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Healthy Coping, Depression And Perfectly Hidden Depression: What’s The Difference?

Over the last few years, I’ve received all sorts of comments and questions about the syndrome I’ve described as Perfectly Hidden Depression (PHD)®. Some people have readily identified, but others have questioned its viability. Today we’re going to talk about how PHD differs from healthy coping and “classic depression.”

The meaning of PHD seems understandable from the very term itself. It involves hiding depression, if not perfectly, as perfectly as humanly possible. Yet how is this different from fairly normal people who are aware of their emotional struggles, but who are using good coping mechanisms for stress? Those people may not talk much  about how badly they feel. They are busy trying to put their best foot forward. They get sad. Overwhelmed. They may be grieving a loss, or feeling out of control.

But they pull it together.

One woman put it best.

Aren’t we all  hiding to a certain extent? Isn’t that a healthy thing to do, rather than another behavior that’s a problem?

Healthy coping and compartmentalization…

She makes a great point. “Everyone has something,” is a phrase we probably hear a lot. We all have our own problems that we cope with on a daily basis. And frequently, may not reveal to others.

We carry on. We cope. We make life work.

But that’s not depression. That’s the skill of compartmentalization — putting anger, fear, even something traumatic away for the moment, and attending to the needs of the present. It’s an important skill, and one that many healthy people know how to use well and effectively. When the time is right, healthier people then pull that pain back out, and work their way through whatever loss or struggle there is.

The Beck Depression Inventory and classic depression…

Let’s use the Beck Depression Inventory to help clarify the difference between classic depression and PHD.

If you’ve ever been curious about whether or not you were depressed, you might’ve googled, “depression test.” More than likely, the Beck Depression Inventory was one of the first to arrive on your screen.

It’s a very well-known questionnaire, that’s often used to determine if someone meets the criteria for depression. It’s self-scored. It’s easy to understand. It covers the mental, emotional and physical aspects of depression, and even quantifies just how depressed you might be, dependent on your answers.

An inventory like the Beck can help people identify the symptoms of depression. People may or may not realize how slowly the lights have gone down on the joy or satisfaction with their life. They may not see how much they are struggling with negativity, irritability or sadness. They may rationalize going back to bed after taking the kids to school. They may make excuses about the reasons why they’ve lost their appetite, or can’t seem to get a good night’s sleep. They may be blind to the many ways they’re isolating from others, or beginning to pull into themselves.

It’s shocking one day when you start to imagine your own death — or some kind of escape from the world you’re living in. If given an inventory, like the Beck, your honest answers may surprise you, as you reveal how dark or closed off your life has become, or how your depression has entrenched itself into who you are and how you think.

This is depression. It’s on a spectrum, from mild to severe. And if severe enough, you lose your desire or ability to function at all. And it can feel like a huge relief to put a name to what you’ve been living through, and learn there is something you can do about it.

So how is Perfectly Hidden Depression (PHD) different from any of this?

The difference between classic depression and PHD…

First, let’s compare it using, again, the Beck Depression Inventory.

One man I interviewed recently said, “The inventory asks the wrong question for me (someone with PHD…). I would answer a resounding “no” to the statement, ‘I often feel hopeless.’ I wouldn’t admit feeling hopeless, to anyone, ever. Instead, if the question was, ‘If you could admit feeling hopeless, would you?’ — the answer still would be “no,” but it would reveal PHD.”

Perfectly Hidden Depression is a term to describe a syndrome, or a set of characteristics and behaviors that tend to appear together, and enable people to hide or detach from emotional pain. That doesn’t mean the pain isn’t there, or that it’s not having an effect.

It’s not a diagnosis. That’s important to remember.

People with PHD rigidly and repetitively use compartmentalization as a major tool to handle life. They deny, maybe even dissociate darker emotions or trauma. They are constantly vigilant, ever defending their persona. They don’t let down. They don’t work through emotions when enough time has passed.

Instead, they’re doing all things to the best of their ability, all the time, every day. They push themselves to the limit, put others before themselves, believing that a focus on self is selfish. They live very deliberately, getting things done, accomplishing the seemingly impossible.

They ignore memories of hurt. Avoid revealing too much about themselves. Laugh off extreme fatigue.

They don a mask of happiness every day, that they may even have come to believe is the real thing. Others admire and tell them what a great life they have. They are invested in maintaining that image.

Yet it’s not fueled by purposeful deceit. No other way of living feels safe, or has ever felt safe.

The Beck Depression Inventory would never reveal PHD. Because whoever was taking it, would know someone else would see their answers.

They are too afraid of the potential outcome.

While someone with classic depression may struggle to admit it, or may fear they’ll be stigmatized if they do, they’re much more likely to be honest about what they’re experiencing. They have to — the symptoms are choking the life out of them.

Someone with PHD?

Their lives are going fine. Nothing is seemingly wrong.

Only when life starts becoming too complicated, when their sense of panic about things getting out of control starts rising, might they consider revealing who they are, or attempt to confront what they’ve been telling themselves.

Here’s a video explaining the difference.

Three reasons for change…

I want to change that, for many reasons.

First. Because sometimes someone with PHD will wait too long. They will want to end their life, and no one even knows they need help. The loneliness can become unbearable.

Second. Because showing vulnerability does not equate with lack of strength. It simply doesn’t.

And third. Because even though many of the things that someone with PHD focuses on are admirable, being invisible hurts.

No one needs to hide.


In next week’s segment, I’ll provide a questionnaire on PHD, where you can determine where on a PHD spectrum you might fall.

You can always reach me via email: It’s confidential and I’ll get back with you. I’m continuing research on PHD and would love your feedback.

You can hear more about PHD and many other topics by listening to Dr. Margaret’s new podcast, SelfWork with Dr. Margaret Rutherford or click here to read her other work.

Perfectly Hidden Depression® is a registered trademark.




Healthy Coping, Depression And Perfectly Hidden Depression: What’s The Difference?

Dr. Margaret Rutherford

Dr. Margaret Rutherford is a clinical psychologist who's practiced in Fayetteville, Arkansas for twenty-five years. Her passion for researching Perfectly Hidden Depression began in 2014 and she's currently writing a book to be published next year by New Harbinger. Her work has been featured on Psychology Today, The Huffington Post, The Mighty and The Good Men Project, among others. She's the author of "Marriage Is Not For Chickens", a blogger (Https:// and podcaster (SelfWork with Dr. Margaret Rutherford). She welcomes your questions and comments --

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APA Reference
Rutherford, D. (2018). Healthy Coping, Depression And Perfectly Hidden Depression: What’s The Difference?. Psych Central. Retrieved on October 27, 2020, from


Last updated: 2 Mar 2018
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