How to Break Free from The Perfectionism that Masks Your Depression—with Dr Margaret Rutherford | BlissTalk Podcast

Is Your Drive for Excellence a Wtrength—or a Mask?

 In this powerful conversation, Blisspot Founder & CEO Deborah Tyson sits down with psychologist, author, and SelfWork podcast host Dr. Margaret Rutherford to explore Perfectly Hidden Depression—when high-achieving, “together” lives quietly camouflage emotional pain. Dr. Margaret unpacks the crucial difference between constructive and destructive perfectionism, why rates of perfectionism track with suicidal ideation, and how shifting from “vulnerability” to emotional transparency gives us back a sense of choice and safety.

Drawing on decades of clinical practice, personal stories, and her bestselling book, Dr. Margaret shares practical ways to widen your emotional range, release shame that isn’t yours to carry, and build self-acceptance: recognizing that neither your strengths nor your struggles fully define you.

In this episode, you’ll learn:

• The 2 types of perfectionism—and how to tell which one is driving you
• How “perfect” identities form and why they often feel so lonely
• The link between rising perfectionism and suicidal thinking (and what to watch for)
• Why “emotional transparency” can be safer and more empowering than “vulnerability”
• The 10 traits of Perfectly Hidden Depression (and how to start unmasking them)
• A practical definition of self-acceptance you can use today

Resources & links:

• SelfWork Podcast: https://learn.blisspot.com/courses/selfwork-podcasts
• Book: Perfectly Hidden Depression: How to Break Free from Perfectionism That Masks Your Depression
• Website: drmargaretrutherford.com
• Email: askdrmargaret@drmargaretrutherford.com
  
  

If you’re struggling, please reach out to a qualified mental health professional in your area. You don’t have to do this alone.

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Transcript

Deborah Tyson (Blisspot Founder & CEO):
Welcome, everybody. I’m absolutely delighted to be here on our BlissTalk podcast with an incredible expert joining us all the way from Arkansas in the USA: Dr. Margaret Rutherford. Dr. Margaret has worked as a psychologist in private practice for over 30 years and brings a wealth of experience. She began writing online in 2012 and later launched the hugely successful SelfWork podcast. She’s also a TEDx speaker on recognizing “Perfectly Hidden Depression,” and that talk has had almost two million views — which really shows the need for education in this area.

Dr. Rutherford is the author of Perfectly Hidden Depression: How to Break Free from Perfectionism That Masks Your Depression. She’s written for HuffPost, Psychology Today, The Mighty, Psych Central, The Gottman Blog, Psychologies, Stigma Fighters, The Good Men Project, and This Is My Brave. She’s also a Blisspot expert, where she shares her SelfWork podcast.

She’s passionate about helping people become more comfortable with vulnerability in everyday life and confronting the prejudice against both mental illness and its treatment. I’m absolutely delighted to talk with Dr. Margaret today. Fun fact: we share the same birthday and have been married for the same number of years — which we won’t go into! Dr. Margaret, I’ll hand over to you to share a little about your work.

Dr. Margaret Rutherford:
Thank you, Deborah — and it’s delightful to be back with Blisspot. I’ve been a psychologist for over 30 years. I never thought I’d write a book or host a podcast — I’m actually quite introverted — but in 2014 I wrote a blog post about people who came into my office adamant they weren’t depressed. They’d smile, appear self-assured, and say things like, “I don’t know why I’m here; I just can’t make decisions,” or “I’m anxious all the time.” I titled it “The Perfectly Hidden Depressed Person — Are You One?” It went viral. HuffPost featured it, and within two days I had hundreds of emails from around the world: “How do you know this? It’s like you’re in my head.”

I dove deeper, discovering Dr. Brené Brown’s work on perfectionism, shame, and vulnerability. As a researcher, she stops where the data stop — ethically so — but I saw a missing link: the relationship between destructive perfectionism that camouflages emotional pain and suicidal thinking. Research over the years has shown that as perfectionism rises worldwide, suicidal ideation and deaths by suicide also rise. Not everyone who dies by suicide is a perfectionist, of course, but in its most severe forms, perfectionism is highly correlated with suicidal thoughts.

