By Rebecca Ogle, LCSW

What do you know about “high functioning depression”? Read on to find out what “high functioning depression” is, what makes the term outdated and inaccurate, and how to cope if you think you may have it.

What Does It Mean to Be “High Functioning”?

The terms “high functioning” and “low functioning” were originally used in the past to describe autistic and/or intellectually disabled folks.

Typically, when people describe themselves or a client as “high functioning,” they mean:

  • They can maintain full-time employment
  • They consistently manage activities of daily living (like eating regular meals, showering, drinking enough water, and remembering to take medications)
  • They regularly leave their home and socialize with others

“High Functioning Depression” is Persistent Depressive Disorder

“High Functioning Depression,” in clinical mental health terms is known as Persistent Depressive Disorder, formerly known as Dysthymia.

People diagnosed with Persistent Depressive Disorder may be going to work regularly, caring for themselves, and engaging in healthy relationships.

At the same time, they experience ongoing depressed mood, and at least 2 of the following symptoms:

  • Change in appetite
  • Insomnia (difficulties sleeping) or hypersomnia (sleeping too much)
  • Fatigue or lack of energy
  • Low self-esteem
  • Difficulty concentrating and/or making decisions
  • Hopelessness

What’s the Difference Between Persistent Depressive Disorder and Major Depressive Disorder?

Persistent Depressive Disorder is characterized by many of the same symptoms as Major Depressive Disorder. However, it’s chronic, occurring over the course of at least 2 years, as opposed to 2 weeks with Major Depressive Disorder.

Also, Persistent Depressive Disorder requires fewer symptoms to make a diagnosis than Major Depressive Disorder.

In order to be diagnosed with Major Depressive Disorder, someone’s symptoms need to “cause clinically significant distress in social, occupational, or other important areas of functioning.” But this same criteria is not needed to diagnose someone with Persistent Depressive Disorder.

This is where “high” and “low functioning” come in. In the simplest terms, “low functioning depression” is Major Depressive Disorder, whereas “high functioning depression” is Persistent Depressive Disorder. However, there’s more complexity and nuance to these phrases than meets the eye.

Causes and Risk Factors for Persistent Depressive Disorder

The causes and risk factors for persistent depressive disorder are complex and still being researched.

As outlined in our free eBook Understanding and Healing Trauma, over 50% of people who try to access mental health services have experienced trauma, defined by The American Psychological Association (APA) as “a person’s emotional response to an extremely negative (disturbing) event.”

Trauma can be a one-off traumatic event or it can occur over a prolonged period – this is now referred to as complex trauma.

Trauma can be a contributing factor to the development of depression, but not everyone who experiences trauma will necessarily go on to develop depression.

Researchers have observed physiological differences in the brains of people with Persistent Depressive Disorder and people who don’t have this diagnosis. However, correlation does not equal causation. It’s hard to prove that these physiological differences are the cause.

People are more likely to have Persistent Depressive Disorder if they have a family member with Persistent Depressive Disorder or Major Depression. Also, individuals with other mental health diagnoses may be at higher risk for developing Persistent Depressive if they have a family member with Persistent Depressive Disorder or Major Depression. Also, individuals with other mental health diagnoses may be at higher risk for developing Persistent Depressive Disorder.

People with certain personality traits, such as low self-esteem, may be more likely to have Persistent Depressive Disorder.

The Problem With “High Functioning” and “Low Functioning” Language

Some mental health clients, clinicians, and activists have criticized the terms “high functioning” and “low functioning” to describe people.

Separating people into categories of “high” or “low” functioning contributes to societal stigma. There are biases towards “low functioning” people that don’t exist about “high functioning” people. For example, about “low functioning” people as being lazy or unintelligent, neither of which is true.

If mental health or medical providers don’t regularly examine their biases, it could negatively impact mental health and medical treatment, particularly for “low functioning” clients.

Also, labeling people as “high” or “low functioning” implies that these are fixed identities. This isn’t the case. In a lifetime, it’s possible to have diagnoses of Major Depressive Disorder and Persistent Depressive Disorder. In other words, someone could be considered “high functioning” at some points in their life, and “low functioning” at other points.

This demonstrates how mental health is best understood as a spectrum that we all move along in our lives. The Wellness Society is critical of the current diagnostic approach to mental health and advocates for a spectrum-based framework for understanding human psychology.

Finally, it’s worth noting that the definition of “high functioning” from earlier in this post is not universally accepted.

In non-Western cultures and at other times in history, “low functioning” folks had artistic, spiritual, or other gifts that were considered equally important to performing a specific type of labor. Additionally, many cultures have expectations that communities will care for individuals, as opposed to all of the onus being on individuals to take care of themselves and their responsibilities.

How to Cope With High Functioning Depression?

A psychotherapist  will be able to assess your mental health and support you to develop coping skills for depression.

You may also want to seek out resources to help you cope, such as The Mental Wellbeing Toolkit.

Last, but not least, if you’re more comfortable with the term “High Functioning Depression,” than just depression, ask yourself why. It’s likely you have some internalized stigma related to depression. If so, that’s okay. You didn’t put the stigma there; society did. A therapist can help you work through internalized stigma as well.

Summary

  • “High Functioning Depression” in clinical mental health terms is Persistent Depressive Disorder.
  • Persistent Depressive Disorder is chronic, but requires fewer depressive symptoms for a diagnosis compared to Major Depressive Disorder, which is acute, short-term, and impacts at least 2 areas of functioning.
  • Labeling folks as “high functioning” and “low functioning” is misleading and stigmatizing.
  • Referring to specific strengths and challenges is more accurate and inclusive than using the terms “high functioning” or “low functioning”.
  • Folks with Persistent Depressive Disorder can benefit from psychotherapy as well as other self-help tools.

About Rebecca

Rebecca Ogle, LCSW, is a Licensed Clinical Social worker and therapist in Chicago, IL.

Rebecca provides therapy to people with anxiety, low self-esteem, and people pleasing tendencies. She uses a feminist and social justice lens, and interventions based in CBT, mindfulness, and motivational interviewing.

For helpful, free content, follow her on Instagram or go to her website

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