Masked depression: what it is, symptoms, causes and what to do

In many cases, physical pain such as headache, gastrointestinal upset, and back pain can have a psychological origin. These symptoms can actually be the somatization of a psychological disorder, such as depression.

Masked depression is one of the ways this disorder can presentThis is only in a way that seems to be the main physical problem. Apathy and sadness are hidden under the patient’s somatic complaints.

Below, we will learn more about what masked depression is, what are the somatic symptoms that may be related to it, and what is the explanation for it to manifest.

    What is Masked Depression?

    Our body is a true reflection of our mental state, and masked or somatomorphic depression is a clear example of the close relationship between body and mind.

    This type of depression is one in which the main symptom of which the victim complains is not of a psychological nature, such as deep sadness or great apathy, but physical. Her depression is suffocated by all the organic pains and discomfort she experiences every day and it is these physical symptoms for which she seeks a professional.

    The person suffers a lot psychologically, but finds it difficult to cope with and focuses on healing the physical issues that they complain about over and over again. It is estimated that almost 10% of people who come to primary health care centers to complain of physical pain are in fact suffering from depression and only half of these are properly diagnosed. The rest will go from doctor to doctor to see if they resolve their physical complaints, without much success, since, as we have indicated, the problem is not physical, but mental.

    People with somatomorphic depression put a lot of effort and money into finding out what is causing their physical discomfort.. Take any type of medication prescribed (or not) by your doctor, such as anti-inflammatory drugs, pain relievers, sleeping pills, or antacids in the hope that the symptoms will go away.

    But despite the administration of all kinds of pills, there is rarely an improvement, and the patient continues to turn to all kinds of professionals. As the pharmacological and other pathways have focused on resolving organ failure, many call masked depression “specialist frustration” because, as long as the psychological origin is not raised, the physical symptoms do not go away.


    As you might expect, the psychological symptom of masked depression is pathological apathy and sadness. However, the person does not seem to be aware of their psychological distress or the physical symptoms resulting from this disorder focus their attention.

    Physical symptoms still mask psychological distress and since organic pain and discomfort is often assumed to be easier to resolve, the person devotes all of his or her effort and resources to trying to resolve them.

    Among the most common physical symptoms of this type of depression, in which psychological distress is somatized by turning it into physical symptoms, we have:

    • headache
    • paresthesias
    • Back ache
    • fear of heights
    • heart trouble
    • anxiety
    • digestive problems
    • Fatigue, asthenia and fatigue
    • Loss of appetite
    • Loss of sexual desire
    • Sound issues
    • late insomnia

    Diagnostic problems

    Diagnosing this type of depression is complicated because, as we have said, the physical symptoms mask psychological distress. The person is in mental pain, however, focusing on their physical discomfort, in many cases, they do not even report to their doctor that they are deeply depressed. This is why, the patient not indicating his state of mind, the professional rarely considers the hypothesis that the physical discomfort of the person concerned is due to depression.

    Fortunately, many doctors consider the patient’s physical discomfort to be due to a psychological cause. This is especially raised when, after prescribing medication to the patient, no improvement has been seen. The problem is that even if the doctor assumes that there is psychological discomfort behind him that may explain it, the patient is reluctant to accept it. People who suffer from this disorder often do not connect with their feelings or emotions.

    In addition, we live in a society in which, despite a growing awareness of the importance of mental health, not everyone recognizes that they have a psychological problem. Physical symptoms, such as back pain or upset stomach, are less stigmatized than psychological problems such as depression or anxiety. This causes many people with depression to end up somatizing their psychological distress in the form of all kinds of physical discomfort.

      Masked depression in children and the elderly

      Masked depression it seems to be very common in boys and girls. Children don’t have enough language or assertiveness skills to indicate that they feel deeply sad and listless, so they can end up somatizing their psychological discomfort into all kinds of more obvious issues such as letting go. ‘hyperactivity, aggressive behavior, antisocial behavior and learning disabilities.

      Some depressed children show psychological discomfort primarily by complaining of an upset stomach or headache.. Many suspected cases of hyperactivity, bedwetting, changes in character, eating problems and behavior problems could have their origin in depression.

      Interestingly, depression is a barely recognized diagnosis in children. For much of the 20th century, it was thought that depression did not manifest in childhood. It was not until 1972 that it was verified that boys and girls could also suffer from this disorder, recognizing itself as a depression masked by psychiatrists Leon Cytryn and Donald H. McKnew. It is now accepted that boys and girls can exhibit both masked depression and the most obvious form of the disorder.

      Masked depression also occurs in older people, but it should not be due to difficulty recognizing that they have a psychological problem. In many cases, the physical symptoms of normal aging can be mistaken for the same physical symptoms that manifest as masked depression, make doctors treating the elderly consider that it is in fact only any pain attributed to age.

      However, that mindset should change. It has been claimed that between 15% and 20% of the elderly population suffers from some psychiatric disorder and, of course, among them could be depression. This masked depression, whether it is because the patient does not want to acknowledge his psychological distress or because his physical problems obscure his mental disorder, is very detrimental to the health of the patient and can hasten his death.

      The importance of diagnosis

      As we have seen, we live in a society where the physical is much less stigmatized than the psychological, with serious consequences when seeking help. People seek professional care for an upset stomach rather than depression, And he also has a hard time accepting that he may be suffering from a mental disorder. All he does is make the situation worse, make the help he needs longer to arrive, and even make his psychological distress chronic.

      Fortunately, the professional often sees the real cause of the patient’s physical discomfort and motivates them to seek psychological treatment. This is where we can emphasize the importance of diagnosis and treatment, as the treatment of underlying psychological problem will greatly improve the health of the patient. He will improve both physically and psychologically, acquiring strategies allowing him to manage his psychological discomfort and, consequently, acquire healthier habits.

      Understanding that not all physical problems have an organic origin is essential, because, as we have mentioned, 10% of patients who see their doctor may suffer from depression that would cause their physical discomfort. You must understand that an unhealthy mental state will negatively affect our physical health and that you cannot expect to be healthy just by playing sports or dieting. varied. The physical pain will never be cured if we do not heal the psychological pain sooner.

      Bibliographical references:

      • Ford CV (1992) Illness as a way of life. The role of somatization in medical practice. Spine 17: 338
      • Goic A (1991). Masked depression: the medical face of psychic depression. Tower. Med. Chile 119 (3): 321-326.
      • JJ López Ibor (1972). Masked depression. Brit. J. Psychiatry. 12: 120-245.

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