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Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression

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If you were raised to believe that painful emotions are a sign of weakness, or if being vulnerable has always made you feel unsafe, then you may have survived by creating a perfect-looking life—a life where you appear to be successful, engaged, and always there for others. The problem? You’re filled with self-criticism and shame, and you can’t allow yourself to express fear, anger, loss, or grief. You recognize something is wrong, but you’re not sure what exactly—only that you feel trapped and alone. If this sounds like you, you may have perfectly hidden depression (PHD).

With this compassionate guide, you’ll begin the process of understanding your perfectionism, identifying destructive beliefs, and connecting with emotions suppressed for far too long. You’ll also find tangible tips for quieting that critical inner voice, and powerful strategies for coping with difficult feelings. Most importantly, you’ll learn that asking for help isn’t a sign of weakness, but a sign of strength. If you’re ready to stop hiding and start healing, this groundbreaking book will guide you—every imperfect step of the way.

216 pages, Paperback

First published November 1, 2019

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About the author

Margaret Robinson Rutherford

2 books51 followers
I have been a psychologist in private practice for over twenty-five years. I began writing online in 2012, and I’m excited to announce that my book, entitled Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression, will be launched in November of 2019.

You can learn more about perfectly hidden depression and other topics by searching for articles on my website and by listening to my podcast called SelfWork, which you can find here or on your favorite podcasting platform.

I’ve been researching and writing on perfectly hidden depression for over five years, and I’m passionate about the message that although depression can be heavily masked by perfectionism, it’s damage can still be devastating to that someone who’s trying so hard to smile their way through growing loneliness and despair.Along the way, I’ve met many authors, researchers, bloggers, and psychologists. I’ve written for HuffPost, The Mighty, Psych Central, The Gottman Blog, Psychologies, StigmaFighters, The Good Men Project, This Is My Brave, and others as I’ve spread what I hope is a passionate message about becoming more comfortable with vulnerability in every day life, and confronting the prejudice against not only mental illness itself, but its treatment.

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Displaying 1 - 30 of 45 reviews
Profile Image for Dani (The Pluviophile Writer).
502 reviews48 followers
June 8, 2019
No one knows the real you because you never let them in. You're not comfortable with the reality of you so you pretend it doesn't exist.  If this sounds all too familiar to you, then you need this book.

5/5 stars.
ARC, ebook, 232 pages.
Read from May 29, 2019 to May 31, 2019.

Review at The Pluviophile Writer: https://bit.ly/2WIm0F6

You always meet your deadlines regardless of how you're feeling, you push forward through difficult circumstances and hide behind a facade in order to keep an appearance of having it all together. All because you don't want to be perceived as incompetent or weak, yet inside you're constantly battling with yourself, your feelings, and your self-worth. You've tried to line yourself up with the standard definitions of depression yet you never fully fit it due to your heightened sense of responsibility, your inability to recognise or share your feelings, and the high sense of control you constantly try to implement in your life. No one knows the real you because you never let them in. You're not comfortable with the reality of you so you pretend it doesn't exist.  If this sounds all too familiar to you, then you need this book.

After some harrowing experiences with patients, the author of this book noticed a pattern and began to put together the shape of this unique type of depression that often goes unnoticed and undiagnosed. Coined by the author, Perfectly Hidden Depression (PHD) can be the result of a variety of factors such as upbringing, ingrained beliefs, and personality traits. The author states that there isn't anything in the Diagnostics and Statistics Manual (DSM) on this type of depression but that this is an acknowledgement and an observation from her own professional experiences (which she details and provides resources for). The author believes PHD is a subset of depression that many practitioners miss because it doesn't present the way the DSM has listed. The author gives this list of defining features that make up someone with PHD:
Are highly perfectionistic and have a constant, critical,
and shaming inner voice

Demonstrate a heightened or excessive sense of

Detach from painful emotions by staying in your head
and actively shutting them off

Worry and need to control yourself and your

Intensely focus on tasks, using accomplishment to feel

Focus on the well-being of others but don't allow them
into your inner world

Discount personal hurt or sorrow and struggle with

May have an accompanying mental health issue, such
as an eating disorder, anxiety disorder, obsessive-compulsive disorder, or addiction

