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What does it mean to have high-functioning depression?



When I was diagnosed with depression for the first time in 19459004 many people – even those who knew me well, who took care of me – reacted with the opposite of what I had to hear. This was partly because they did not understand it, but partly because we live in a world where it is believed that the mental illness is a weakness and that one Person with depression is someone who can not leave her. House sleeps all the time, it lacks enthusiasm and neglects the personal care. Most of the time, that was not me at all. And even when it happened, I managed to hide it.

I have a lot of "You are the last person I can imagine, depressed!" Or "But you have done so much for you" and "How can someone like you have depression?" The cumulative effect of this unhelpful commentary was tremendous. It did not stop me from receiving treatment, but it has kept me open about my illness for more than 1

5 years because part of me felt I did not need help.

I was diagnosed with depression for the first time at 19 It took another 13 years for a doctor to diagnose me of major depression (MDD). In recent years, the phrase "High Functional Depression" has come to my radar. It was something I could relate to, albeit with a very literal interpretation: I was a highly functional person with depression.

Although not new, high-level depression has become a kind of mental health. Phrase – but the exact definition depends on who you ask.

It is almost impossible to determine where the phrase highly functioning depression originated. "I do not think anyone knows," psychologist Michael E. Silverman, a lecturer, clinical professor at the Icahn School of Medicine at Mount Sinai, told SELF.

But it does deserve credit: "Clinical depression refers to a period of reduced function, with treatment goals emphasizing symptom reduction," explains Silverman. "However, this characterization is inadequate or at least incomplete if the person has a positive psychosocial level of functioning, that is above the average level of non-depressive persons. "

Depression occurs at various levels of severity, so Silverman may be difficult to land on a particular diagnosis." That is, some depression lead to severe disability and hospital admissions, while others Depression is more akin to the "walking wounded" [meaning] who perform the individual functions during their daily lives, but do not work as efficiently or productively as before or earlier. I think they should. "He says, a person who is as a highly functioning Identifying a person with depression could describe the feeling "as if she were constantly trudging through mud. "It is not a recognized clinical disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (19659011) DSM-5 ) or for use in research. Moreover, mental health professionals disagree as to whether the use of the term "high-functioning" for depression is a good or bad thing, or whether someone diagnosing depression with functioning depression meets the diagnostic criteria for actually experiencing depression altogether.

This is because highly functional depression, depending on how the person using that terminology defines them, does not necessarily require clinical intervention, while a formal diagnosis like MDD does, explains Silverman. This does not mean that a person diagnosed with high-functioning depression can not benefit from a visit to a therapist, but MDD is a formal psychiatric disorder for which a doctor would prescribe treatment in the form of therapy and / or medication. Some analysts suggest that the term highly functioning depression is due to a lack of clarity about persistent depressive disorder (PDD), or dysthymia which is a form of depression that is ongoing, but Symptoms can be less severe than MDD.

To better understand the many depressions, it may be helpful to first think about how all people have a typical mood. "We tend to almost always work near our baseline and of course have both positive and negative variations," says Jamie McNally, a psychologist and adjunct professor of psychology and owner of Sycamore Counseling Services in Michigan, to SELF. [19659016] Most people have a common understanding of MDD, a mood disorder that affects one's ability to function in everyday life. So someone with MDD has a mood that is far below the average of the individual. However, with PDD, the mood for someone with PDD is less clear and lies somewhere between the MDD baseline and a "normal" baseline, McNally explains.

Silverman explains this in the DSM-5 [19659019] experts essentially broke two mood disorders – chronic major depression and dysthymia – into one: PDD. Prior to the latest release of the DSM PDD was known as dysthymia and was used to identify individuals in whom depressive symptoms occur for two years or more, but not enough symptoms or so severe that they are classified as MDD can be. (Today, PPD and dysthymia are often used interchangeably.) When MDD lasts for two or more years, it is usually considered chronic. While both PDD and chronic severe depression have a duration of two or more years in adults, they differ in severity.

The symptoms of the two disorders are somewhat different and can be confusing, says Silverman. (You can learn more about the very subtle differences here .) He also says that DSM-5 and the associated diagnoses bring no real benefit to the average human or patient, but merely provides physicians with an opportunity to speak effectively about a person's experience and current level of disability.

"However, with MDD versus PDD, this is not always efficient or clear," he says. "For example, when I'm called by a colleague in California asking for help with a patient, and he says Mr. Jones has a PDD diagnosis, I still do not know if the patient suffers from dysthymia or if it does A major depression is chronic. Another question is: what diagnosis trumps the other? That is, MDD or PDD? This becomes all the more confusing as a small group of chronic cases that meet the MDD criteria would not meet the PDD criteria.

