Is there really such a thing as high-functioning depression?

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High-functioning depression, otherwise known as dysthymia is a topic that divides sufferers and mental health professionals alike. Can you really be suffering from depression but still able to keep up appearances?

Everyone has their own idea of what depression looks like. Constant low mood, withdrawing from daily activities, inability to sleep or maybe sleeping too much, not eating. For most people that is what serious depression looks like.

But what do we say about people who, on the surface of things do not operate like that? In fact, they appear to be the complete opposite? They may be the life and soul of the party, continually socialising, excelling at work and for all intents and purposes, look like they’ve really got their lives together. They are unflappable.

That is until of course, you cut to the moment when they’re at home and their bubbly demeanour breaks down. With no one to perform to, they finally concede to their depression.

So what does it mean to be high-functioning?

Depression is more than just a low mood. It’s a combination of negative thoughts and cognitive distortions (feelings of worthlessness, re-living negative experiences and events, overgeneralisation, distorted interpretations of perfection), and physical reactions (poor concentration, low energy, problems sleeping, changes in appetite and loss of libido). Like most mental illnesses, depression can restrict an individual’s ability to go about their day-to-day activities or even complete the most basic task.

If an individual is described as having high-functioning depression it usually means that they are able to maintain their relationships, their work life and fulfil all their duties and life responsibilities, while also living with depression.

Generally, sufferers of high-functioning depression tend to be driven by their own unrealistic ideas of perfection. By trying to attain unachievable levels of perfection, individuals wreak havoc on their mental health and it often exacerbates feelings of failure and worthlessness when an unrealistic goal they set for themselves was not achieved.

Couple this with the need for external validation and peer acceptance, sufferers from high-functioning depression can easily find themselves trying to maintain a false facade, which only seeks to put more and more pressure on their already fragile mental state.

The difficulty with high-functioning depression is that there is always a breaking point, which is not always known to the sufferer. Although they can continue for months and even years trying to juggle many different responsibilities and keep all balls off the ground, eventually they will reach their limits. In truth, high-functioning depression is unsustainable.

Although to many, sufferers appear to be keeping it together, the reality is that the longer they go without seeking treatment, the more their depressive symptoms will continue.

How can CBT help?

According to the National Institute of Clinical Excellence (NICE) CBT or Cognitive Behavioural Therapy is recommended as an effective psychological treatment to overcome depression and maintain your mental health. 87 percent of patients who seek out CBT for their depression make a full recovery, and many sufferers of high-functioning depression seek out CBT to help balance their cognitive and behavioural distortions.

An accredited CBT therapist will help sufferers recognise their negative thinking and behavioural patterns and work with them to take the steps to challenge their thoughts, beliefs and assumptions.

If you suspect that you may be suffering from depression, why not take our test.


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