On the surface, being a people-pleaser seems to come with perks. Always being agreeable can keep people around; saying yes to every last-minute work request makes you feel less dispensable.
In the long run, however, people-pleasing doesn’t just lead to being taken advantage of and shallower relationships: it can also be detrimental to your health.
Dr. Judith Joseph, a New York City-based psychiatrist and author of “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy,” said chronic people-pleasing may increase the risk of high-functioning depression, an informal term for depression in people who appear outwardly put-together and successful while exhibiting symptoms like hopelessness, irritability, and emptiness.
While the term isn’t an official diagnosis in the DSM-5, the primary diagnostic manual used by mental health clinicians, they still use it sometimes to informally describe people whose depression isn’t outwardly obvious.
Unlike burnout, which is typically tied to a specific stressor like work or caregiving, high-functioning depression doesn’t necessarily improve when someone changes jobs or takes a break from those responsibilities, Joseph said. “They still have the symptoms even though the environment’s gone,” Joseph told Business Insider.
Overwhelmingly, she sees patients with high-functioning depression exhibit some levels of people-pleasing and constant self-sacrifice. “I think of people who believe that they have to be the rock,” Joseph added. “I think of the nurse in the ER who hasn’t had a pee break but has made sure to empty everyone else’s Foley [catheter].”
Joseph shared why untreated high-functioning depression can lead to long-term physical health issues. She also gave tips on how to stop being a people-pleaser.
Achievement without enjoyment
Joseph, who works in Manhattan, said she sees many successful patients in her practice. On paper, everything looks great. They have no problems completing their daily responsibilities or getting promoted at work. They just don’t know why none of it makes them feel good.
“There’s a difference between someone who is productive and loving what they’re doing, versus someone who is busying themselves, but it’s pathological productivity,” Joseph said.
She added that achieving things “just to get through the day,” rather than because they bring you joy, may reflect anhedonia — a core symptom of depression marked by a loss of interest or pleasure in activities you once enjoyed.
People-pleasers might continue to push through symptoms like anhedonia because of low self-worth and a history of internalized shame, she said. Because they feel like they can’t pause, say no, or ask for help, they continue marching onward.
“They have developed this personality and this identity tied to doing for others or showing up in a role, and they kind of lose who they are,” Joseph said. “I see this often with high-functioning folks.”
Dangerous ways to cope
Left unaddressed, Joseph said, there are a few common outcomes for people with high-functioning depression.
The first is that they dip into a more typical display of depression, where they struggle to get out of bed or withdraw from loved ones. They might also start to experience physical symptoms.
“Their brain is still coasting, but their bodies physically break down,” Joseph said. “They end up in the ER with neurological symptoms or chest pain, dehydration, or physical exhaustion.”
Joseph has also seen patients cope through excessive drinking, drugs, or unhealthy behaviors like gambling, overspending, or endlessly scrolling on their phones. “They’re soothing in these ways because they don’t understand what’s happening,” she said.
The best way to stop people-pleasing
If you know you have people-pleasing tendencies but can’t seem to draw boundaries, Joseph suggested digging deeper into worst-case scenarios.
“What’s the worst thing that’ll happen if you don’t show up for this? What if you don’t work on the weekends? What if you don’t turn in that project because you’re really tired?” she said.
Because people-pleasers rarely put themselves first, Joseph said they can often be taken advantage of. “People pick that up,” she added, noting that it’s not always maliciously done, either. Joseph said it’s human nature for people to take what is constantly given.
Joseph said many of her clients find that setting clearer boundaries ultimately improves how they’re treated by others.
“Over time, you get more comfortable with that exposure, and you see that nothing bad happened,” Joseph said. ” In fact, they respected you more, and they actually listened. That is a game changer for a lot of my clients.”
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