Given the clinical definition, someone who has been theoretically diagnosed with PDD has symptoms that do not necessarily affect their ability to live their lives the way MDD symptoms appear. It is possible that many people with PDD describe their situation as highly functioning depression.

But Silverman also points to the psychiatric concept of "highly functional" and the clinical characterization of depression both occur in one spectrum. "While a clinical diagnosis of depression has a discrete characterization of DSM-5 the term" highly functional "has no meaningful clinical benefit and is related to different individuals in different situations," he says. "While a professional athlete with PDD is certainly considered" highly functioning, "for example, a person who lives with schizophrenia and can successfully control a typical workday can also be considered" highly functioning. "

Shameka Mitchell Williams, a trained clinical social worker in Baton Rouge, La., Tells SELF that the term high-functioning depression is also used so often because it overrides some of the ambiguity of a label like PDD. "Who would not be considered" working well "even if he is depressed, as opposed to stubbornly depressed?" "There is less stigma if you can still manage to work."

But it is the problem of stigma that can also make the concept of highly functioning depression problematic.

Less stigmatization among those who consider themselves highly functioning may mean more guilt, judgment and misunderstanding for those who are not, and it could make people with depression question the legitimacy of their own illness put.

"To be highly functional in some way, it affects the trivialization of disability-related disability that many of these successful patients feel – both internally and in others," says Silverman. "I've let patients say," I'm so unhappy, if I could stay under the covers all day, I feel inadequate and I have to think about it clearly. I'm just about to burst into tears and I can not remember a time that I did not feel that way. Nevertheless, I get up every morning, go to work, I can give a presentation, negotiate and make a deal. So I can not really be depressed, "he continues. "They often lessen the seriousness of their own disorder."

According to Justine Mastin, a licensed therapist and owner of Blue Box Counseling in Minneapolis, people living with this kind of "hidden" depression can delay treatment. "Because others do not see their pain, they may receive implicit and explicit messages that they need to do only with what's happening because it's not that bad," she tells SELF. "I have heard stories from my clients who, when they reveal their suffering, are often not taken seriously, because they are able to do all they have to do. The internalized message states that the way they feel is not a concern and that help is unjustified.

However, because highly functioning depression is colloquial, this can be a less anxious way for a patient to identify or explain his condition or symptoms in a way that makes sense to him. "As a therapist who works primarily from a narrative therapeutic perspective, it is important to me to use the language of my clients," says Mastin. "So, if a client calls themselves 'high-functioning depression,' that's the language we use.

However, this is not a term she considers" clinically useful. "As with so many aspects of life the evaluation of a high-functioning depression on a person's external view and not on their inner experience. "

Just because the depression of a highly functioning depression is not clinically codified meaning does not mean that it is not relevant if it helps you To understand or communicate your symptoms, as was the case in my own experience.

I did not identify with the term diagnosed with severe depression until many years after I had received a formal diagnosis, and only after I became aware of it had informed about my diagnosis and treatment.

In my case, I had the impression that I had been deprived of non-medical professionals I had an impression that I could not be depressed because I was so "normal". In fact, I was more than well functioning – I was very efficient. I studied or passed exams or worked in a challenging career or ran my own business or ran marathons. I became engaged and pregnant and married and fulfilled all my adult responsibilities. In short, I did everything that healthy, happy people do – and then some. On the surface I won in life. I was someone to admire and to be proud of. But inside I had big problems.

It is the internal experience Mastin has pointed out that this is so important when it comes to getting help. "You should not get caught up in a definition or diagnosis," says Julie M. Bowen, senior psychotherapist at the Hope Therapy and Wellness Center in Springfield, Virginia, opposite SELF. "The treatment of depression looks similar across the board. Clinicians and physicians work with the individual to relieve the symptoms of depression through therapy and / or medication. The treatment is specific to the symptoms, not the diagnosis. They are not your diagnosis. Diagnosis is only part of who you are.

Recognizing this – and really believing what the hard part is – was a crucial part of my own recovery. Recognizing a well-functioning depression helped me because I had been burdened with an invisible disease for so long, struggling with guilt and insecurity about whether I actually deserved help.

At the same time, I am aware that the wording may be problematic for some people. But given its validity and how it relates or overlaps with more "official" diagnoses, it has helped me. Depression is never a one size fits all. I've learned that only I can understand my feelings and see when my personal baseline falls into the danger zone, and that labels in my daily life – whether officially recognized or not – are irrelevant.

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