Believe strongly in counting your blessings as the foundation of well-being

May enjoy success within a professional structure but
struggle with emotional intimacy in relationships
Think of some of the shocking celebrity suicides that have happened recently, Anthony Bourdain, for example. Everyone thought he has this dream life and that he seemed like a generally happy and satisfied person. What if Anthony was the epitome of PHD? In that, he felt his personal value was only in his accomplishments, driven by how grateful he thought he should feel, and then feeling burdened and overwhelmed by the mask of achievement and perfection that he felt he had to wear. He also had addiction problems. If we knew more about people that presented with this perfectly masked depression we could provide them with better treatment and save them and those around them an immense amount of suffering
"Anthony Bourdain was apparently not physically ill, not financially destitute, not concerned about getting his next meal, and not lacking in fame. In fact, he remarked he had “the greatest job in the world.”" - Toronto Sun, July 7, 2018
It's hard not to get personal in reviewing this book as I picked it up from Netgalley out of my own personal interest. After reading  The Gifts of Imperfection eight years ago I worked through my own PHD, which at the time was just learning to be vulnerable again. I started talking and writing about my issues and the condition, dermatillomania, that still plagues me, something that would have been unthinkable before. I made steep headway with Brené Brown's book but it wasn't enough. This book feels like the acknowledgement and the validation I need to press forward in my own personal growth and happiness in terms of the regressions I have made at this point in my life.

The author of this book is shedding light on an area of depression that requires some serious attention. Her writing is personable, concise, insightful, informative, resourceful and clinical. I have already recommended this book to at least three people I know and I anxiously await its publication as I look forward to adding this to my permanent bookshelf.  At this time, I have not done the reflections recommended in the book as I was excited and anxious to get through all the content because of how alarmingly relevant I found it. I am now looking forward to re-reading the book and diligently doing the reflections which I believe will be immensely valuable. I've already started recommending this book which is due to be published on November 1, 2019. I highly recommended this book to anyone who feels they fit this description, and if you do, chances are you're reluctant to reach out for help, so start with this book, no one has to know.

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Profile Image for Kate.
883 reviews16 followers
May 30, 2019
I really resonated with this book. I seem to always have some level of chronic anxiety and depression and much of it all stems from my perfectionism. I am in a frenzy if someone wants to come over last minute and the house isn't perfect or if I haven't lost the baby weight after leaving the hospital after giving birth 48 hours late.r In my head I sometimes realize that things like these may be a bit silly, but somehow in the moment they never seem that way and it really takes a toll on my emotional health and my ability to be there for my family.

This book really helps to make the reader aware of issues like these and to also realize it is normal but doesn't have to be how you live your life. You can get the help you need and make the commitments to consciously do what you need to be happier (not just on the outside, but on the inside!) Learning to accept your imperfect self can be challenging and is something I know I am working on, but this book can really help give that motivation and outline those steps in order to make the appropriate changes necessary.
Profile Image for Annelies.
357 reviews
November 15, 2020
Ik vond dit echt een zeer interessant boek over perfectionisme en depressie. Heel confronterend, met veel voorbeelden uit haar prakijk. Het is voor een groot deel ook echt een werkboek met oefeningen, en die heb ik tijdens het lezen overgeslagen, maar ik heb eigenlijk wel zin om een voor een alle "reflecties" eens te doen.
Profile Image for Jessica Watson.
101 reviews
June 19, 2021
like reading my damn mind. i feel like this book also went well with Adult Children of Emotionally Immature Parents.
Profile Image for Donna.
789 reviews32 followers
December 15, 2019
Perfectly Hidden Depression by Dr Margaret Rutherford s a must read. Even if you do not think you have it, I am confident that you know someone with it and it will help you in your interactions with them. These people do not appear depressed. They are very active and appear happy; not what you expect depression to look like.

Some of you may automatically know you are a perfectionist. Others may not recognize the behavior until you read how it can manifest itself. The author shares 10 characteristics of perfectly hidden depression.

Once you understand what perfectly hidden depression is very well, the author gives you a quiz to see how well you relate to it. From there we move to part II where you start learning the five stages of healing.