I felt a book needed to exist that didn’t yet exist. I interviewed over 60 volunteers — perfect strangers who trusted a therapist from Arkansas — about the “camouflage” of a perfect-seeming life and the loneliness beneath it. I learned so much from them. Through a bit of serendipity I found an agent, New Harbinger acquired the book, and Perfectly Hidden Depression was published in 2019. It’s now been translated into 15–16 languages — from Korean to Persian, Dutch, and Polish. The pandemic in 2020 pulled the rug out a bit for 2019 books, but I remain passionate about the subject. I teach clinicians how to recognize this pattern of perfectionism and the masked depression underneath it, and I love speaking to anyone who might be hiding behind a perfect-seeming life — chasing more and more accomplishments while denying painful feelings.

Deborah Tyson:
It’s obvious your work struck a chord. How wonderful that you’ve been able to meet that need with insights that help people find a more life-enhancing path toward their goals.

Dr. Margaret Rutherford:
Thank you. One thing many listeners may notice: we tend to think of perfectionism as anxiety-related, not depression-related. Most perfectionistic people even see it as a strength — “I get promotions and praise because I’m reliable.” That identity can look enviable from the outside, but the inner cost is often hidden.

Deborah Tyson:
Exactly — perfectly hidden! I’d love to ask about balance. Some perfectionism can drive great quality — I once read that Giorgio Armani personally checked every hem and seam before shows. That pursuit of excellence can elevate a brand. But perfectionism can also become a harsh inner voice pushing “more, more, more.” How do we find the healthy balance?

Dr. Margaret Rutherford:
Great question. I think of two kinds of perfectionism:

Constructive perfectionism is driven by values like conscientiousness, generosity, creativity, and curiosity. You accept mistakes, you’re guided by what you value, and you pursue excellence without self-attack.

Destructive perfectionism is fueled by shame and fear — often rooted in childhood or young adulthood. A former patient I’ll call Steve retired after a high-status role and began drinking in the afternoons, gained weight, and felt he was “falling apart.” As we explored his past, he recalled a mother who would throw rocks at him in the yard and scream he’d “never amount to anything.” His career had provided constant affirmation that drowned out unhealed shame. Without it, those emotions returned. In destructive perfectionism, accomplishment becomes a shield against feeling unworthy. You must keep achieving just to feel safe or valuable.

Deborah Tyson:
That’s a powerful distinction — and awareness is everything. We can ask: “Is my drive coming from values I love, or from fear that I’m not enough?” Healing the past helps us develop a supportive inner voice instead of a punishing one.

Dr. Margaret Rutherford:
Exactly. My own mother developed a prescription drug addiction trying to be the perfect 1950s wife — perfectly thin, social, and composed. I never saw her cry. She was kind and respected, but never happy, and never sought help for the shame she carried. People often ask if I wrote the book about myself. I was fortunate to get good therapy — but witnessing my mother’s struggle shaped me.

Deborah Tyson:
I can relate — many women of that generation felt intense pressure to be “perfect,” and I felt that pressure earlier in my life, too. Therapy helped me redirect my drive from fear to passion.

Dr. Margaret Rutherford:
Younger generations are also grappling with this. Many Gen Zers feel they must “adult” perfectly. Some were intensely planned and scheduled from a young age; their guardrails became search engines — “I can Google anything” — and there’s little tolerance for mistakes. A heartbreaking example is told in What Made Maddie Run? Her social media looked joyful, but the inner pressure was immense. Across generations, perfectionism shows up differently, but it’s widespread.

Deborah Tyson:
I’ve seen that here in Australia too — parents mapping out the “right” school and path from age five. It’s a lot for kids to carry; they need space to discover who they are.

Dr. Margaret Rutherford:
Yes — it’s rampant. Which brings us to vulnerability. I’ve learned that the word “vulnerability” can feel like a one-down, unsafe position for some people, so I often use emotional transparency instead. Transparency emphasizes choice: I can choose when, where, and with whom to be open. That sense of agency matters, especially if you didn’t grow up in an emotionally safe environment.

Deborah Tyson:
I love that. People feel trapped when they don’t have choice. Emotional transparency in safe spaces — like therapy — is powerful.

Dr. Margaret Rutherford:
Many people say early in therapy, “I feel worse than when I started.” My response: “Good — it’s working.” We’re uncovering what’s real. We just need to pace it so insights can be absorbed. Some clients are shocked to realize that what happened at five can affect them at 35 or 55.

I’ve also encouraged people to “practice transparency.” One construction worker told me, “Doc, you won’t believe it — at 6:30 this morning, a coworker and I were talking about our depression.” Women who risked being more real on girls’ weekends discovered everyone had struggles — and their group chats shifted from celebrity news to genuine support.

