What Is High-Functioning Anxiety?
While high-functioning anxiety isn’t technically an official medical diagnosis, it’s an increasingly common term used to describe a collection of anxiety-related symptoms that very well may be indicative of a diagnosable condition(s).
Why the surge in popularity? As far as mental health conditions go, it's somewhat "appealing," according to Elizabeth Cohen, Ph.D, a New York City-based clinical psychologist. More often than not, people would prefer to be considered "high functioning" rather than just "generally anxious," she explains, who half-jokingly adds, that people like "to have a disorder that makes them sound good."
In a way, this is somewhat of a Trojan horse; it can lead those who wouldn't normally check-in with their mental health to look inward. Because there's still so much stigma shrouding all forms of mental health diagnoses, the desire to distance oneself from these conditions could impede inner reflection and access to necessary mental health care, explains Cohen. But, on the other hand, the labeling of "high functioning" may provide a friendlier access point, due in part to the way this condition is framed. (Related: The Stigma Around Psychiatric Medication Is Forcing People to Suffer In Silence)
That doesn’t mean, however, that there is a "low functioning" anxiety or that any other forms of anxiety are lesser functioning. So, what is high-functioning anxiety exactly? Ahead, experts break down everything you need to know about high-functioning anxiety, from signs and symptoms to treatment.
What Is High-Functioning Anxiety?
High-functioning anxiety is not an official medical diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorder (DSM), the catalog of psychological conditions widely used by clinicians to diagnose patients. It is, however, generally recognized by many mental health practitioners as a subset of generalized anxiety disorder, says Cohen. GAD is an anxiety disorder characterized by chronic anxiety, extreme worry, and exaggerated tension, even when there’s little or nothing to provoke it, according to the National Institute of Mental Health. That’s because high-functioning anxiety is essentially a "blend of different anxiety-related conditions," she explains. "It has the people-pleasing that usually comes with social anxiety, the physical responses and 'waiting for the other shoe to drop' component of GAD, and the rumination of obsessive-compulsive disorder (OCD)."
In essence, high-functioning anxiety is a form of anxiety that drives someone to be hyper-productive or hyper-perfectionistic, thereby yielding seemingly “good” results (in the material and social world). But this comes at somewhat of a mental cost: as they work harder and harder to achieve a metaphorical A+, they’re simultaneously overcompensating for the fears (i.e. failure, abandonment, rejection) that are fueling the fire, explains Cohen.
Still, it might be hard to pinpoint when a person is struggling with high-functioning anxiety — so much so, in fact, that it’s frequently referred to as "hidden anxiety," according to the experts here. This is due largely in part to the "high performance" part of high-functioning anxiety, which people don’t typically associate with mental illness or mental health challenges. (Although, friendly reminder, mental health is varied, and these conditions don't look the same for everyone.)
"Often, people with high-functioning anxiety look like rock stars and show outward trappings of success," says clinical psychologist Alfiee Breland-Noble, Ph.D., director of the AAKOMA Project, a nonprofit dedicated to mental health care and research. In other words, their public, outward life is often marked with a prolific career, achievement, and/or a polished family and home life — all of which is typically fueled by fear rather than a passion: "a fear of not comparing to others, a fear of falling behind, or a fear of getting older," says Cohen. These are the people who tend to "have it all" on the surface, but it’s kind of like, Instagram in human form — you're only seeing the highlights.
And while social media feeds are starting to fill up on more #nofilter posts (and TG for that because screw 👏 the 👏 stigma 👏), society tends to reward those with high-functioning anxiety, thereby perpetuating this success-no-matter-the-stress mentality.
Take, for instance, someone who, out of anxiety or fear that they’re not doing enough to please their boss, spent the whole weekend working on a particular project. They then return to work on Monday completely depleted and strung out. Still, they're likely praised by their boss and colleagues, called a "team player," and lauded as someone for whom no task is too big nor too small. There's a heap of positive reinforcement for this anxiety-fueled behavior that's not necessarily healthy or sound. And, because of it, someone with high-functioning anxiety will likely assume that their overworking, perfectionist tendencies are responsible for their success, says Cohen. "But, in reality, this behavior leaves them and their nervous system feeling frazzled, on edge, and in a heightened state of anxiety.” (Kind of like burnout.)
"When you figure out what behaviors work, you repeat them; you want to survive, ultimately, and if you believe it helps your survival, you do it more," explains Cohen. "Behaviors associated with high-functioning anxiety get really, really reinforced by the world around you."
So, perfectionism, people-pleasing, overachieving, and overworking — no matter the negative mental health impact — are understandably all signs of high-functioning anxiety. Of course, that’s just the shortlist of the possible symptoms of high-functioning anxiety. For example, you can also be guilty of constantly apologizing, says Cohen. "Saying 'I'm so sorry,' or 'I'm so sorry I'm late,' gets seen as conscientiousness — but in reality, you're putting extra pressure on yourself."