The author includes sections to journal, answer questions and think through what you have read and how it relates to you. In addition, there are real stories; these were very impactful for me. The author’s compassion and empathy come through the book loud and clear. It makes you feel like you know her and the book is written to where you feel she is talking to you directly.

Again, I want to stress that I highly recommend this book. Even if you think it is not for you, I am confident you will know someone you want to share the book with.
11 reviews
May 3, 2021
Anyone living in North America should read this. Especially men, and especially those who have read No More Mr. Nice Guy, as I think they are complementary. Rutherford articulates some concepts that otherwise have no vocabulary. Do the exercises, as much as they'll make you cringe.
366 reviews286 followers
December 25, 2020
Have you ever said: "I Should be grateful", "My life is perfect, why am I feeling like this?!"

Probably you're suffering from Perfectly Hidden Depression (PHD). How to make sure you really have this? There are ten characteristic, some of them are:

You detach from painful emotions by staying in your head and actively shutting the off.

"You may deny emotional pain of any kind. you might tell yourself, Things just don't bother me. You've stuffed all your painfull experiences and memories into boxes and shoved them far away in some remote closet in your mind."

You worry and need to control yourself and your environment.

"Worry leads to a need for control, which leads to taking more responsibilty, which lead to exhaustion, whch leads to hidden anger or resentement."

Then the book will talk about the stages of healing. One of them is: Attain consciousness

"Mindfulness is being aware of each moment of an emotion's wave apparent life, riding it until it inevitably comes to an end."

What I liked about the books is that it's filled with "Reflections", each one is a task to do; write what you are thinking/feeling, each one is realted to the main topic and it's not an easy task.

I learned many lessons from this book, the major two were:

1. Moving toward learning how to feel calm and give up constant worry.

"All of us, every day, cope with not knowing excatly what will happen in the next moment. if you tried to imagine and protect yourself and those you love from every potential mishap, your anxiety would go through the roof."

2. Moving toward allowing others into my real world.

"Leting other people in so that they really know you is something you've not done. This is a chance for you to allow other people who care about you to discover their own talent for giving. Allow your loved ones to know how good it can feel to be leaned on, to know that you value their opinion, or that your relationship with them can survive and thrive even given conflict."
Profile Image for Klaudia Poloncová.
12 reviews6 followers
June 17, 2022
Lifechanging and powerful book. I have never thought that one book can change so much in me. I’ve found so many answers about myself, opened boxes hidden in me for many years which were still there, but locked deep inside, and I didn't even know about them. They caused so many constantly recurring problems/ patterns in my life. Now, after reading this book I really see where my emotions affect me and from now on it'll be easier to work with them. I recommend this book not only to people who are dealing with PHD but also to those who want to know much more about themselves. This book also helps you understand what a mental health is as a whole and how important it is for living your unperfectly perfect life.
Profile Image for Julia.
461 reviews13 followers
January 19, 2020
Perfectly Hidden Depression is a dangerous thing and not enough people are aware of it. This book provides comforting guidance in finding the root of the readers’ PHD and chronic perfectionism and how to move forward. I skimmed through a lot of the reflections because I’m currently too lazy for that but the prompts definitely seemed like they would be enlightening.
June 15, 2019
If your own critical thoughts are oftentimes your worst enemy, this might be a book for you?

If nothing for you is ever quite as good as it could be, if your focus is on what isn’t, instead of what is, and inwardly you’re chastising and demeaning yourself over what you perceive as inadequacies and failures, then this book might be for you?

It's a funny(not in the HAHA way) thing how shame works, isn't it? Let’s face it. Sometimes, we all need to be critical of ourselves. Obviously, having a conscience is important, and empathy for those around you is necessary to enjoy quality connections with others. Holding yourself accountable is important, but constantly nagging yourself? Opening your eyes first thing in the morning, and having some kind of negative thought about yourself? Well, that's a waste of your life!

