Hidden struggles: the basics

Look for these guides

• Choosing not to have children
• Friendship breakups & losing a community
• Holding feelings in & toxic positivity
• People-pleasing & rejection sensitivity
• Shame & self-criticism

Each one explains the struggle, how it can feel, what helps, and how to support someone else.

Common reasons

• Fear of looking weak or ungrateful
• Not having a word for what you feel
• Others seem to cope, so you think you should too
• Still getting things done, so it “can’t be that bad”
• Worry about being a burden

Cleveland Clinic notes that people who look confident and organized may feel shame about letting their guard down, for fear of seeming weak.

Cleveland Clinic describes people who come across as confident, outgoing and organized while dealing with a lot of worry inside. Instead of avoiding stress, they tend to push themselves to work harder to beat the anxiety.

What it can look like

• Being very organized and meeting every deadline
• Finding it hard to say no
• Imagining worst-case outcomes
• Needing a lot of reassurance
• Overthinking and replaying conversations

Some people keep smiling, joking and helping others while feeling numb, sad or hopeless inside. They may lose joy in things they used to love, or feel their wins don’t mean anything. Because they still “function,” they may not think it’s worth mentioning.

Things to notice in yourself

• Dragging yourself through days that look fine on paper
• Feeling tired most of the time
• Pulling away from friends “because you’re busy”
• Success or praise that feels hollow
• The smile drops the moment you’re alone

Keeping up a cheerful front can be exhausting. Research on emotion habits found that people who mostly hide their feelings tend to feel fewer good emotions and more bad ones, and have poorer relationships.

Common costs

• Feeling lonely even when surrounded by people
• Getting support late, or not at all
• Others assuming you can always take on more
• Losing touch with what you really feel

Strong grades, a busy career or a full calendar can hide a lot. People in these roles often worry that admitting a struggle will make them look like they can’t handle it.

Try this

• Answer “How are you?” honestly with one trusted person
• Notice when your smile doesn’t match how you feel
• Practise saying no to one thing this week
• Try slow breathing when you notice tension
• Book a check-in with a counselor or your clinical provider

A 2023 review of 16 studies describes camouflaging as the effort autistic people make to disguise and compensate for autistic traits in social settings. It is often measured in three parts: compensation, masking and fitting in (assimilation).

What it can look like

• Copying other people’s facial expressions, gestures or phrases
• Forcing eye contact even when it feels uncomfortable
• Hiding repetitive movements or intense interests
• Preparing scripts for small talk
• Watching others closely to work out “the rules”

Reasons people give

• Being accepted and making friends
• Getting access to jobs, school and social chances
• Staying safe from teasing or worse
• Succeeding at work or school

Masking can bring short-term benefits. The same review notes those benefits may come at a long-term cost.

In the 2023 review, camouflaging was linked with anxiety and, to a smaller degree, depression. People described exhaustion, feeling like they were deceiving others, losing touch with who they are, and isolation.

Masking may also delay a diagnosis and support, because struggles are harder for others to see. Some studies found it more common in autistic women and girls, though not all studies agree.

People may hide a mental health condition, a disability, their sexuality or gender, their faith, or their past. The American Psychiatric Association notes that stigma can lead people to feel shame and avoid getting help.

Ideas

• Notice when and where you mask the most
• Plan quiet recovery time after long social days
• Find one or two people you can be fully yourself with
• Look for peer groups of people who share your experience
• Ask for adjustments at work or school if they would help

You don’t have to drop every mask everywhere. The goal is to have places where you don’t need one, and to choose when to use it.

Common signs

• Brain fog: losing words or forgetting names
• Feeling exhausted and overwhelmed
• Feeling irritable
• Going over and over a choice after you make it
• Putting off decisions, or avoiding people and situations
• Snap choices, like impulse buys
• Tension headaches or an upset stomach

Decision fatigue is usually short-lived, and many people feel better after a day or so of rest. If you feel like this every day, something longer-lasting may be going on, and it’s worth talking with your clinical provider.

