Welcome to this week’s exploration and discussion of Perfectly Hidden Depression ®!

Included today is a questionnaire to see where you might “score” on the spectrum of Perfectly Hidden Depression (PHD). This isn’t meant, nor should it be used, to diagnose depression or any other mental illness. It’s created to help you identify with this syndrome, and hopefully begin your own journey for healing.

When I wrote my first post on Perfectly Hidden Depression (PHD), I was thinking about several patients I had seen in my practice. Basically, I was describing their characteristics, what struggles they had very painstakingly revealed to me. They weren’t comfortable with too many in depth questions, and liked to keep a fair amount of control over our conversation. They needed me to wait, and let them gain enough trust of me and of therapy itself, before they would open up.

In fact, it might be several weeks, or even months, into therapy, before I heard what was their reality– what was underneath the polish and the smile that hid so very much.

So I waited. And gave them enough space to come forward. The specific work that was needed has taught me so much, and through this column, I want to share that knowledge with you, and learn even more from your comments and reactions.

Let’s recap…

In my first column, we discussed exactly what PHD is — a syndrome. A group of behaviors or characteristics, beliefs or actions that appear together. If you’ve heard of codependency, that’s a syndrome as well. Not a diagnosis.

In the second week, we heard descriptions and stories from actual people who had identified with my work on PHD. And in the third, there was an explanation of how PHD varies from the “hiding” that can occur in healthy coping, where many of us keep certain things to ourselves. Or we wait until it’s the appropriate time to work through painful or traumatic emotions or events. That’s called compartmentalization, and it’s a vital,healthy skill.  We discussed how someone with PHD over-utilizes this strategy of compartmentalization, and then gets stuck in either intentionally pretending, or more seriously in many ways, losing whatever ability they initially had as children to be open and vulnerable. Their actions are not about deceit. This defense is the only way they feel safe.

Why is this important to identify?

Because there are secrets. And where there are secrets, there is loneliness.

Because there is little self-care or compassion for self. And where there is lack of compassion, there is criticism.

Because this way of life, the perfectly hidden life, doesn’t feel like a choice.

And where there is lack of choice or freedom, there is enslavement — there are “shoulds,” “musts,”  and “have to’s” that govern lives.

What follows is a questionnaire for you to take, to help you identify, or not identify, with Perfectly Hidden Depression.  Be as honest with yourself as possible. There are scoring instructions at the end.

A checklist for Perfectly Hidden Depression…

  1. Do you struggle with confiding in others — especially about your real-life difficulties and problems? Yes______ No______
  2. Do you obsess about things looking perfect, both for yourself and through others’ eyes? Yes______ No______
  3. Do you avoid talking to your partner (or your friends) about feeling hurt by them, or about a growing resentment you might have? Yes______ No______
  4. Do you have trouble sleeping or turning your mind off at night? Yes______ No______
  5. Do you have trouble admitting when you’re feeling overwhelmed? Yes______ No______
  6. Do you push yourself to get the job done, regardless of the cost to you? Yes______ No______
  7. Do you respond to the needs of your friends even when it can short-change your own? Yes______ No______
  8. Did you grow up in a family where feelings of sadness or pain were avoided, or where you were criticized or punished for expressing them? Yes______ No______
  9. Have you ever been hurt emotionally, physically or sexually, and told no one? Or if you did tell someone, you weren’t believed or supported? Yes______ No______
  10. Did you grow up in a family (or are you still experiencing a family) where you felt like you had to meet defined expectations rather than being allowed to be yourself? Yes______ No______
  11. Do you like to have control of a situation if you’re going to be involved? Yes______ No______
  12. Do you have a growing sense that it’s becoming harder to maintain an organized structure in your life? Yes______ No______
  13. If so, do you feel anxiety or even panic? Yes______ No______
    Do you tend to not cry or rarely cry? Yes______ No______
  14. Are you considered ultra-responsible, the one that can always be counted on by your co-workers or family and friends? Yes______ No______
  15. Do you think that taking time for yourself is selfish? Yes______ No______
  16. Do you dislike people considering themselves “victims”— that it’s not their fault when something goes wrong? Yes______ No______
  17. Did you grow up being taught that you were supposed to handle painful things on your own? That asking for help reflected weakness? Yes______ No______
  18. Do you strongly believe in focusing on the positives in your life, or “counting your blessings”? Yes______ No______
  19. Do you have a critical, nagging inner voice telling you you’re not good enough, or that you could have tried harder, even though you accomplished your goal? Yes______ No______
  20. Do you outwardly seem hopeful and energetic while, at times, you struggle with a sense of being trapped? Yes______ No______
  21. Do you make lists of tasks to get done during the day, and if they are not completed, feel frustrated or like a failure? Yes _______ No_______
  22. Were you an older child in a family where parents weren’t available, and you took care of your younger siblings? Yes_______ No _______
  23. Did you have to care for an alcoholic or otherwise dysfunctional parent as a child? Yes _______ No_______
  24. Were you told that you were extremely special to one parent, and felt that you needed to please them in order to maintain their emotional stability? Yes_______ No _______


Count your positive answers to the questions above. If you answered “yes” to five to eight questions, you’re likely to be a very responsible person, though you may need to consider taking more time for yourself. A “yes” response to eight to eleven questions indicates that your life is being governed by highly perfectionistic standards, which may be detrimental to your well-being.

Twelve or more positive responses may reflect the presence of PHD, or a depression that you deny (or are unaware of). You do this by intentionally creating a happy, perfect façade.Lots of driven, accomplished people share these traits, or have these dynamics in their history. Often, they can lead to success and happiness.

When many of them are present, you may be experiencing PHD.

I’d love to hear about your experience with the questionnaire, as I’m always open to constructive suggestions, improvements or comments.  You can comment below or email me confidentially at [email protected]

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.