What's not a waste of your life, I don't feel anyways, is giving this book a try whether or not you yourself are actually a sufferer of hidden depression or not. I've never thought educating yourself on any subject matter that you don't know much about is a waste, in fact just the opposite is true for me. Reading stories about other people's struggles and successful(and sometimes not) outcomes helps me to take a more open-minded approach to how I deal with the daily struggles of living with a high functioning teenager who deals with both ends of the spectrum where mental health is concerned. This teenager wears the "mask" each and every day when they leave the "safety" of home and on the rare occasion lately the "mask" has partially slipped off in public ... scary I know, but on the other hand so beneficial for this teenager to see that even the people who weren't aware of the issues do actually care and do actually reach out to help once they see what has been hidden fairly well up to this point.

I could prattle on and on and on about the need for more mental health awareness in our society and in our families and communities but bottom line is, I really enjoyed reading this book(even if it's not an actual physical book yet, Nov. '19 I think? And yes I want to buy it when it becomes available, it was a beneficial enough read for me that I would spend the $$ to own a hard copy)(I'm old school, what else can I say?!) 4 ½ Stars for it and its author. Seems like she knows what she's talking about!
Profile Image for Sarah E..
113 reviews
April 13, 2021
I regret letting this book go unread for far too long. It is fantastic. A much needed resource for those struggling with perfectionism and depression, and the professionals that help them. The journaling reflections will be priceless to them!

If you don’t struggle with perfectly hidden depression, this book can give you insight and compassion for someone you know that does. Depression doesn’t have the same characteristics in everyone. That woman you know that seems to do everything effortlessly may be barely keeping it together inside.

While I would say that this book may be geared towards mothers and/or career women, the information is invaluable to all.

I received an advance reader copy from NetGalley and New Harbinger Publications in exchange for my honest review.
October 21, 2019
I was lucky enough to receive an advanced readers copy from Dr Margaret! And I urge everyone to give it a read!

I didn’t fit the ‘typical depression’ criteria, but I always knew something wasn’t quite right with my mood, I had anxiety sure, but my mood didn’t fit the standard mould. I was perfectionistic, highly strung and functional, I filled my days with busyness you mask the crippling inadequacy I felt.
for years i was often ignored by professionals. So To finally have someone recognise that depression isn’t one size fits all, was such a relief! I wasn’t crazy or imagining what I felt.

My impressions of the book:
It’s easy to read
It’s not jargon heavy, which makes it easier to understand.
The reflections/journal prompts are in manageable bites and are connected throughout the book and I found them really helpful on my journey of self reflection.
The Anecdotes are well placed and relatable to each of the topics covered.

Hell! even if you don’t identify with PHD, or depression this book is still worth a read if you’re on a self-discovery journey!

Over all I’ve loved reading it, as far as self help books go this is the best one I’ve read yet! Thank you Dr Margaret Rutherford!
Profile Image for Trina.
117 reviews4 followers
January 10, 2020
Perfectly Hidden depression is a well written book, with amazing exercises that I would encourage for many if not most people that are really motivated to work on their depression. However, I found Margaret Rutherford's tone a bit harsh at times and it rather than the difficult exercises made me want to stop. Rutherford also, in my opinion, takes liberties about naming perfectly hidden depression without any true examples about how this hidden depression is not, in fact, diagnostically relevant depression. This book does know it's own boundaries and Rutherford does a good job of encouraging the reader to get IRL support when necessary. I believe that the exercises in this book may be very helpful for anyone wanting to make changes in their depression, if they can manage the book.
Profile Image for June.
590 reviews20 followers
August 26, 2019
This is a powerful book. I recognized traits and behaviors in myself and others that I never would have attributed to depression before, yet it makes perfect sense. I hope this work will not only bring relief to those struggling with depression, but also bring more understanding to mental health as a whole. There is an unfair stigma around depression that prevents many from getting the help they need, and that needs to change. Margaret Rutherford does an excellent job of explaining issues in layperson terms and without judgment. If you have ever known a perfectionist or been one yourself, you need to read this book.

