People-pleasing may mask high-functioning depression risks

people-pleasing may – A New York City psychiatrist says chronic people-pleasing can increase the risk of “high-functioning depression,” a term used informally for people who appear successful while feeling hopelessness, irritability, and emptiness. She also warns that symptoms may

For a long stretch, it can feel like the job is simply to keep things moving—say yes, stay agreeable, absorb the extra requests. The problem is that people-pleasing can look like competence from the outside, even when someone is losing themselves on the inside.

Dr. Judith Joseph. a New York City-based psychiatrist and author of “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy. ” said chronic people-pleasing may increase the risk of high-functioning depression. an informal term for depression in people who appear outwardly put-together and successful while exhibiting symptoms like hopelessness. irritability. and emptiness. While the term isn’t an official diagnosis in the DSM-5—the primary diagnostic manual used by mental health clinicians—Joseph said it is sometimes used informally to describe people whose depression isn’t outwardly obvious.

Joseph pointed out a key difference between high-functioning depression and burnout. Burnout is typically tied to a specific stressor like work or caregiving. she said. but high-functioning depression doesn’t necessarily improve when someone changes jobs or takes a break from those responsibilities. “They still have the symptoms even though the environment’s gone,” Joseph told Business Insider.

In her Manhattan practice, Joseph said she sees many successful patients. On paper, everything looks great: they can complete daily responsibilities and may still get promoted at work. The gap is what happens underneath. “They just don’t know why none of it makes them feel good,” she said.

Joseph described a split between productivity that comes with engagement and productivity that is really a coping mechanism. “There’s a difference between someone who is productive and loving what they’re doing. versus someone who’s busying themselves. but it’s pathological productivity. ” she said. She added that achieving things “just to get through the day. ” rather than because they bring joy. may reflect anhedonia—a core symptom of depression marked by a loss of interest or pleasure in activities once enjoyed.

People-pleasers, Joseph said, may continue pushing through these symptoms because of low self-worth and a history of internalized shame. They often feel like they can’t pause, say no, or ask for help, and so they keep marching onward. “They have developed this personality and this identity tied to doing for others or showing up in a role. and they kind of lose who they are. ” Joseph said. She added that she sees this often with high-functioning folks. including an example she uses with patients: “I think of people who believe that they have to be the rock.” She told one story to make the point concrete—“I think of the nurse in the ER who hasn’t had a pee break but has made sure to empty everyone else’s Foley [catheter].”.

When left untreated, Joseph said high-functioning depression can slide into more recognizable patterns and also start showing up physically. One common outcome is a shift toward a more typical display of depression. where a person struggles to get out of bed or withdraws from loved ones. Others may begin to experience physical symptoms. “Their brain is still coasting, but their bodies physically break down,” Joseph said. She added that some end up in the ER with neurological symptoms or chest pain, dehydration, or physical exhaustion.

Joseph also said she has seen patients cope with the condition through habits that can become harmful—excessive drinking. drugs. or unhealthy behaviors like gambling. overspending. or endlessly scrolling on their phones. “They’re soothing in these ways because they don’t understand what’s happening,” she said.

The cycle can also leave people vulnerable at work and in relationships. Joseph said that because people-pleasers rarely put themselves first, they can often be taken advantage of. “People pick that up,” she added, and she emphasized that it isn’t always malicious. “It’s human nature for people to take what is constantly given.”.

The practical question then becomes how to stop the pattern. Joseph suggested that people with people-pleasing tendencies who can’t draw boundaries should dig into worst-case scenarios. She asked clients to test the idea in plain language: “What’s the worst thing that’ll happen if you don’t show up for this?. What if you don’t work on the weekends?. What if you don’t turn in that project because you’re really tired?”.

Joseph said that over time, setting clearer boundaries can change how others treat a person. “Over time, you get more comfortable with that exposure, and you see that nothing bad happened,” she said. “In fact. they respected you more. and they actually listened.” For many of her clients. she said. that becomes the turning point: “That is a game changer for a lot of my clients.”.

high-functioning depression people-pleasing Judith Joseph anhedonia DSM-5 burnout boundaries