Perfectly Hidden Depression with Dr. Margaret Rutherford

In this episode, we talk to Dr. Margaret Rutherford about perfectly hidden depression, destructive perfectionism and self acceptance.

dr. margaret rutherford headshot
January 18th, 2022

Episode Notes

Memorable Moments:

  • 5:49 But there’s a thing called destructive perfectionism, which is all about accomplishment, task, task orientation. You constantly have to meet the expectations of others around you. And I mean, all expectations. 
  • 6:13 That kind of perfectionism actually can be a camouflage for emotional pain that actually you may have suppressed that pain for so long that you’re not even conscious of it anymore. 
  • 11:56 If you’re aware that when perfectionism is present, when some of these, what I call the 10 traits of perfectly hidden depression, when those things are present, it’s a syndrome of behaviors and beliefs that [hang] together.
  • 13:07 People with high functioning depression know they’re depressed. They know they’re depressed. They’re in treatment, they’re on medication. They make sure they get lots of exercise, so they don’t get sad. They have seasonal affective disorder. They’ve learned how to cope. They’re not so depressed that they can’t get to work or take care of their kids. But this is different. 
  • 13:30 This is truly something that is…camouflage. You know, it’s something you, you strap on every day and you really don’t do it consciously. It’s just who you have become. And the wonderful, incredible work that these people can do in therapy when they begin to let down that camouflage, it is amazing and it takes a lot of courage.  
  • 15:54 To convince someone that their thinness is really about an eating disorder is very difficult because that eating disorder has become their best friend. Perfectionism is very much the same way. 
  • 18:03 It is hard to admit that something you counted on as much as, you know, you being the person who’s always the go-to, who always gets things done. And to begin to shift that thinking into something that’s a little more human is hard. And so it takes a lot of honesty with yourself. 
  • 20:14 There could have been something that was in their family environment, in their cultural environment that caused them to adapt this way. And the very thing that helped them live through that and survive that is the thing that now has grown into this. And it’s become their task master. 
  • 23:26 You really want to look at the absolutes in your life, the rules you’re following: the musts, the shoulds, the have tos, the aughts, the nevers and begin to say, well, which one of these does still work for me, but which does not? 
  • 23:51 There’s that work that’s more cognitive behavioral and then there’s the work of really going back and looking at your childhood, the family, the culture, the region, whatever, the country, and to see how the events of your life, both good and beneficial and painful and harmful, began to form patterns in your behavior. Going back and acknowledging with compassion.
  • 23:53 What is it that was hard for me and that I began covering up by just being highly achieving and caring about others and focusing on others, not on myself and counting my blessings to the point where it’s toxic? You know, there’s a toxic positivity that’s out there. 
  • 25:54 These steps, they’re hard because it really does turn some of what you believe upside down. But I have had people say to me, I, I feel so much more free than I did before. 
  • 26:00 To me, self-acceptance is really claiming that your strengths nor your vulnerabilities define you, that they both exist and they are facts about your life. And neither one of them define you. I think that’s where people, in fact, I say in the book, self acceptance is the antidote to perfectly hidden depression. 
  • 27:17 During the pandemic people have used the strategy that has best worked for them [in the past] as their lives have gotten more and more ambiguous, more out of control, financial issues, obviously health issues, fear for your children, fear for your parents or grandparents, you know, our environment. I mean, it’s just been chaos. 

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This podcast is hosted by Allison Walsh and Dr. Angela Phillips. It is produced by Allison Walsh, Ashley Tate, and Nicole LaNeve. For more information or if you’re interested in being a guest on this podcast, please visit

Show Contributors

Dr. Margaret Rutherford

Dr. Margaret Rutherford, a clinical psychologist, has practiced for twenty-eight years in Fayetteville, Arkansas. After winning an Arkansas Psychological Association award in 2009 for her community volunteering, she began blogging in 2012, and podcasting in 2016, extending the walls of her practice so that the general public could hear more about what therapy has to offer. Her writing can be found at, as well as Psychology Today, Psych Central, Psyche,  the Gottman Blog and others. She hosts a highly popular podcast, The SelfWork Podcast, which is consistently ranked in the top 50 of US mental health podcasts, and a monthly FBLive presentation for The Mighty. Her new book Perfectly Hidden Depression (New Harbinger, 2019) focuses a much-needed light on the dangerous link between destructive perfectionism and depression.