Many families may be kids, teens and adults with depression or anxiety disorders being referred to as “high-functioning” As described in media outlets, social media and throughout communities, “high-functioning depression” or “high-functioning anxiety” describes an individual that can complete their daily tasks, appear put together or carry a positive attitude while struggling with anxiety or depression internally.
However, Baleska Alfaro, a licensed marriage and family therapist at CHOC’s Co-Occurring Clinic, warns that there are some problems with labeling kids or teens as having “high-functioning depression” or “high-functioning anxiety.”
Here, she debunks the myth of the term “high-functioning” when describing depression and anxiety, and how parents can help reduce stigmas surrounding mental health challenges.
Although the phrases “high-functioning anxiety” and “high-functioning depression” have gained popularity in recent years, neither is a clinical diagnosis. If fact, the term is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the manual that clinicians use to diagnose and explain mental health disorders to patients.
“’High-functioning’ is a colloquial term that can be misleading,” says Baleska. “I only use language that is in our DSM-5 to explain a diagnosis to patients so that they have a clear understanding of their mental health symptoms and so that the diagnosis is not misinterpreted by the patient, their family and/or friends.”
“High-functioning depression” is an unofficial term that is used to reference a child, teen or adult who experiences bouts of depressive symptoms that either do not or only mildly interrupt their day-to-day life.
Persistent depressive disorder, which some may define as chronic depression, is a milder type of depression that develops more gradually and may last for two years or longer. This type of mood disorder may be labeled as “high-functioning depression” informally by communities because its symptoms do not always appear to impede day-to-day functioning.
Similarly, kids, teens and adults who have mild anxiety symptoms, such as worried thoughts about the future and challenges controlling such worries, may be labeled as having “high-functioning anxiety” because they may be seen as thriving externally despite their internal challenges with managing their anxiety symptoms.
It’s common for depression and anxiety symptoms to change in intensity and/or frequency depending on many factors like external psychosocial stressors or the use of medications, says Baleska. Using a term like “high-functioning” can lead people to believe that their depression or anxiety cannot shift or change in intensity or frequency when it certainly can.
This colloquial term can also contribute to patients, families and communities believing that mental health conditions like anxiety or depression will not interfere with a person’s daily life because their condition is “high-functioning.” So, if a child or teen believes that they have “high-functioning anxiety or depression” and their symptoms begin to worsen, that belief may prevent them from seeking help or create shame about their sudden inability to carry out those day-to-day tasks they used to be able to do.
The term can perpetuate a false narrative that because the depressive disorder or anxiety is “high-functioning,” the symptoms are “not that bad” and do not warrant monitoring, says Baleska. It may also convince kids and teens that they do not need to or should not seek mental health services to cope.
In addition, labeling some kids and teens with depression or anxiety as “high-functioning” may be harmful to other kids that are struggling with the same disorders. They may feel like their peers who are “high-functioning” have more power over their symptoms than them, which can perpetuate a harmful stigma around mental health.
The DSM-5 recognizes the following depressive disorders. Each has varying symptoms with variable intensity and frequency of said symptoms:
If a child or teen is depressed, parents may notice the following symptoms:
View CHOC’s ultimate guide for articles, helpful resources and frequently asked questions about depression.
The DSM-5 recognizes the following anxiety disorders. Similar to depressive disorders, each anxiety disorder has varying symptoms that may fluctuate in severity overtime:
Children or teens with anxiety disorders may experience different symptoms than adults would. Unlike adults with anxiety, children and teens often don’t realize that their anxiety is more intense than the situation calls for.
Symptoms may be a bit different for each child. But the most common symptoms of anxiety are:
The symptoms of anxiety may seem like other health problems. Make sure your child sees their healthcare provider for a diagnosis.
View CHOC’s ultimate guide for articles, helpful resources and frequently asked questions about anxiety.
Parents can have an enormous impact in reducing the stigma surrounding mental health by dismantling myths and providing factual information about mental health conditions to their children. To do this, it’s important for parents to be informed with accurate, reliable information from professionals. They can seek advice from resources like National Alliance on Mental Illness (NAMI), Substance Abuse and Mental Health Services Administration (SAMHSA), Orange County Health Care Agency or CHOC mental health education and services.
Once parents are equipped with accurate information, they can talk to their kids about mental health conditions and how they may impact their life or the lives of others. Parents should be open and honest, using respectful language about mental health disorders and people who have them. They should explain to their kids that symptoms of mental health disorders can ebb and flow, and explain why terms like “high-functioning” can be harmful.
Learn more about reducing mental health stigmas from CHOC experts. A CHOC pediatric neuropsychologist offers 5 practical ways to help reduce stigma around mental illness and a CHOC pediatric psychologist helps parents understand the role of cultural stigma on seeking mental health services.
If you think your teen might be depressed or have anxiety:
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