Things that add to the load

• Decisions that affect other people (parents, caregivers, managers know this well)
• Hard life situations, like illness, a move or a breakup
• Making lots of decisions each day
• Perfectionism: needing every choice to be the “best” one
• Uncertainty about what comes next

Caregivers and parents often carry a long, invisible list of decisions. If that sounds like you, see The mental load guide and the Family caregivers guide.

A popular idea says self-control is like a fuel tank that runs low the more you use it. When 23 labs tested this with over 2,100 people using the same method, they found the effect was close to zero. Scientists are still debating how mental tiredness works.

You may also have seen a precise number of decisions people supposedly make each day. Treat exact figures like that with caution. What matters is how you feel: if your mind feels overloaded, it’s worth lightening the load.

Try this

• Automate small choices: a weekly meal plan, a simple “work outfit,” the same grocery list
• Hand some decisions to others, and accept they may do it differently
• Make important choices earlier in the day when you can
• Move your body: short walks during long sitting spells can help your thinking
• Protect your sleep, since tiredness affects self-control and mood
• Schedule “no-decision” downtime

Another trick is “good enough.” For small choices, pick the first option that meets your needs instead of searching for the perfect one. Save your energy for decisions that really matter.

Researchers describe compassion fatigue as a mix of two things: burnout (exhaustion from too many demands) and “secondary traumatic stress” (stress from hearing about or seeing others’ suffering). Burnout grows when you can’t reach your goals. Secondary trauma grows when you can’t rescue someone from harm.

What protects against it is “compassion satisfaction”: the good feeling that comes from helping. When that runs low, compassion fatigue can take hold.

Risk factors researchers found

• Deep empathy, the very thing that makes you good at caring
• Lack of recognition and poor support from managers
• Little control over your work
• Seeing severe trauma or caring for people who are very ill or dying
• Very heavy workloads and short breaks between shifts

You might notice

• Dreading work or caregiving
• Feeling numb or detached from the people you help
• Intrusive images or stories from work
• Irritability and exhaustion
• Losing the sense of meaning that drew you in

These are signs of strain, not signs that you are a bad helper. They often show up in the people who care the most.

A review of 13 studies found mixed results for different approaches. Programs that built resilience showed the most promise, and some education programs helped reduce burnout and secondary stress.

Everyday protection

• Debrief with peers after hard days
• Keep firm boundaries between work and home
• Notice and celebrate the good you do
• Rest, move and do things unrelated to caring
• Talk to a counselor who understands helping roles

Fear of aging can show up as dread about wrinkles or gray hair, worry about losing health or independence, or feeling invisible as you get older. Many of these fears are fed by negative messages about older people.

Those messages matter. The World Health Organization says half the world’s population is ageist against older people. Ageism is linked to poorer physical and mental health and a shorter life.

How we think about our own aging counts too. In a U.S. study of 660 people aged 50 and over, those with more positive views of aging lived 7.5 years longer, on average, than those with more negative views.

Thinking about death now and then is normal and can even help us focus on what matters. It becomes a problem when the fear is constant, causes panic, or stops you from living fully, like avoiding doctors, travel or anything that reminds you of death.

It may show up as

• Avoiding funerals, hospitals or news
• Checking your body often for signs of illness
• Panic or a racing heart when death comes to mind
• Trouble sleeping because of these thoughts
• Worrying a lot about your health or loved ones dying

Researchers say talking therapies that work well for anxiety may help with fear of death too, though more research is needed.

Many people find comfort not in “solving” these fears, but in living in a way that feels meaningful. Focusing on relationships, values, faith, creativity or leaving something good behind can make mortality feel less frightening.

Questions to reflect on

• What brings me a sense of peace or awe?
• What do I want my days to be full of?
• What do I want to be remembered for?
• Who do I want to spend more time with?

Spending time with people of different ages can also shift fears about aging. The WHO says programs that bring generations together help reduce ageism.

By 2030, about 1 in 6 people worldwide will be 60 or older. By 2050, the number of people aged 80 or older is expected to triple to 426 million. Aging is becoming one of the most shared human experiences.