Thanks to the publishers and NetGalley for the digital ARC.
872 reviews18 followers
August 17, 2019
Goes through five stages of healing, understanding and living. There are reflections sections - throughout the book and are exercises, then someone's story/ information. progress through the information presented. Does give some information on a few disorders. There are 3 pages of references and 2 pages of resources for readers which can help the reader to go further. Good starting point to anxiety and depression.
Profile Image for Penny Wright.
94 reviews12 followers
June 20, 2019
In this new book, due to be released in November 2019, Rutherford talks about an obscure form of depression marked by completely hiding your symptoms and being a perfectionist. Whereas with normal depression, people will notice your lethargy or increasingly sad moods, people with Perfectly Hidden Depression (or PHD, as she calls it in the book) outwardly show no signs of being depressed.

For people who are perfectionists, how others perceive you is incredibly important, and showing your vulnerability is not an option. You might hide your symptoms so well that even the people closest to you might have no idea what you’re really going through.

The book is perfect for people who think they might be experiencing this sort of depression and want to do something about it. Each section of the book is followed by a journal prompt to help you reflect on yourself and your own habits. I like that with a book such as this one, you’re able to move at your own pace and spend plenty of time on the prompts and reflections. There are also real-life stories about Dr. Rutherford’s patients and how they learned to deal with PHD.

I do not have what Dr. Rutherford calls “Perfectly Hidden Depression;” my depression is of the more typical variety. However, if you recognize that your perfectionism is causing you to internalize your depression and you want a way out of that suffering, I highly recommend this book.
Profile Image for Erin.
583 reviews7 followers
March 22, 2023
I can see how this book would be super helpful for someone who hasn't sought help for depression before. There's a lot of info about how difficult it can be to ask for help, especially if you're someone who sees themselves as totally self-sufficient and not weak in any way. However, for someone who's been in treatment for awhile, there probably isn't anything earth-shatteringly new to learn about.

There is a lot I could relate to with the description of what 'perfectly hidden depression' and perfectionism are. And there were a few things that I think I can think about in a reframed way. But because I've been in therapy for so long and have been working on shying away from hiding my feelings, I don't think this will really change the course of my treatment. The inclusion of specific cases was the most helpful aspect - hearing people's stories and how they worked to overcome their depression made this a worthwhile read. This book could be useful for therapists to suggest to new clients who need to learn more about how hiding their depression can negatively impact their mental health.

*Free copy provided by Netgalley and the publisher in exchange for an honest review*
Profile Image for Erin.
264 reviews22 followers
October 2, 2019
This book delves into what author Margaret Rutherford she "perfectly hidden depression", a syndrome that doesn't fit the official diagnostic criteria for depression, and so has flown under the radar, as have the people struggling with it. While some of the symptoms that charactize this condition came be helpful in moderation, those who struggle with PHD are so convinced they must present a "perfect" front to the world, that they don't acknowledge that they're struggling, often even to themselves.
While I don't have this myself, I could relate to a lot of the perfectionism the author writes of, and the journaling prompts and exercises would help anyone who struggles with perfectionism. I love how she frequently says things like, "This isn't something else you have to do perfectly." Rutherford is a reassuring guide on the journey to acceptance.
Profile Image for Kris Compton.
3 reviews
July 13, 2020
This book describes me to perfection! I definitely have perfectly hidden depression. Thankfully I've been in counseling off and on for 13 years now, which saved my life.

Working thru the reflections were a great exercise, along with therapy, to do some deep inner work. One thing I've learned about my particular form of darkness is that I cannot take days off from pursuing healing and doing the inner work. This is an ongoing journey for me.

I appreciate that this book is in every day language rather than medical terms. It really puts the application right at our fingertips. I have given away copies of this book to others - that's how helpful I believe it is.

To me, this book and a therapist are must haves for everyone!
Profile Image for Antonin Sulc.
22 reviews
May 16, 2021
The book describes quite interesting phenomenon of people who are seemingly doing great but are sad inside.

The first half describes what the PHD is, how to identify, and about the patterns that we sometimes obey without a reason. In between, there are short stories to understand better the context of what was mentioned. I found particularly interesting the study of the behavioral patterns that I mistakenly followed and the way how author suggest to change them for your own good, without being a selfish asshole

However the second half of the book is horribly boring and I either did not understand the message conveyed by author or it was redundant.

I strongly recommend this book to anyone who having a feeling that it is not ok to not feel ok.

