High-Functioning Depression & Anxiety: Appearing “Fine” While Struggling Inside

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At a glance

  • You can look successful and “together” yet feel persistently low, exhausted, anxious, or overwhelmed.
  • “High-functioning depression” isn’t a DSM-5-TR diagnosis; many presentations overlap with Persistent Depressive Disorder (PDD) and Major Depressive Disorder (MDD). (American Psychiatric Association, National Institute of Mental Health)
  • It’s often missed—especially in perfectionists, high achievers, carers, leaders, and students—because coping and masking are part of the picture. (PubMed, PLOS, NCBI)
  • Early, evidence-based support (counselling/psychotherapy, CBT-based approaches, GP care; sometimes medication) is effective. Hypnotherapy can be a useful adjunct for some people. (NICE, World Health Organization, NCBI, PubMed, ScienceDirect)

What High-Functioning Depression & Anxiety can look like

You might be outwardly sociable, productive and reliable—and still be dealing with:

  • Low mood most days; brief “highs” that quickly fade

  • Constant tiredness, even when you’ve slept

  • Insomnia or disrupted sleep – a known risk factor for worsening mood  (PMC)

  • Relentless self-criticism; difficulty accepting praise

  • Impostor feelings despite clear achievements (NCBI)

  • Irritability, guilt, or emotional numbness

  • Doing everything on your list, but at significant inner cost

  • Withdrawing from genuine support while keeping the “mask” on at work or home

Important to note regarding terminology: “High-functioning depression” is a popular phrase, not a clinical diagnosis. Clinically, presentations often map to Persistent Depressive Disorder (PDD)—long-lasting low mood with additional symptoms—or to MDD. A GP/clinician can assess properly. (American Psychiatric Association, National Institute of Mental Health)

Why it’s so often missed

  • Perfectionism & over-achievement. Strong links exist between perfectionistic traits and depressive symptoms. (PubMed, PMC)
  • Workaholism & overworking. Overwork correlates with higher anxiety/depression. (PLOS, PMC)
  • Sleep problems. Insomnia doubles the future risk of depression; addressing sleep helps. (PubMed, PMC)
  • Impostor phenomenon. Feeling like a fraud is associated with higher depression and stress. (NCBI, BioMed Central)

Causes and risk factors. Multi factors, that are not your fault

Depression arises from a mix of biology, psychology and environment. Family history, medical conditions, for example, thyroid issues, as well as chronic stress, adverse life events, and neurochemical factors can all contribute. Your GP may check physical causes and discuss options. (World Health Organization, National Institute of Mental Health, HSE.ie)

Unhealthy coping strategies, and why they backfire

Coping simply means “how we deal with stressors.” Some strategies bring relief short-term but carry long-term costs. Research calls these maladaptive or avoidant strategies. (PubMed, PMC)

Common examples include:

  • Alcohol or drug overuse; reliance on painkillers or sedatives (HSE.ie)
  • Vaping or nicotine dependence; heavy caffeine/energy drinks
  • Emotional eating, bingeing, or restrictive cycles (BioMed Central)
  • Compulsive overworking; “busy-ness” as avoidance (PLOS)
  • Doom-scrolling; gaming or online shopping to numb out
  • Isolation, procrastination, or “people-pleasing” to avoid conflict
  • Rumination (mentally replaying worries) and harsh self-talk (PMC)

Healthier, evidence-based alternatives—gradual activity scheduling, CBT-style thought tools, problem-solving, sleep-supportive routines, social connection, and structured goal-setting—are teachable and practical. (NCBI)

Where Hypnotherapy sits in evidence-based care

First-line support for adults with depression includes psychological therapies (for example, CBT-informed approaches) and, where appropriate, medication—planned with your GP/psychiatrist. (NICE)

What about Hypnotherapy?

  • One rigorous randomised trial found clinical hypnotherapy was not inferior to CBT for mild–moderate major depression over 16–20 sessions. (PubMed)
  • Broader reviews suggest promising effects of hypnosis across mental and physical outcomes, and potentially useful roles alongside other therapies—but the depression-specific evidence base is still developing and mixed. (Frontiers, ScienceDirect)
  • Hypnosis can support deep relaxation, focus, and behavioural change, and may help with sleep—an important lever in mood recovery. Evidence for insomnia is encouraging but methodologically variable. (PMC)

Bottom line: Hypnotherapy can be a valuable adjunct to counselling/psychotherapy and medical care. Many clients like its practical, skills-based nature and the way it complements CBT-style work and nutritional strategies.

How I work with high-functioning presentations

I integrate Counselling & Psychotherapy, Clinical Medical Hypnotherapy, Hypnosis, and Rapid Transformational Therapy (RTT) with a Functional Medicine perspective as a Registered Nutritionist. Together we will:

  • Map your unique symptom pattern (Mood, Anxiety, Sleep, Energy, Focus)

  • Unpick perfectionism, impostor feelings, emotions and overworking tendencies with practical tools

  • Rebuild sleep and daily structure (small, sustainable steps)

  • Use targeted hypnotherapy to rehearse better coping, reduce rumination, and support behaviour change

  • Address nutrition, stress-physiology supports, and relapse-prevention plans

All sessions are available ONLINE and in-person in Adare, Newcastle West, Abbeyfeale, Midleton, Youghal, Cork and Dungarvan.

