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Do you know what your teen's smile really means?

Updated: Jan 27

Smiling depression is what’s known as an oxymoron—two words that don’t seem to make sense together. Unfortunately, smiling depression is real. It’s a form of depression in which a person appears to be happy and even thriving on the outside, while suffering on the inside. A teen with smiling depression may get good grades, do lots of extracurricular activities, and have a large circle of friends, all while hiding their true feelings even from those who are closest to them.

Smiling depression is especially dangerous because it’s more difficult to detect than other types of depression, so teens don’t get the support and treatment they need. In addition, people with smiling depression may be at higher risk of suicide. Because they’re accustomed to powering through the pain, they may have more energy and focus to make a suicide plan and follow through with the attempt.

What Is Smiling Depression?

Also known as walking depression or high-functioning depression, smiling depression has become a commonly used term over the last few years. However, it is not a recognized diagnosis and thus does not appear in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Experts believe that smiling depression may actually be a condition known as major depressive disorder with atypical symptoms, formerly known as atypical depression. While the symptoms are essentially the same as those of major depression, what makes them “atypical” is that they are experienced internally and not expressed in any visible way. Another confusing element of major depressive disorder with atypical symptoms is that individuals with this diagnosis can experience a lift in mood in response to positive events, enhancing the façade that they are “doing fine.”

While there are no smiling depression statistics as such, researchers estimate that between 15 and 40% of people with depression experience atypical symptoms. Smiling depression can also resemble the manic phase of bipolar disorder, or what’s called “bipolar disorder with mixed features.” With this condition, depressive symptoms manifest as manic behavior and increased energy.

Smiling Depression and Suicide Risk

The biggest danger of smiling depression is that it will go unnoticed and therefore untreated. Because smiling depression doesn’t fit the stereotypes most people have about depression, family members and close friends often fail to notice what’s going on. Teens can seem cheerful, optimistic, successful, and high energy even while living with depression that may be quite severe.

Sometimes even teens themselves may not realize they are depressed. For example, one study found that people from cultures that are less focused on individual emotional states were more likely to experience the physical symptoms of depression—such as fatigue, headaches, stomachaches, and lack of appetite—rather than the emotional ones. Therefore, they don’t recognize what’s happening to them.

Furthermore, while teens coping with depression often feel alone, smiling depression can leave teens even more isolated, because no one around them sees what they’re really going through. Without treatment, teens with this type of depression may have a higher likelihood of self-harm and death by suicide.

A Sad Person Acting Happy: How Teens With Smiling Depression Really Feel

While putting on a happy face for the world, teens with this disorder usually feel very different inside. They are exhausted by the effort of hiding their depression day in and day out, and constantly afraid of being discovered. In addition, they may experience any or all of the following depression symptoms:

  • Overwhelming sadness and hopelessness

  • Lack of self-confidence and self-worth

  • Anxiety

  • Mood swings

  • Difficulty concentrating and making decisions

  • Suicidal thoughts

  • Feeling “too fast” or “too slow”

  • Not taking pleasure from activities they used to enjoy, despite pretending to.

Teens with smiling depression become extremely good at hiding their symptoms. Therefore, parents may be more likely to identify some of the physical and behavioral signs as indicators of a problem:

  • Sleeping too much or too little, including long naps during the day

  • Significant changes in appetite or weight

  • A feeling of heaviness in the arms and legs

  • Body aches

  • Headaches

  • Irritability and restlessness

  • Substance abuse

  • Extreme reactions to what they see as criticism or rejection.

Why Teens Hide Behind a Smile

Teens with smiling depression often have a strong support system and resources, yet they are unable to open up about their struggles. This is particularly true if they belong to a culture that tends to stigmatize mental health issues, or are part of a family that puts high value on using willpower and self-reliance to get through hard times, rather than talking about it or asking for help. In these cases, teens may feel that struggling emotionally is a sign of weakness or a lack of personal character. This is particularly true of male adolescents, who are conditioned to be less open about their feelings.

In general, if a teen has shared what they’re feeling in the past and been told to “snap out of it” or “try harder,” it will be even harder for them to bring it up again. In addition, teens who are more likely to have smiling depression are often perfectionists, afraid of failure, and more easily embarrassed and humiliated. They have high expectations of themselves and don’t want to disappoint others’ expectations, or change the image that others have of them as a successful, positive person. They believe they just need to be “stronger” and “better” in order to get through it.

Moreover, if the family is dealing with financial issues, or another family member has physical or mental health problems, a teen may hide their depression because they’re worried about being an additional burden. (That may be one reason for a possible increase in smiling depression, along with other mental health issues) On the other hand, a depressed teen may feel guilty about suffering and “complaining” when their life is “fine” and other people “have it so much worse.” Or they may be in denial about the fact that they are living with depression.

Social Media and Smiling Depression

Social media, where teens are always “smiling”—showing images of their best, happiest selves—tends to create a disturbing dissonance between what someone is really feeling and the face they show to the world. Looking at other people’s carefully curated self-images can give teens the feeling that they have to appear just as positive and smiley in order to gain approval. And that idea can then translate to real life, opening the door to smiling depression and other psychological issues.

To interrogate the images of perfection that are so common on social media, Women’s Health and the National Alliance on Mental Illness did a reality check. They surveyed women about what they were feeling when they posted a happy selfie. About 20% of the women who responded admitted that they had shared photos and captions that depicted the opposite of their real feelings at that moment, because they didn’t feel safe sharing about their anxiety or depression.

On the flip side, there’s also a social media phenomenon known as "sadfishing" —displaying one’s emotional pain in social media posts in order to garner attention and sympathy. Sadfishing posts aren’t always authentic, any more than smiling ones are, but they serve as much more obvious warning signs that a teen may be suffering.

Recognizing and Treating Smiling Depression

Since signs of this type of depression are so subtle, it’s important for parents to maintain close communication and connection with teens even when they appear to be doing well. When parents encourage open conversation and listen to teens rather than judging them, their kids feel more comfortable being honest about their emotions. Moreover, teens need to hear that their parents won’t be disappointed in them if they aren’t “perfect,” and that having the courage to ask for help is a strength, not a flaw.

As with other types of teen depression, atypical depression requires a full assessment and professional care provided by clinicians who specialize in treating this age group. Ultimately, effective treatment for smiling depression involves helping a teen acknowledge what they’re experiencing and guiding them to process underlying trauma and attachment wounds. As they build self-compassion and resilience, teens come to realize that it’s okay to stop hiding and step into their true, authentic selves.

Article courtesy of Newport Healthcare.

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