1,628 reviews22 followers
June 5, 2019
As a mostly-recovered, recovering-perfectionist, I read this out of curiosity and to see there were any new tips I could use (or just learn something new, in general). This is really good stuff. The author describes a set of recovery stages, and also includes lots of stories and wisdom from others; Great tips and techniques as well. She also heavily encourages readers to journal (ugh!), which I didn't do -- but I'm sure it's well-worth the effort. Make no mistake that if you're struggling, this book will help if you put in the effort while reading it; so it's obviously going to take some time to read and utilize. Highly recommended.

I really appreciate the complimentary copy for review!!
Profile Image for Walker Walker.
61 reviews3 followers
October 28, 2019
This book was speaking to me directly. I had no idea I was battling with OCD which was contributing to my depression. This book will help you process what is happening in your life. For instance, I get depressed whenever I take classes. It helped me pin point that I was so busy trying to perfect all of my assignments to the point where I got nothing done. That alone was depressing in and of itself. This book help me discover my actions and how to work on improving these habits in order to light my stress levels. It’s working so far. So, this book is a must and I will add it to my arsenal of books.
Profile Image for Rebecca.
249 reviews22 followers
November 8, 2019
This was a good starter guide that is aimed at people who aren’t aware that they actually have depression.

It includes criteria for diagnosis, support exercises & advice on how to tell the people in your life.

I thought it was interesting read though there was often a focus on people who have faced trauma or significant adversity rather than including people who have had no prior issues but are now having to fake being okay for fear of being seen as an attention seeker.

Overall 3.5 stars
Profile Image for Laurie.
Author 6 books67 followers
November 10, 2019
This informative book identifies those negative patterns or beliefs that keep us emotionally detached from our selves and others. With detailed explanations, readers can use this book to help address their own issues of perfection. Perfectly Hidden Depression is a unique construct that explores a hidden mental health struggle becoming more and more prevalent.

The book includes great reflections questions throughout, but I do wish the publishers had included room for readers to respond to each question, more like a workbook style.
Profile Image for Emily Mellow.
871 reviews8 followers
March 31, 2022
I did not find this book to be especially useful.
I think it's an important concept for sure, that people can be ruined by depression on the inside, even suicidal, and look and act perfectly on the outside.
I don't know if it's groundbreaking, maybe. We should all be aware of this possibility in our loved ones and ourselves.
I thought initially this might describe myself, as I'm very high functioning but I also cry super easily, and the author states over and over that the subjects of her book don't ever cry. So I couldn't really relate
Profile Image for Diah R.
408 reviews5 followers
October 13, 2019
(I received a digital ARC via NetGalley. All thoughts and opinions are my own.)

Perfectly Hidden Depression is perfect for those who doesn't know that they're depressed or can't/won't admit that they're one. I like that it contained step by step to identify and to tackle it without being too condescending. It gave more than 50 questions to ask ourselves, mostly on our beliefs. It'd be nice to do the questions/exercises with group. Overall, it was a good book, but a bit boring to me.
Profile Image for Tasha Driver.
Author 2 books23 followers
November 14, 2019
This is a well written and researched book on the perfectionism that masks depression. It has conversational language and the style of a good therapist. This book should be read by everyone because you are either hiding your depression from those around you or you know someone who is. This book can help pick up on the signs of masked depression and get the person that needs it the help that they need.

It is very easy to follow and I highly recommend it.
Profile Image for Holly.
540 reviews6 followers
November 18, 2019
I could really relate to the beginning of this book. It was like she was speaking directly about me. Towards the middle of the book, it slows down a lot and becomes more like a therapy session. I can see where this could help many people if they want to be helped. For me, it was an interesting look at a topic I wasn't aware of before.
Thanks to Netgalley and the publisher for the advanced copy of this book. The opinions are my own.
Profile Image for Niamh Mitchell.
20 reviews
November 15, 2022
I really wanted to like this book, many of my clients struggle with perfectionism and it gets in the way of their ability to enjoy life so I'm always on the look out for resources to recommend - this will not be one of them.

The tone was very condescending and it a lot of it was filler, I kept wondering if there was a pount being made or a tool being framed but there wasn't.

I'm sure the authors intentions were good but the delivery failed in my opinion.
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