How is high-functioning depression diagnosed?

High-functioning depression (often linked with persistent depressive disorder/PDD) is diagnosed using clinical criteria from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).

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:

  1. Clinical interview with a mental health professional
    A man listening to his psychologist.

The diagnosis begins with a thorough psychological assessment that usually involves:

    • A detailed history of symptoms (onset, duration, intensity).
    • Questions about mood, energy, sleep, self-esteem, concentration, appetite, etc.
    • Exploration of daily functioning and life stressors.
    • Discussion about medical history, medications, and substance use.

Professionals may use structured tools like:

    • PHQ-9 (Patient Health Questionnaire).
    • Beck Depression Inventory (BDI).
    • Or specific diagnostic interviews like the SCID-5.
  1. Meeting the DSM-5 criteria for persistent depressive disorder

The person must have the following to be diagnosed with PDD:

    • Have a depressed mood most of the day, for at least two years (for adults).
    • And experience at least two of the following symptoms:
      • Poor appetite or overeating.
        A man grabbing his stomach in pain from overeating.
      • Insomnia or hypersomnia.
      • Low energy or fatigue.
      • Low self-esteem.
      • Poor concentration or difficulty making decisions.
      • Feelings of hopelessness.

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 also be used to make an accurate analysis as well.

  1. Ruling out other causes

The clinician will also rule out:

    • Major depressive episodes (though PDD can co-occur with MDD, called “double depression”).
    • Bipolar disorder.
    • Substance-induced depression.
      A man looking sad while sitting on a white couch and drinking alcohol.
    • Depression caused by a medical condition, like hypothyroidism.
    • Short-term adjustment reactions or grief.
  1. Assessing functionality vs. internal distress

Someone with high-functioning depression might appear “fine” externally due to managing work, parenting, or school, but feel constantly:

    • Unmotivated.
    • Numb or emotionally flat.
    • Self-critical or inadequate.
    • 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.

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