We all know a Type A person in our life who is an overachiever at work, the master chef at home, or the flexible yogi at the gym. Their facade is put together and accomplished, except they're not happy, they're depressed. This painful form of depression, known as "smiling depression", can be easily masked, and sometimes patients don't even realize they're sad.

Smiling depression is characterized by appearing happy on the outside, and keeping the pain on the inside. There is a stark contrast between how a person looks and how they feel. In a survey conducted by Women's Health and the National Alliance of Mental Illness (NAMI), 89 percent of 2,000 women who reported suffering from depression or anxiety also admitted to keeping their struggles hidden from friends, family, and coworkers.

Read More: Sitting Up Straight May Treat Depression Symptoms, Boost Happiness

Carrie Krawiec, a licensed marriage and family therapist at Birmingham Maple Clinic in Troy, Michigan and Executive Director of Michigan Association for Marriage and Family Therapy, says this disorder exemplifies how happy, put-together people who appear to have good relationships and friends can keep their inner turmoil hidden.

There has been a link between perfectionism and depression that is mediated by self-esteem. Previous research has found perfectionists are more prone to depression because they obtain their self-worth by being “perfect” for themselves and their peers. They often have high or unrealistic expectations for themselves.

A prime example of smiling depression is "a married, working person who is even educated that smiles, and perhaps even feels genuinely happy on occasion like a friend's wedding, but inside may feel empty, self-critical, insecure," Krawiec told Medical Daily.

These individuals are functioning well in life, and this makes them less likely to seek help, because they feel even more insecure or self critical that they are depressed when they "should feel happy" or "seem to have everything going for them." This only leads to further guilt and shame, which contributes to worsening of depression. Krawiec believes it's also dangerous since they function very well in life, and none of their confidants recognize they are depressed.

"[T]hese people would likely hide symptoms and true feelings from others feeling more and more isolated, which would contribute to more worthlessness and hopelessness, and without adequate help could lead to suicide," she said.

A common symptom of those suffering from smiling depression is the belief they're not good enough. They possess a poor self image, emptiness, emotional numbness, self critical behavior, high expectations for self/unmet expectations. This is also accompanied by traditional symptoms of depression, like lost or diminished interest in or pleasure from previously enjoyed activities, weight loss or weight gain, under sleeping or oversleeping, fatigue, worthlessness, guilt, difficulty concentrating, and thoughts of death or dying.

Read More: Mindfulness As Good For Depression As Talk Therapy For Many Psychiatric Symptoms

It can be difficult for smiling depression patients to admit they need to seek a therapist, but Krawiec insists it's urgent when someone is having thoughts of death, dying, or a preoccupation with suicide. In general, she recommends seeing a therapist if patients have one or several depression symptoms.

"If a person can learn to recognize the symptoms of depression and or develop tools to cope, especially when they are feeling well, they will be more likely to apply them to prevent or intervene when a more severe depression sets in," said Krawiec.

Acknowledging the existence of smiling depression can help patients, friends, and family cope together. Friends and family can help by providing understanding, and not trying to make the feelings go away. Krawiec emphasizes it's important to let them know they are loved, but also that they do not have to be perfect to be loved.

"Offer support to find a professional, but do not try to replace a professional," she said.

Meanwhile, Krawiec recommends those struggling with smiling depression to follow these seven coping strategies:

  1. Talk to a therapist.

  2. Talk to a psychiatrist.

  3. Learn techniques to replace negative/critical self talk.

  4. Learn to set reasonable expectations.

  5. Learn techniques for healthy self care.

  6. Learn techniques to seek out and communicate with natural supports like friends or family.

  7. Learn techniques to seek out healthy supports if none currently exist.

Currently, there are 14.8 million American adults in the U.S. who are affected by depression in a given year. However, up to 80 percent of those treated for depression show an improvement in their symptoms within four to six weeks of starting medication, psychotherapy, attending support groups or a combination of these treatments, according to the Depression and Bipolar Support Alliance. Those battling smiling depression should seek professional help to start getting proper treatment for their symptoms, and get better.

This brings patients a step closer to feeling whole and happy with themselves inside and out.

See Also:

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