Ideas for groups, teams and families

• Leaders and parents can share their own struggles, simply and honestly
• Respond to hard news with listening, not quick fixes
• Start meetings with a quick “one word for how you’re feeling”
• Treat asking for help as a strength

Naming feelings out loud can help calm the brain’s alarm system. Making it a group habit helps everyone practise.

Teams that debrief together, recognize each other’s work and look out for signs of strain can help protect against compassion fatigue. Poor support and lack of recognition are known risk factors.

The World Health Organization says programs that bring younger and older people together are one of the best ways to reduce ageism. Mentoring, shared gardens, reading programs and family meals all count.

In families and teams, share whole jobs, not just tasks. When one person owns “meal planning” or “the school calendar” entirely, others are spared the decisions. Letting others decide, even if they do it differently, is a gift to your tired brain.

Groups that accept differences, like quiet breaks, different ways of talking, or different life paths, make it easier for people to stop masking. Contact with real people is also one of the best ways to reduce stigma.

Simple welcomes

• Avoid prying questions
• Follow up if someone stops coming
• Learn and use people’s names
• Offer quiet spaces and clear plans at events

You might notice

• Always helping others, never resting
• Jokes about being exhausted or “dead inside”
• Saying “I’m fine” but seeming tense or flat
• Talking a lot about getting old or dying
• Trouble making simple decisions

Try saying

• “How are you, really?”
• “You seem a bit worn out lately. Want to talk?”
• “No pressure, I’m here if you ever want to vent.”
• “Can I take one thing off your plate this week?”

Then listen and validate. Avoid rushing to advice or silver linings.

Try to avoid

• “But you seem so happy!”
• “Everyone gets tired, push through.”
• “You don’t look autistic.”
• “You chose this job, so you can’t complain.”
• “Don’t be morbid.”

These responses skip past the feeling. Instead, reflect what you hear and show it makes sense: “That sounds like a lot to carry on your own.”

Ideas

• Cover a shift or a caregiving hour so they can rest
• Invite them along to something regular, like a weekly walk
• Make one decision for them, like choosing dinner
• Offer a quiet, low-pressure hangout where they don’t need to perform

Being a steady, regular presence matters more than finding the perfect words. Social connection itself is protective.

If struggles last for weeks or affect daily life, gently suggest talking to a clinical provider or therapist. Offer to help them find one, or to go with them to the first appointment.

Supporting someone can be tiring, especially if their struggle lasts a long time. Deep empathy, the very thing that makes you a good supporter, can also wear you down if you never rest.

Protect your own wellbeing

• Keep doing things that refill you, like time outside, hobbies and sleep
• Remember: you can support someone without fixing everything
• Set kind limits on how much you can give
• Share the support with others so it isn’t all on you
• Talk to someone about how you are feeling too

Cleveland Clinic describes people who seem confident, outgoing and organized on the outside while dealing with a lot of worry inside.

A review of 16 studies linked autistic camouflaging with anxiety, exhaustion and isolation, and noted it can delay support.

Scientists are still debating how mental tiredness works. Your tiredness is still real, and lightening the load still helps.

Empathy is central to developing compassion fatigue. The most caring people often need the most protection.

People with more positive views of aging lived 7.5 years longer in one long-term U.S. study. Ageism, on the other hand, is linked to poorer health.

You don’t need to be in crisis to see a therapist. Many people go to understand themselves better, ease worry, and learn new ways of coping. Cleveland Clinic suggests talking therapies like CBT for people who struggle quietly while still functioning.

DBT balances accepting who you are with learning to change. It teaches skills like emotion regulation (understanding and managing feelings) and distress tolerance (getting through hard moments without making them worse).

NIMH suggests talking to a primary care provider if you have concerns about your mental health. They can check your health and refer you to a therapist or counselor. For anything medical, consult with your clinical provider.

Reach out any time

• 988 Suicide & Crisis Lifeline: call or text 988
• Crisis Text Line: text HOME to 741741
• If a life is in danger: call 911

The 988 Lifeline offers free, confidential support, 24/7, to people in suicidal crisis or emotional distress. You don’t have to wait until things are at their worst.

Find A Helpline lists free, confidential helplines around the world. You can search by country and topic.