Gentle safety reminder within Ireland

If you’re feeling unsafe or having thoughts of self-harm:

Book a Consultation Today

Confidential, evidence-based support for High Functioning Depression and Anxiety.
Online or in-person private rooms  in Adare, Newcastle West Limerick  Abbeyfeale, Charleville, Fermoy, Midleton, Youghal, East Cork, CORK city, Dungarvan.

Telephone or text message Claire to discuss

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References and guideline sources

  1. American Psychiatric Association. Persistent Depressive Disorder (DSM-5-TR). https://www.psychiatry.org/getmedia/fd3dfaad-d409-4e94-8605-0350adec5b91/APA-DSM5TR-PersistentDepressive.pdf (American Psychiatric Association)
  2. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management (NG222). https://www.nice.org.uk/guidance/ng222 (NICE)
  3. National Institute of Mental Health (NIMH). Depression—Health Topic. https://www.nimh.nih.gov/health/topics/depression (National Institute of Mental Health)
  4. National Institute of Mental Health (NIMH). Persistent Depressive Disorder (Dysthymic Disorder). https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder (National Institute of Mental Health)
  5. World Health Organization. Depressive disorder (depression) — Fact sheet. https://www.who.int/news-room/fact-sheets/detail/depression (World Health Organization)
  6. HSE Ireland. Clinical depression: symptoms. https://www2.hse.ie/conditions/clinical-depression/ (HSE.ie)
  7. HSE Ireland. Clinical depression: diagnosis. https://www2.hse.ie/conditions/clinical-depression/diagnosis/ (HSE.ie)
  8. HSE Ireland. Clinical depression: treatment. https://www2.hse.ie/conditions/clinical-depression/treatment/ (HSE.ie)
  9. Samaritans. Contact a Samaritan (includes 116 123). https://www.samaritans.org/how-we-can-help/contact-samaritan/ (Samaritans)
  10. Limburg K, et al. Perfectionism and psychopathology: meta-analysis. https://pubmed.ncbi.nlm.nih.gov/28026869/ (PubMed)
  11. Andreassen CS, et al. Workaholism and mental health (PLOS One). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152978 (PLOS)
  12. Andersen FB, et al. Prevalence of workaholism: systematic review/meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC10643257/ (PMC)
  13. Baglioni C, et al. Insomnia predicts depression: meta-analysis. https://pubmed.ncbi.nlm.nih.gov/21300408/ (PubMed)
  14. Li L, et al. Insomnia & risk of depression: meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC5097837/ (PMC)
  15. Huecker MR, et al. Imposter Phenomenon (StatPearls). https://www.ncbi.nlm.nih.gov/books/NBK585058/ (NCBI)
  16. El-Ashry AM, et al. Imposter syndrome & depression/anxiety in nursing students. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-02414-w (BioMed Central)
  17. Thompson RJ, et al. Maladaptive vs adaptive coping & depressive symptoms. https://pmc.ncbi.nlm.nih.gov/articles/PMC2872051/ (PMC)
  18. Holahan CJ, et al. Avoidance coping and stress generation in depression. https://pmc.ncbi.nlm.nih.gov/articles/PMC3035563/ (PMC)
  19. Konttinen H, et al. Depression, emotional eating & long-term weight changes. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0791-8 (BioMed Central)
  20. Chand SP, et al. Cognitive Behaviour Therapy (overview). https://www.ncbi.nlm.nih.gov/books/NBK470241/ (NCBI)
  21. Fuhr K, et al. Hypnotherapy non-inferior to CBT in MDD (RCT). https://pubmed.ncbi.nlm.nih.gov/33725616/ (PubMed)
  22. Souza FL, et al. Hypnosis for depression—systematic review/meta-analysis (2024). https://www.sciencedirect.com/science/article/abs/pii/S1744388124000860 (ScienceDirect)
  23. Rosendahl J, et al. Meta-analytic evidence on hypnosis across outcomes (2024). https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1330238/full (Frontiers)
  24. Chamine I, et al. Hypnosis intervention effects on sleep outcomes. https://pmc.ncbi.nlm.nih.gov/articles/PMC5786848/ (PMC)
  25. HSE Ireland. Alcohol and mental health (resources/helpline). https://www2.hse.ie/living-well/alcohol/ (HSE.ie)

Ready to take the next step?

I offer ONLINE sessions and in-person appointments (one to one) in my private rooms in Adare, Newcastle West, Abbeyfeale, Midleton, Youghal, Cork and Dungarvan.
Discreet, evidence-based help that is tailored to your individual needs and your personal goals.

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