a student walking into school illustrating how those with high functioning depression are still completing everyday tasks

Our Therapists’ Take on “High Functioning” Depression

Est. reading time: 4 mins
Posted Under: Insights

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW

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“High functioning depression” is a newer term in the world of mental health and therapy, most recently made popular by a viral TikTok video addressing the “Top 7 Signs of High Functioning Depression” (which resonated with over 8 million viewers!). In the post, the clinician explains this experience of depression as one that is heavily masked by achieving everyday tasks, such as attending school and work.  

However, not everyone is on board with the term “high functioning” or “low functioning” when it comes to describing mental health challenges, as it may increase stigma or add confusion to the complexity of diagnoses.

“It’s important to talk about how the term ‘high functioning’ may exacerbate shame and misunderstanding about mental health and depression. Saying someone is high functioning even though they have a mental illness in and of itself raises the stigma associated with mental illness,” explains The Dorm’s Chief Clinical Officer, Dr. Amanda Fialk, LCSW, LICSW

Considering the burst of popularity of the term in our post-pandemic mental health landscape, we thought it was important to address what young adults should know about what may be going on with those who identify with this type of depression, and how someone can best approach treatment and therapy if they think they may be struggling with wearing a “mask” of feeling ok even if they’re not truly doing ok

The following interview is a synthesis of responses from Lead Senior Therapist Tina Bryant, LGSW and Assistant Director Chris Davis, LPC to give us a clinical perspective on their views of “high functioning” depression what it means, what it is not, and signs that you or someone you love could benefit from treatment support. 

What is “High Functioning” Depression?

This new term is somewhat of a controversial topic for therapists since depression can come in many forms and still be depression. In general, a diagnosis usually serves to highlight significant barriers to daily functioning, which makes the phrase “high functioning” interesting because it is referring to the fact that everyday activities don’t appear to be impacted by depression. 

Essentially, high functioning depression may be a less-severe version of clinical depression, but it is not a recorded disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM). 

Someone with “high functioning” depression may still exhibit the internalized symptoms and feelings associated with depression (i.e. low energy, anhedonia, boredom eating), but they are better able to mask it. They do everything that is expected of them in the external world yet still struggle to feel happiness and joy on the inside.

The term does give therapists and loved ones the opportunity to validate those who are on the lower end of the spectrum of depression, but might still need help to address the root of symptoms with a professional. 

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Persistent Depressive Disorder (PDD) versus “High Functioning” Depression

“High functioning” depression, while not a formal diagnosis, may in some cases fall within Persistent Depressive Disorder (PDD), characterized by a depressed mood for at least two years. 

The main differentiator is that PDD involves the physical and mental aspects of depression, whereas “high functioning” depression is more intrinsic and self-reported. 

Since physical signs (i.e. not getting out of bed, over or under-sleeping, lack of hygiene, not showing up to work) are reportedly absent in “high functioning” depression, it’s obviously harder to detect. 

These are individuals who might put on a smile and function seemingly fine – but an ability to carry out daily activities doesn’t automatically mean happiness and self-efficacy on the inside.

7 Signs of “High Functioning Depression”:

  1. Feelings of sadness
  2. Feelings of low confidence and not feeling good enough
  3. Low self-esteem
  4. Not feeling joy or pleasure in something
  5. Difficulty with future planning
  6. Low feelings of hope for the future
  7. Difficulty concentrating or making definitive decisions 

Treatment Considerations for Someone Exhibiting Signs of “High Functioning Depression”

Treatment of “high functioning” depression looks the same as treatment for depression, with an additional focus on increased education and validation of what depression looks like. 

Since depression doesn’t always look the same for everybody, not being able to get out of bed in the morning isn’t going to be a universal depiction of someone who is struggling. Perhaps 10-20 years ago a doctor may have dismissed internal feelings because someone may look fine on the outside. Now, we have a culture that agrees that if you are feeling low in any capacity then you deserve to get help. 

This particular type of depression really is self-defined. Providing psychoeducation on these differences in symptom presentation is essential to validate the fact that everyone deserves help if they need it, regardless of severity.

Tina and Chris outlined several group therapy options they would suggest for clients with high functioning depression:

  • Process Groups: These types of groups help validate how clients are feeling and add a social component to the treatment process where you can bring your own unique experience to the table and hear other people’s thoughts or connections with it.
  • DBT Skills: This group is both a reflective and process-focused way of learning DBT to cope with triggers and uncomfortable feelings or thoughts. The teachings and discussions in this group offer clients a healthy toolbox of skills that help with mood regulation throughout young adulthood.
  • Community Clubhouse: A sense of community and belonging is really helpful in feeling validated. Giving oneself a chance to find commonality with other clients, despite different diagnoses is helpful in reducing shame and stigma. Everyone at The Dorm is present for the purpose of obtaining treatment, so there is already a common understanding. The community is nurturing for someone who may feel a certain way inside, and seeks peer connection despite symptoms not showing on the outside.

The Importance of Looking Beyond Diagnoses in the Treatment of Young Adults

In conclusion, our therapists agreed that people’s experiences and language around mental health evolve a lot faster than the DSM can keep up with. Any time we are in a position to diagnose we are held back by what the books say and the options we have. Therefore, it’s important for therapists and clinicians to stay informed about the way young adults are talking about mental health and validate those who may believe they’re living with “high-functioning” depression. 

While high functioning depression is not a formal diagnosis, we always have to respond to who is in front of us. Differentiating between time periods and frequency of symptoms to fit the criteria of a certain diagnosis may not alway be relevant – it’s essential to work with the client to validate, understand, and treat the person in front of you, even if they present with an atypical set of symptoms for a certain disorder.

Thank you to Tina and Chris for your clinical insights!

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