An Integrated Approach to Young Adult Mental Health Rehab

Hidden Depression

What Is Hidden Depression in Young Adults?

Reading Time: 6 minutes

Hidden depression can be hidden from others—or it can be hidden from ourselves. A young adult with hidden depression may deliberately conceal how they’re feeling for fear of how they’ll be perceived. Or they may think that the feelings will resolve themselves if they can just “fake it ‘til they make it.”

But in other cases, hidden depression can result from a detachment from one’s own emotions and state of mind. Sometimes even the person struggling is unaware of the extent of their own distress, so they don’t receive support or treatment. That’s when hidden depression has the potential to be life threatening.

What Is Hidden Depression? 

Hidden depression, also known as smiling depression, walking depression, or masked depression, is marked by an absence of observable symptoms. Considered a form of atypical depression, hidden depression is not formally recognized as a distinct disorder by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders

The most characteristic symptoms of depression are an unrelenting feeling of sadness and the loss of pleasure or interest in activities that were once enjoyed. However, people with hidden depression don’t fit this description. From outward appearances, in fact, someone with hidden depression seems to be living a happy and productive life. 

8 Signs of Concealed Depression 

How to know if someone is secretly depressed? The primary symptoms are the physical complaints and behavioral changes associated with depression. Hidden depression symptoms can include:

  1. Aches, pains or digestive problems that cannot be explained by some other cause
  2. Fatigue or a lack of energy; sleeping too much or too little
  3. Changes in appetite and resulting weight gain or loss
  4. Feelings of heaviness in limbs
  5. Irritability or intense sensitivity to rejection
  6. Difficulties with concentration or memory
  7. Changes in substance use
  8. Thoughts of suicide

Untreated hidden depression can be especially dangerous. That’s partly because it is so easily overlooked or dismissed and thus left untreated. In addition, however, people with concealed depression are typically more functional than those with more typical manifestations of major depression. Hence, they may actually have the energy to follow through with a plan to harm themselves.

If you experience perfectly hidden depression, you don't recognize what's going on as depression. The very idea of you being depressed may seem ludicrous to you.

Margaret Robinson Rutherford, PhD,
author of Perfectly Hidden Depression

Why Young Adults Are Vulnerable to Secret Depression

Few times in life are as filled with monumental changes as young adulthood. Emerging adults face an intense series of major decisions and life tasks, including:

  • Choosing a career
  • Deciding whether or how to invest time and money in education
  • Establishing independence from family
  • Forming a friend group
  • Potentially connecting with a partner 
  • Learning life skills ranging from fitness to finance.

Grappling with these challenging tasks can cause a crisis in confidence and leave young adults feeling vulnerable and out of control. At the same time, this age group often feels intense pressure to appear strong and capable to friends and on social media. This disconnection between our inner and outer worlds—between how we look on the outside and how we feel on the inside—can trigger or exacerbate hidden depression.

Know the Facts

1 in every 3 US adults is struggling with depression, according to new research from Boston University School of Public Health.

Risk Factors for Hidden Depression

Hidden depression can affect young people of all genders, from all backgrounds, for a variety of reasons. Here are some of the factors that may contribute to its development:

Self-protection: Sometimes a young adult with hidden depression unconsciously presents a face to the world that is the exaggerated opposite of what they are actually feeling. This may be a form of reaction formation, an unconscious defense mechanism: The person expresses the opposite of their true feelings in order to avoid acknowledging a part of themselves they consider unacceptable. 

Stigma: The stigma that previous generations attached to mental health issues lingers for many people. Even if they do not share that attitude, a young adult may want to avoid the disapproval of others they admire. Or they may fear that exposing a vulnerability may have a negative impact on their relationships, school, or work.

Gender differences: Boys and men tend not to have a harder time expressing the full range of their emotions due to a combination of biological, developmental, and societal factors. That’s why depression in males is more likely to manifest as substance abuse, behavioral issues, and physical problems. Girls and women tend to internalize negative emotions like sadness, fear, anxiety, and guilt. If they keep those feelings bottled up inside, it may lead to hidden depression.

Cultural biases: While the range of human emotions is universal, different cultures value them to varying degrees. Within a particular family, community, religion, or ethnicity, emotional expression may be more or less valued. In cultures where individual emotions and mental health are less of a priority, hidden depression can be more common.

Lack of trust in the medical profession: Communities that have suffered historical abuse or neglect by the medical community, including African Americans and Native Americans, are less likely to seek help for distressing feelings. Other people avoid treatment because they harbor misconceptions about treatment—for example, fearing that it will result in a dependence on medication. 

Personal history: Childhood trauma as a result of abuse or neglect can leave a deeply ingrained pattern of disconnection from one’s inner life. A child who learns that it is not safe to express their emotions, or who learns to organize their emotions and behaviors around a caretaker’s emotional life, will have a difficult time recognizing and prioritizing their emotions as a young adult. They  might also be distressed by the idea of asking for help or the perception of being a burden on others. 

How Growing Awareness of Mental Health Can Reduce Secret Depression

Secret depression is often hidden because of the shame connected with it—whether conscious or unconscious. That’s why the current movement to reduce the stigma around mental health issues and treatment has the potential to diminish the phenomenon of hidden depression. 

Gen Z, the most stressed-out generation, is at the forefront of this growing movement toward mental health awareness and destigmatization. Young adult celebrities—from Olympic athletes to rappers—have added their voices to the conversation, publicly sharing their stories about their mental health challenges. 

Moreover, COVID has accelerated these efforts. Because so many people are struggling with pandemic-induced anxiety and depression, it has become more accepted and normalized to talk about mental health and to tend to our mental health. 

Concealed depression in young adults
Hidden depression in young adults - mobile image

5 Tips for Helping Someone with Secret Depression

Are you concerned that you or a young adult in your life is experiencing hidden depression? Here’s how you can help.

  • Educate yourself. Awareness of the factors that affect mental health has evolved dramatically in recent decades, especially the complex interplay between mind and body. Check to see if your assumptions and understandings are still current. (Newport Institute’s ever-growing archive of resources is a great place to start.)
  • Beware of enabling unhealthy perfectionism. Are you fostering or buying into the misconception that mistakes are to be avoided? Failing is essential in the process of maturing; it allows us to learn and grow. Don’t just celebrate the wins in your own or your friends and loved ones’ lives. Find a way to celebrate the learning we all gain from mistakes, large and small.
  • Be an ally. Speak up when you hear people making light of mental health struggles. Your words will help establish a sense of safety for your loved one or friend who may be struggling, as well as for others in your friend group, family, or larger community.
  • Offer support and a listening ear. If you think someone you know might have concealed depression, share your concerns with compassion and without judgment. Here’s how to help a friend who’s struggling with their mental health.
  • Encourage them (or yourself) to seek help. We all deserve support to move out of depression and into thriving. If you’re on the fence about getting treatment, or someone you know is, remind them that seeking help is the most important thing they can do for themselves and for their future. 

Treatment for Hidden Depression

The longer depression goes undiagnosed, the harder it is to treat. The team at Newport Institute knows how to recognize and how to treat hidden depression, helping a young adult bring their inner and outer worlds into alignment. 

Contact us today to learn more about our approach to young adult treatment and our outpatient and residential locations around the country. 

Sources

Lancet. 2022 Jan; 5: 10091.

Ann Fam Med. 2021 Jan–Feb; 19(1): 4–15.

Humanistic Psychol. 2021; 49(4): 555–572. 

Integr Med Res. 2016;5(2): 105-109.

Emot Rev. 2015; 7(1): 14-21.

Mental Health / February 4, 2022

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