A patient's outward presentation seems out of keeping with an underlying problem. Before revealing the answer, decide what distinguishes smiling depression from la belle indifférence.

Ask whether the mismatch concerns a maintained cheerful front over a genuinely depressed underlying mood, or a striking lack of concern about a specific physical symptom. Smiling depression differs from la belle indifférence, which concerns unconcern about a specific physical symptom rather than a maintained cheerful front over an underlying depressive illness: in smiling depression, a person experiencing significant depressive illness presents outwardly with a smile or cheerful social manner, often maintained consciously and effortfully out of a wish not to burden others, shame, or habit, masking the true severity of what they feel. La belle indifférence, by contrast, is a striking lack of concern about a significant physical symptom, such as a limb that will not move, most often described alongside functional neurological or conversion-type physical symptoms, with the person otherwise willing and able to describe the symptom in detail. Whether the underlying problem being masked is a depressive mood state or unconcern about a physical symptom is the key distinguishing feature.