What is high-functioning anxiety?
According to the DSM-5, high-functioning anxiety isn't a clinical diagnosis, so it's still a relatively under-researched term. Although it hasn't been classified as an official anxiety disorder, it's still an overwhelming experience for those who suffer from the symptoms.
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If you have high-functioning anxiety, to the outside world, you might seem confident and put-together. "You appear to be quite successful in life. You're driven to do a lot of things and meet many challenges," says clinical psychologist Marla Deibler, Ph.D. Since you're able to pay your bills and socialize well with others, it gives other people (and yourself) the impression that you're excelling personally and professionally. However, on the inside, it's a different story.
Clinical psychologist Nicole Pensak, Ph.D., tells mbg that your desire to succeed is likely due to sophisticated compensatory strategies designed to repress your anxiety and persistent feelings of dread. "High-functioning anxiety is when you're suffering a great deal internally, but you're still able to perform exceedingly well at your job and in other domains," she says.
Pensak says sufferers of high-functioning anxiety endure debilitating rumination and panic attacks but work overtime to hide visible symptoms. "Internally, it drives you to perform at high levels to avoid failure, rejection, or disappointing others, which is hidden by perfectionistic tendencies."
Difference between anxiety and high-functioning anxiety.
"Anxiety is a 'normal' reaction to something we experience as threatening in some way. It's a biological response that involves the activation of the nervous system to help us get ready to confront a stressor," Deibler says. It only becomes problematic once the anxious thoughts begin to negatively interfere with your life for a significant amount of time–six months or longer.
"Anxiety is helpful when it's experienced in moderation, for example, meeting deadlines or completing obligations," she adds. "Too little anxiety and it may lead to a lack of motivation to meet the demands of your life. Too much, and you feel overwhelmed and incapacitated."
Therein lies the main difference: People with lower-functioning anxiety usually find it difficult to juggle many responsibilities. In their day-to-day life, their anxiety is clearly disruptive. But high-functioning anxiety people respond to the same stressors by exceeding expectations. They work harder and pack their schedules to push away their inner turmoil. Being overwhelmed is a preferred emotional state that distracts them from their true feelings.
Potential symptoms of high-functioning anxiety.
Since it seems like you're doing well, it's easy to deny, dismiss, and overlook symptoms. Intervention may only happen when it reaches a point where the feelings become unmanageable and you need to seek help from a licensed professional.
If you have traditionally identified as a high achiever at school or work, you might be prone to developing high-functioning anxiety. To detect anxious patterns and emotional changes easier, it might be useful to pay attention to your inner world and place less weight on performance-based metrics or external success.
Pensak and Deibler list some signs of high-functioning anxiety:
driven and task-oriented
bad sleep habits or insomnia
restlessness and fatigue
feeling on edge
obsession and rumination
tense shoulders/neck, clenched jaw
nervous habits, shaking leg or biting lip
trouble expressing emotions (e.g., being hard to read or feeling numb)
The difference between burnout and high-functioning anxiety.
The World Health Organization defines burnout as "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."
"Burnout is typically a response to chronic stress at the workplace [and] is classified by exhaustion, lack of meaning and drive, and loss of interest at work," Pensak points out. "It has more overlap with depression rather than anxiety." If you're experiencing burnout, you'll likely find yourself making more mistakes, pushing back deadlines, and calling off work often.
On the other hand, high-functioning symptoms show up differently in the workplace. You might wake up with anxiety, but for the most part, you go to work with a smile on your face and can perform your job to optimal ability. "You may be able to function very well in a stressful environment and maintain high levels of achievement despite the stress because you tend to power through and ignore your own needs in lieu of success," she says.
Tips for managing high-functioning anxiety.
To reduce the internal and external stress that makes up high-functioning anxiety, you should give yourself the permission and grace to release some of your burdens. It's OK to need help, and although you can push yourself quite far, that doesn't mean you always have to take it to the extreme.
Here are some tips to ease your anxiety and take better care of yourself:
"Taking time to practice being fully present and aware of your moment-to-moment experience can be helpful in managing anxiety," Deibler says. In times of stillness, work on connecting to your present-moment internal thoughts, environment, emotions, and bodily sensations.
Pensak agrees that practicing mindfulness will help reduce overall levels of stress and anxiety, which contributes to a drop in cortisol levels.
Accept the overwhelming feelings.
"Rather than trying to push away anxiety, which tends to be futile and results in feeling less in control, make room for anxiety," Deibler suggests. "[Anxiety] is showing up to try to bring your attention to something and is a 'normal' experience." Notice what feelings come up (exhaustion, frustration, overstimulation) and bring them along for the ride.
By creating space to feel your feelings without shame, you're able to delve into your anxiety and what might be causing it without getting swept away in its intensity.
Maintain self-care with stress management techniques.
"Attend to healthy lifestyle practices [which] take care of your mind and body," Deibler advises. Healthy stress management looks like making time in your schedule for good sleep, proper nutrition, stress-supporting supplements, regular exercise, and treating yourself kindly with self-compassion and gratitude.
A part of self-care is community care, so don't forget to talk with your loved ones as well. People may not expect you to need help since you seem happy, but opening up about your fears will go a long way. "Social support from friends and family is an important part of stress management, so take time to spend social time with others," she says.
Make rest and play essential.
Deibler recommends carving out intentional time for yourself with thoughtful breaks and enjoyable activities. When you're trying out old and new hobbies, the goal is to be in play with your interests without using them to seek validation, perfection, or monetization.
High-functioning anxiety is fueled by wanting to prove yourself, so move to the opposite reaction by embracing imperfection. Approach your creativity from a place of pure creation so it doesn't feel results-driven.
Try cognitive-behavioral therapy.
"Cognitive behavioral therapy (CBT) is the gold standard, evidence-based treatment for high-functioning anxiety," Pensak recommends. This type of therapy works to challenge cognitive distortions in your thinking and develop better ways to cope with your stress.
"Speaking to a therapist that practices CBT can help provide insight into the root of the anxiety and provide strategies to treat the maladaptive thoughts, feelings, and behaviors related to high-functioning anxiety," she adds.
Practice exposure safely.
One type of CBT, called exposure therapy, slowly exposes you to your fears. Avoidance can make your fears seem worse and bigger than they are. By habituating yourself to the situations that bring you distress, you'll eventually experience a reduction in anxiety.
Start small by safely exposing yourself to uncomfortable feelings that you can manage, for example, not preparing for a low-stakes work presentation and being OK with the possibility of stumbling over your speech. Then keep working your way up. Pensak says the more you do this, the more you'll realize that making mistakes won't cause your world to crash around you. Sitting with the humanness of failure and rejection will help you put less pressure on yourself.
High-functioning anxiety is hard to spot because being a high-achiever is desirable in today's productivity-obsessed society. It might be hard to admit that you have this condition if you see it as a sign of weakness or you've used it as momentum to achieve your goals, but taking care of your mental health comes first.