As already mentioned before, even though the term “high-functioning” isn’t officially used in diagnostic manuals, it typically describes someone who meets the criteria for PDD but still maintains outward functionality in daily life.
Here’s how it’s clinically diagnosed:
- Clinical interview with a mental health professional
The diagnosis begins with a thorough psychological assessment that usually involves:
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- A detailed history of symptoms (onset, duration, intensity).
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- Questions about mood, energy, sleep, self-esteem, concentration, appetite, etc.
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- Exploration of daily functioning and life stressors.
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- Discussion about medical history, medications, and substance use.
Professionals may use structured tools like:
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- PHQ-9 (Patient Health Questionnaire).
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- Beck Depression Inventory (BDI).
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- Or specific diagnostic interviews like the SCID-5.
- Meeting the DSM-5 criteria for persistent depressive disorder
The person must have the following to be diagnosed with PDD:
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- Have a depressed mood most of the day, for at least two years (for adults).
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- And experience at least two of the following symptoms:
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- Poor appetite or overeating.
- Poor appetite or overeating.
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- Insomnia or hypersomnia.
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- Low energy or fatigue.
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- Low self-esteem.
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- Poor concentration or difficulty making decisions.
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- Feelings of hopelessness.
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It should be noted that symptoms cannot be absent for more than two consecutive months during the two years.
I was diagnosed with dysthymia by my psychologist, although other mental healthcare professionals can be used to make an accurate analysis as well.
- Ruling out other causes
The clinician will also rule out:
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- Major depressive episodes (though PDD can co-occur with MDD, called “double depression”).
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- Bipolar disorder.
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- Substance-induced depression.
- Substance-induced depression.
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- Depression caused by a medical condition, like hypothyroidism.
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- Short-term adjustment reactions or grief.
- Assessing functionality vs. internal distress
Someone with high-functioning depression might appear “fine” externally due to managing work, parenting, or school, but feel constantly:
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- Unmotivated.
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- Numb or emotionally flat.
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- Self-critical or inadequate.
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- Disconnected or hopeless.
That internal emotional landscape is key to an accurate diagnosis, even if the person is still “performing well” outwardly.
I was still performing well at my job and in my social circle but felt emotionless and unmotivated on the inside, unbeknownst to others.