As for the other signs of high-functioning anxiety...
What Are the Signs and Symptoms of High-Functioning Anxiety?
This is a tricky question to answer. Why? Because, as mentioned earlier, high-functioning anxiety isn’t the easiest to spot or identify. "The average person cannot typically see how high-functioning anxiety impairs the person living with it," says Breland-Noble, who adds that even as an expert, it can take a few sessions before being able to identify the "magnitude of a patient’s anxiety" if it’s "high functioning."
What’s more, high-functioning anxiety (and GAD for that matter) can and often do look different depending on the patient and variables, such as their culture. This is due largely in part to the fact that high-functioning anxiety isn’t an official medical diagnosis and also because of the lack of BIPOC in mental health studies, explains Breland-Noble, who actually started AAKOMA Project for that reason. "So, overall, I'm not certain that we as mental health professionals have a deep understanding of the full range of presentation styles as it relates to anxiety, in general, and high-functioning anxiety specifically," she says. (Related: Accessible and Supportive Mental Health Resources for Black Womxn)
That said, both experts say there are some general symptoms of high-functioning anxiety.
Emotional Symptoms of High-Functioning Anxiety:
- Stress, anxiousness, worry
- Trouble concentrating
Your physiological and psychological body are one in the same, and your mental symptoms will beget physical symptoms (and vice versa). "Our bodies are not separated like hospital floors," says Cohen. So…
Physical Symptoms of High-Functioning Anxiety:
- Sleep issues; difficulty waking up or waking up in a panic
- Chronic fatigue, feeling depleted
- Muscular pain (i.e. a tense, knotted back; aching jaw from clenching)
- Chronic migraines and headaches
- Nausea in anticipation of events
Is There Treatment for High-Functioning Anxiety?
This type of mental health challenge can absolutely be managed, and rewiring of behaviors or habits is absolutely achievable. "Working on lessening high-functioning anxiety and bettering yourself, however, is a daily process and hard; it's like each time you have the opportunity to fall into behavior, you have to do the opposite action," says Cohen.
As Cohen puts it, high-functioning anxiety is "a way of being in the world; a way of interacting with the world — and the world is not going away." This means that if you're dealing with high-functioning anxiety, you have "years and years of conditioning to undo," she says. Here’s how:
Name It and Normalize It
In Breland-Noble’s practice, she works to "reduce stigma by naming and normalizing” anxiety, including high-functioning anxiety. "I want my patients to understand that they are not alone, a lot of people live with this, and there's a healthier way to live — but only if you name and acknowledge what you're dealing with." (Related: How to Use a Wheel of Emotions to Name Your Feelings — and Why You Should)
Try Out Therapy, Particularly CBT
Both psychologists recommend cognitive behavioral therapy, a type of psychotherapy that helps people identify and change destructive thought patterns, and, thus, a trained professional who can guide you through these techniques as well as other treatments. "CBT focuses on the thoughts that get it the way and push this perfectionism," explains Cohen. "If you challenge your thoughts, however, you can see shifts in how you think and, thus, how you act.” (Read about CBT, check out mental health apps, or look into telemedicine if you want to understand more.)
"Less self-flagellation, less responding to emails and texts all the time, less apologizing. Do less by taking a sacred pause and stop optimizing — unless it's optimizing for joy or for ease," suggests Cohen. Sure, that’s easier said than done, especially when you’ve gotten into the habit of being constantly available. So, take Cohens advice and start to wait 24 hours before returning an email or text (if you can, of course). "Otherwise people expect instant responses from you," which perpetuates this unhealthy cycle of high-functioning anxiety. "Make it clear that you want good results, not fast results; that you know there's a benefit to reflecting and taking time," she adds.
Practice Outside of Therapy
Therapy doesn’t — and shouldn’t — be confined to a weekly appointment. Instead, continue to build upon what you discuss and work on in each session by, say, pressing pause during the day and tuning into your brain and body. When working on bettering her own high-functioning anxiety tendencies, Cohen found that doing this reflection at the end of the day and in the morning helped her recognize when she actually worked best vs. just working because that equal success. “Ultimately, I could tell that if I were to read an email at 5 p.m., I’d respond in a drastically different manner than I would in the morning. In the a.m., I’d feel better, more confident while in the p.m., I’d be more self-deprecating and apologetic,” she explains. (Both of which, reminder, are signs or symptoms of high-functioning anxiety.)
Another way to practice what both experts call "ongoing, active coping"? Simply finding healthy routines that you enjoy and that "give you strength," recommends Breland-Noble. "For some, this is meditation, for others prayer, for others, it's the arts."