For years I, too, carried shame — for example, about having two divorces before my current marriage. I wasn’t lying, but I wasn’t open either. One day a client sat on my sofa, sobbing about her second divorce, and said, “I know you wouldn’t understand.” In that moment, I chose to stop hiding. I told her she was joining a club I’d been in for years. I decided I was tired of the pressure of “What if someone finds out?”

Shame often doesn’t belong to us — especially for those who experienced abuse. Perpetrators frequently convince children it’s their fault. There’s real freedom in putting shame back where it belongs.

In the book I outline 10 traits of Perfectly Hidden Depression — beliefs and behaviors like always being the most responsible, never letting others in, and toxic positivity (“if I’m not grateful, I’m doing it wrong”). These traits maintain the camouflage.

I still have shame-tinged memories pop up — say, while driving — of times I embarrassed myself. I ask, “Will feeling shame help me be a better person today?” Ninety percent of the time the answer is no. Then I say, “Thanks for sharing, mind, but I’m not focusing on that today.”

I’m also finishing a workbook to accompany Perfectly Hidden Depression. My current working definition of self-acceptance is this: recognizing that neither your vulnerabilities nor your strengths completely define you — and vice versa. You are an “and.” You can admit, reveal, laugh about, or cry about vulnerabilities, and also claim your strengths.

Deborah Tyson:
Beautiful — holistic and authentic. It makes me think of emotional range. If we shut down feelings like anger, shame, or sadness, do we also dull our capacity for joy and love?

Dr. Margaret Rutherford:
Research suggests yes. If you cut off one end of the spectrum, the other end narrows too. Some people prefer to stay in their heads — that’s fine — but balance matters. I recall, tragically, losing a patient to suicide years ago. Seeking support, I visited a colleague who, in response to my sobbing, said, “Wow, you’re really feeling this.” I felt she couldn’t access or validate the depth of that emotion; it didn’t feel safe to me. Everyone needs spaces — and people — who can meet them emotionally.

Deborah Tyson:
Exactly. We’ve become desensitized in some ways — even accepting extreme on-screen violence as entertainment. Feeling fully is human.

What would you tell your younger self — or a young woman starting adult life — about perfectionism?

Dr. Margaret Rutherford:
Social media bombards us with “how to be perfect.” The problem isn’t striving; it’s that in perfectionism you never feel good enough. If you’re constantly chasing affirmation that you’re “the best,” ask: Where is this coming from? What am I trying to hide or heal?

There’s no perfect identity, and perfectionism hands your power to other people’s reactions — which you can’t control. Retain your power by returning to values-driven excellence. A researcher I admire, Dr. Gordon Flett, likens destructive perfectionism to running on a treadmill where you don’t control the speed or incline — you just keep running without knowing where you’re going.

A former client returned as a mum and said she was being pulled into an app that scripts the “perfect mother” from morning to night — as if a child were a machine. You could run on that treadmill for years. She said, “I want off,” and we worked on that.

Deborah Tyson:
That’s the line between helpful information and harmful pressure. This topic can be incredibly serious — even linked to suicide — so please seek support if you’re struggling. Dr. Margaret, do you still offer one-to-one sessions?

Dr. Margaret Rutherford:
I used to more. I have a PSYPACT license in the U.S., but with speaking, podcasting, and writing, I’ve reduced my practice. Even so, there are excellent therapists worldwide who can help.

Deborah Tyson:
Yes — reach out. I’ve been on a therapy journey myself and still seek support when I need it. We don’t have to do it alone. And remember: Dr. Margaret’s book and the SelfWork podcast are wonderful resources — and the podcast is also available on Blisspot.

Dr. Margaret Rutherford:
The SelfWork podcast is free, and we’re around our 458th episode — lots of practical advice there.

Deborah Tyson:
Fantastic. Any final thoughts?

Dr. Margaret Rutherford:
Thank you for having me. If you’d like to get in touch, my email is askdrmargaret@drmargaretrutherford.com
, and my website is drmargaretrutherford.com. You can also record a question for the podcast right on the site — I answer listener questions regularly. I’d love to hear from you.

Deborah Tyson:
Beautiful — we’ll include those links with the podcast. Dr. Margaret, it’s always a pleasure. I get so much from our conversations, and it’s an honor to share your work with a wider audience. Thank you for your time today.

Dr. Margaret Rutherford:
Same here — thank you, Deborah.

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