Depressive Disorder in Highly Gifted Adolescents

By P. Susan Jackson and Jean Peterson.

SENG strives to provide the most accurate information in our library, and as a result, it is occasionally necessary to provide further clarification regarding previously published articles. Please note that, in the second paragraph of the article below, the authors refer to scores obtained on the Wechsler Intelligence Scale for Children – Third Edition (WISC-III) when discussing levels of giftedness. The authors inaccurately mention classifications of WISC-III scores above 160 or 180. While those classifications (exceptionally gifted and profoundly gifted) are used to refer to children with IQ scores in those ranges, please note that the highest possible score that can be obtained on the WISC-III is 160. Scores above 160 or 180 must be obtained by using some other, often supplemental, instrument with a higher ceiling, such as Stanford-Binet Form LM.

This article examines the nature and extent of depressive disorders in highly gifted adolescents based on current literature and data gathered from a phenomenological study, focus groups, and clinical records. Two case studies and clinical examples document the capacity of some highly gifted adolescents to mask even severe symptoms. Several factors appeared to contribute to this masking phenomenon, including shame for being incapacitated and unable to resolve their dilemma; depression’s signature cognitive confusion, which disengaged their coping mechanisms; and fear of harming others with their toxic state. These findings raise questions about the efficacy of quantitative research instruments to determine actual cases of depressive disorder in this subgroup, as well as current research estimates of depression in the highly gifted population.

Depression is potentially debilitating, invasive, and toxic. It is feared, frequently misunderstood, and often peculiar in its course. Depression is also egalitarian in its manifestation, affecting people at any age, education or economic level, and ethnic background (American Psychiatric Association, 1994). It is a psychological state marked by feelings of sadness, worthlessness, impotence, and incapacity. Untreated major depression can have fatal consequences (Klein & Wender, 1993).

Highly gifted individuals are “those whose advancement is significantly beyond the norm of the gifted where advancement refers to aptitude or potential rather than performance” (Silverman, 1983, p. 16). Extraordinary ability is usually measured in psychometric terms, using scores on intelligence or aptitude tests. For instance, with the Wechsler Intelligence Scale for Children–III (Wechsler, 1991), individuals scoring at or above 145 are labeled “highly gifted,” those scoring at or above 160 are “exceptionally gifted,” and those scoring at or above 180 are “profoundly gifted.” Individuals who show evidence of extremely high levels of creativity or unusual and profound talent are also usually included in this subcategory of gifted learners.

This paper explores major depression in the lives of highly gifted adolescents and synthesizes findings from a phenomenological study (Jackson, 1995), data from clinical records and interviews at the Daimon Institute for the Highly Gifted (White Rock, British Columbia, Canada), and research literature in gifted education and psychology. Poignant narratives illuminate the subjective experience of depression. This paper connects highly gifted adolescents’ experience of depression, general information about depression, and depression-related phenomena peculiar to this population, arguing that highly gifted children are particularly capable of masking symptoms of this disorder.

Depressive Disorder: A Review of Literature

The degree, type, frequency, number, and duration of symptoms determine whether a particular episode/condition meets clinical diagnostic criteria. For example, a child who shows no signs of being comforted or of resuming normal functioning within a week after falling into a low mood or within 6 months of a major loss may be in a depressive state. Depressive states have been roughly categorized into two groups: mild (dysthymic) and major depression. The primary symptom for both disorders is disturbance of mood, and the distinction between the two is a matter of degree (American Psychiatric Association, 1994). Symptoms related to thinking capacity, for instance, can range from mildly slowed to stupourous. Similarly, mood state may range from slightly downcast to unrelentingly bleak. In some cases, the mind may maintain reason; in the extreme, it can be delusional.

There is general agreement that the term depression can refer to the mood itself or to a combination of affective, cognitive, psychomotor, and vegetative manifestations that affect normal functioning. The condition of depression affects mental and emotional tone and capacity, as well as the physical body.

A sad or depressed mood and a loss of interest and pleasure in usual activities characterize major depression. There is often difficulty in falling or staying asleep or a desire to sleep much of the time. A person may also experience a shift in energy and activity levels, becoming lethargic or extremely agitated. Other physical signs include a poor appetite and weight loss or, in some cases, increased appetite and weight gain. Other characteristics of major depression include negative self-concept and self-blame, pessimism, and pervasive feelings of worthlessness, guilt, and despair. A seriously depressed person may have difficulty concentrating and may show evidence of slowed thinking, mental fuzziness, lack of cohesion in thought patterns, and indecisiveness. Those afflicted with major depression may report recurring thoughts and images of death and suicide (American Psychiatric Association, 1994).

According to recent research, as many as 3% of Americans—approximately 19 million—suffer from chronic depression. Of these, some two million are children (Solomon, 2001). Major depression is the leading cause of disability in the United States for those over the age of 5, second only to heart disease in causing premature death (American Psychiatric Association, 1994). Depression is linked to many other diseases, from alcoholism and drug abuse, to ulcers and eating disorders (Karp, 1996), and may coexist with conditions such as anxiety and conduct disorders (Cytrym & McKnew, 1998).

In spite of the fact that treatments for depression are proliferating, it is estimated that only half of those suffering from major depression seek help. Of those 50%, some 90% visit their primary care physician, who may or may not be well versed in psychiatric profiles (Solomon, 2001) and biological psychiatry (Klein & Wender, 1993). It is also estimated that a depressive state in an American adult is recognized only 40% of the time. At the same time, as many as 1 in 10 Americans are on some form of antidepressant medication (Solomon). Optimal treatment for major depression usually involves psychiatric consultation and medication and psychotherapy (Klein & Wender). As many as 10% of American adults will be stricken with major depression, while current estimates of incidence in children and adolescents are 3% and 7%, respectively. There is evidence that incidence of depression is increasing in the developing world, particularly among children. An increase in reported suicide attempts in children (Cytryn & McKnew, 1998) dispels the long-held belief that, while suicidal ideation may occur in prepubertal children, suicide attempts are rare.

Depression at any age may be the result of social or biological factors or both. Current research is attempting to shed light on the impact of environmental stressors that cause particular psychological reactions, leading to the biochemical changes that are at the core of a depressive disorder (Cytryn & McKnew, 1998).

Research on adults with mood disorders has revealed that many people afflicted with depression can date the early signs of their condition to either prepubertal or childhood years (Kendler, Kessler, Neale, Heath, & Eaves, 1993). A consideration of patterns of vulnerability reveals several trends. For example, children of parents with depressive disorder are found to have a significantly higher incidence of depression than does the general population (Cytryn & McKnew, 1998). In addition, children who have experienced difficulty with attachment and separation-individuation are more likely to develop emotional difficulties. Maternal rejection, in particular, has been found to contribute to later depressive states (Mahler, 1972). The growing child responds to rejection with anxiety and ambivalence and gradually shuts down innate, generative exploration and expression of capacity and purpose (Lewis, 1979). A well-established mother-infant attachment bond provides solid footing for the child’s further development. Children with well-established attachments are not prone to anxiety and depressive states (Mahler). In contrast, children who experience significant loss in the early years—of a loved one, for example—are at risk for a depressive episode later in life.