Recognising & Supporting High Functioning Depression at Work

Something we have recently been discussing a lot in the HumanOS slack channel is a concept that, while not classified as a clinical condition, appears to be affecting a significant number of individuals in the workplace. Often, these individuals may not even recognise what they are going through because it doesn't align with the typical perceptions.

So what are we talking about? We are talking about "High Functioning Depression" a type of depression that occasionally gets overlooked by both healthcare professionals and individuals themselves. This occurs because it manifests outwardly, differently from the stereotypical image of depression. However, if left untreated and unacknowledged, it can have long-lasting lasting and harmful consequences on those who experience it.

We had a conversation with Olivia, one of our HumanOS Psychological Therapists, who shared her insight on High Functioning Depression (HFD). She explained that HFD is a type of depression where individuals may exhibit high levels of functionality, despite grappling with depressive symptoms. Detecting HFD can be quite challenging since there may be no obvious signs of distress; in fact, the outward appearance may suggest the opposite, making it particularly insidious. When someone is dealing with HFD, everything on the surface may seem perfectly normal. They efficiently seem to handle their daily responsibilities, excel at work, maintain a vibrant social life, and even stay active by partaking in activities like going to the gym. These behaviours create an illusion of well-being, concealing the inner struggles they are actually facing.

On the inside, it is a very different story. These individuals often harbour a deep self-critique, struggle with low self-worth, experience overwhelming emotions, find it challenging to open up to others, endure high levels of stress, grapple with a sense of directionlessness and a diminished capacity for enjoyment, battle with poor body image and other physical manifestations. Just like the hallmark symptoms associated with depression, such as persistent low mood, fatigue, brain fog, difficulty finding joy in once-beloved activities, changes in appetite, and sleep disturbances, HFD can encompass all of these challenges. The key distinction lies in their adeptness at concealing these inner struggles beneath a facade of outward normalcy.

As Olivia aptly puts it, "The paradox lies in the fact that individuals grappling with HFD often convince themselves that, since they can soldier on despite the symptoms, they can't 'truly be depressed”. There's a prevailing misconception that if their depression doesn't manifest in frequent tearfulness, emotional paralysis, or thoughts of self-harm, then they don't have a genuine issue, or that they can manage it on their own. HFD doesn't conform to the conventional narrative we associate with depression, which makes it challenging for both ourselves and those around us to recognise the extent of what we're going through and how detrimental it can be.”

HFD doesn’t have specific causes, it can be triggered by grief, stress, illness, hormones, major life transitions, or a general imbalance like poor diet and lack of exercise.

The danger lies in the tendency for individuals to conceal their true feelings, both from themselves and those around them, as this can exacerbate the situation. HFD can drive people to overextend themselves in specific aspects of their lives, resulting in a profound imbalance. It may not be immediately apparent that someone excelling at work and maintaining a busy social calendar is grappling with inner turmoil, but a closer look at their domestic life or their ability to maintain a well-rounded diet reveals their true struggles. The absence of a structured routine and control over even the most fundamental tasks can lead to overwhelming stress and eventual burnout. If left unaddressed, these symptoms can intensify and manifest physically, such as aches and pains throughout the body.

In Europe and North America, employees have reported the highest average depression scores, with 65% and 56% of workers, respectively, indicating symptoms ranging from mild to more severe depression (Aggarwal, 2023). Astonishingly, only 10% of employees are actively seeking mental health support (Pindar, 2022). It's important to note that HFD won't be reflected in these statistics as it lacks a formal clinical diagnosis or classification. Nevertheless, at HumanOS, in alignment with the stance of many leading Clinical Psychologists worldwide, we firmly believe that HFD warrants serious attention and consideration.

The prevalence of this issue in the workplace is primarily attributed to the characteristics of HFD individuals. They are often high achievers who overexert themselves in an attempt to suppress other emotions. These individuals may struggle with boundary-setting, displaying perfectionist tendencies, and being highly self-critical. Consequently, their work output is substantial and held to exceptionally high standards. As they swiftly advance in their careers, this results in heavier workloads and increased pressure. Furthermore, these individuals are typically hesitant to seek assistance, as they perceive it as a sign of vulnerability or weakness.

What do corporate organisations need to do to prevent and support individuals with HFD?

Providing support for individuals with HFD is crucial to prevent them from pushing themselves to the point of physical health issues and burnout. Indicators that someone may be grappling with HFD in the workplace can encompass diminished productivity, heightened difficulty in decision-making, increased self-criticism, reduced organisational skills, tardiness for meetings, and a pervasive sense of overwhelm. Other more subtle cues may be behavioural changes and attitudes toward others.

The most effective approach for companies is to cultivate a work environment that destigmatises mental health and promotes self-care. This is achieved most effectively through open and honest conversations.

Some specific things that can help employees struggling with HFD include:

• Encouraging staff to discuss wellbeing and mental health during 1:1s
• If you have concerns or have noticed changes in their personality or work bring it up with them, sometimes starting the conversation can be most helpful. Phrases like “I’ve noticed you’re struggling more to make decisions than usual. Is there anything going on that would be helpful to talk through so we can support you?”
• Creating a space to recognise achievements - people with HFD often worry they’re not doing a good enough job despite performing very well
• Sharing stories about when you’ve struggled mentally
• Offering flexible hours or hybrid-remote schedules or highlighting the importance of breaks
• What's your team culture like? Could your team be under the impression they’re always expected to be ‘on’, even outside of working hours?
• Signposting towards internal wellbeing offerings (such as occupational health) and external support services (such as Samaritans)
• Offering masterclasses and workshops to educate employees on relevant topics to help improve their awareness and understanding of signs and signals - allowing them to make more informed health decisions.

If you or someone you know is experiencing symptoms of depression, it is advisable to seek professional help. If you are on our HumanOS platform contact Olivia to speak further, or head to the Masterclass tab to watch our Stress Management Masterclass with Bianca here.

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Olivia, HumanOS Psychological Therapist & Bianca, HumanOS Co-Founder

Aggarwal, J. (2023). Employees across North America and Europe Are Struggling with Depression and Anxiety. Here’s When It Peaks, According to the Largest Study of Its Kind. [online] Fortune. Available at: https://fortune.com/2023/09/12/employees-america-europe-struggling-depression-anxiety-peaks-study-careers-work-jo-aggarwal/ [Accessed 2 Oct. 2023].

Pindar, J. (2022). Depression Statistics UK | 2022 Data. [online] Champion Health. Available at: https://championhealth.co.uk/insights/depression-statistics/#1.