, because “a lot of times people don’t feel like themselves and they just can’t put their finger on it, and they’re in pain. just in silence. But now it’s like, ‘Oh, high level. Alright, so no wonder I get up and go to work. ”
What are the concerns about the term?
The term can reinforce the shame of depression, said Natalie Dattilo, a clinical psychologist at Brigham and Women’s Hospital in Boston. “Stigma is why we use that term to label it, [as if] it’s so shocking that successful people can suffer from depression. But, she added, “it shouldn’t be so shocking that people are suffering from depression. It should just be a thing, as people can have medical illnesses.
Another one The concern, Woody Cooper said, is that using the term “high functioning” could be misinterpreted as a less severe form of depression.
“Depression is depression,” she said. “Just because some people have personality traits that make them more fit to function doesn’t mean they’re less likely to be taken seriously, and I’m afraid that’s what could happen if we start to really seeing that term “high-level depression” used even more.
Also, using “high functioning” as a descriptor can be misleading, said Matthew Rudorfer, program manager at the National Institute of Mental Health, because it doesn’t take into account the effort required to function.
“If every car on Connecticut Avenue is going 35 miles per hour, but a driver has to press the gas pedal to maintain that, to the outside observer, everything looks fine,” he said. . “But they are trying too hard. It shouldn’t be necessary to depress the pedal to go 35 miles per hour.
Should we even use the term “high-functioning depression”?
Experts have differing opinions on whether “high-functioning depression” should be a widely used mental health term or become an official diagnosis.
“The best thing we can do is to completely move away from labels,” Brendel said, because they can “really prevent us from understanding what’s going on with mental illness.” Instead, she encouraged open conversations “about the symptoms of mental distress” and worked to reduce stigma and other barriers to seeking care.
Cowan, however, said the benefits of using the term “high-functioning depression” might outweigh the potential harms and noted that she believes the term should be included in the next update. of the DSM. (To date, no proposals have been submitted to include “high-functioning depression” in the DSM, according to the American Psychiatric Association.)
“We try to normalize the conversation,” Cowan said. “If we start saying, ‘You can’t use that term, you can’t use that term,’ we won’t have much to say.”
Although she has concerns about it, Dattilo said she’s okay with the term if it can get someone some help. “If that’s the thing that gets them to look and say, ‘Oh, maybe that’s what I’ve got,’ then let’s go ahead and use it and keep working towards something better. “
According to experts, it is important to recognize who might be at risk for this type of depression.
Woody Cooper said she often sees it in people with “Type A personalities”. Other characteristics may include having a high position, struggling with perfectionism, being people-pleasing, or wanting to be seen as strong and capable, Dattilo said.
“None of these qualities are bad, but they can also factor into a person’s belief system about themselves,” Dattilo said. All of this “can contribute to the pressure to perform and be a certain way and have certain things.”
Woody Cooper and Cowan too noted that “high-functioning depression” is often seen in communities of color, where barriers to obtaining treatment may be higher due to cost, availability, and cultural stigma. “In the black community, for example, we’re always trying to fight that stigma of ‘you’re weak,'” Cowan said. “As if we were weak if we asked for help – and that’s not true.”
Barriers to seeking help may be greater for black women, Woody Cooper added. “They have this kind of super-woman image, that they can do anything but feel nothing,” she said.
What are the signs of high-level depression?
It can be difficult to detect signs of depression in people who might not recognize it in themselves or who might actively mask their symptoms and persevere, perhaps because appearing outwardly strong and capable is such an integral part of who they are. said experts.
Brendel said people who are worried about possible depression in themselves or others should monitor for subtle changes, including changes in energy, mood and quality of sleep. These changes could just be a signal that someone needs to reset and prioritize taking care of themselves, she said. But, she noted, if they persist over a two-week period, it may be a sign to seek professional help. Other potentially worrying signs are gloomy thoughts about the future, as well as feelings of hopelessness and helplessness.
If you’re trying to support someone else, avoid making assumptions. Don’t, for example, tell someone they need therapy, Cowan said.
Woody Cooper suggested asking questions first and defining potential behavior changes as things you’ve noticed. For example, you might say, “I’ve noticed when we’ve been hanging out with the band lately, you guys aren’t talking as much,” Woody Cooper said, and follow up with questions like, “Is everything okay? good ? Is there anything you want to talk about?
Experts recommended preparing a referral to a mental health professional. It can also be helpful if you are able to share personal experiences of seeking mental health support.
“Admitting or acknowledging that you are struggling and need help is not an easy thing to do,” Dattilo said. That’s why experts believe that one of the most important things to take away from discussions of “high-functioning depression” is the need to continue to change conversations, education and attitudes about depression and of mental health.