Decoding High Functioning Anxiety

You probably know a person with High Functioning Anxiety, just that to you, they are known as successful, overachiever, or even a perfectionist.

TheDiagnostic and Statistical Manual of Mental Disorders (DSM-5), the prevailing book of guidelines for mental health diagnoses, does not recognize High Functioning Anxiety as an official clinical diagnosis. Nonetheless, this article attempts to explain what this condition is, how it affects the people who suffer, and some tips on what you can do.

What is high functioning anxiety?

The popular phrase high functioning anxiety refers to a person who, while feeling anxious, appears to be able to manage the demands of daily life efficiently.

Why doesn’t DSM-5 list High Functioning Anxiety?

According to the DSM-5, anxiety disorder must cause disruption or impairment in living activities and change behavior to avoid circumstances that provoke anxiety. Since interruption or impairment of life activities is a needed component, some argue that anxiety disorder does not exist if there is no apparent impairment. However, many mental health professionals agree that people with anxiety disorders can have varying degrees of impairment. As a result, when the impairment looks minimal, it is labeled as anxiety disorder with mild impairment rather than anxiety disorder with no impairment. I agree with this part.

However, the prevalent belief is that this is a mild anxiety disorder rather than high-functioning anxiety. This part I have a problem with.

What is the problem with not having High Functioning Anxiety as a separate diagnosis?

Individuals with mild anxiety have minor life impairment and generally have mild symptoms. This argument, however, does not resolve one major problem of High Functioning Anxiety; the battle between how a person feels and thinks inwardly and how they express those emotions and thoughts publicly. While the impairment (the visible expression of anxiety) may be slight, how the person feels on the inside (the internal manifestation of anxiety) may be exceedingly severe. For me, this contradiction between deep inner emotions and the ability to operate well despite those feelings is the concept of high-functioning anxiety.

Thus it is not that the symptoms are mild but that the person suffering from high-functioning anxiety may be better able to regulate how severe internal manifestations of anxiety appear to affect them. 

Because a person is well functioning, they are unlikely to seek therapy. Without therapy, symptoms frequently worsen. When a person with high function in anxiety fulfills the criteria for a formal diagnosis, the problem has gone on for too long without therapy. 

Characteristics and Signs of high functioning anxiety

High-functioning anxiety, unlike clinical disorders, does not cause significant physical symptoms of anxiety that impact behavior. However, anxiety is felt, and it may manifest physically (elevated heart rate, sweaty hands, butterflies in the stomach, etc.). Still, it is typically not powerful enough to limit activities or be recognized by others.

As someone with high functioning anxiety, you may appear to be successful. You may come to work early, nicely dressed, and with your hair properly groomed. Coworkers may describe you as motivated in your work—you’ve never missed a deadline or failed to complete a job. Not only that, but you’re always willing to assist people when they ask. Furthermore, your social calendar appears to be jam-packed.

People may not realize (and what you would never reveal) that behind the surface of your supposedly immaculate façade, you’re fighting a continual churn of worry.

High-functioning anxiety is characterized by the following emotional and behavioral symptoms:

• Worry and anxiety that interfere with attempts to relax or that occur even when things appear to be going smoothly
• Perfectionism and a sense of perpetual dissatisfaction with one’s performance
• Workaholism is the desire to keep moving or doing things at home.
• Overthinking and overanalyzing everything, as well as constant second-guessing after making decisions
• Discomfort with expressing emotions, inability to share actual feelings
• Anxiety before a wide range of everyday situations or meetings
• Obsession with failing or the unfavorable opinions.
• Superstitions or compulsions (the need to repeat certain behaviors or patterns over and over to stave off disaster)
• Insomnia sometimes, inconsistency in sleeping patterns.
• Irritability and a propensity to grow dissatisfied or disappointed when faced with obstacles
• Difficulty saying no, regardless of how time-consuming, complex, or intricate the request.
• A fake cheerful disposition: covert pessimism that contradicts outward displays of positivity
• A variety of unintentional habits or traits (fingernail biting, hair pulling or twisting, idle scratching, lip chewing, knuckle cracking, etc.)

People with High-functioning anxiety often lack self-esteem and self-confidence, and they try to compensate for this by continually pushing themselves to achieve better or satisfy others. Unfortunately, their goals are frequently unachievable, and failing to accomplish them feeds their persistent feelings of stress and inadequacy.

Co-occurring problems with High Functioning Anxiety

Even if the diagnostic criteria for an anxiety disorder are not satisfied, persistent anxiety can have a harmful and long-term effect on mental health and physical well-being:

Depression is the most prevalent co-occurring condition among persons with high-functioning anxiety, with at least half of all instances developing.

Those with a history of high functioning anxiety are two to three times more likely to have substance use disorders.

Eating disorders frequently coexist with anxiety issues and pose a significant danger for persons with high-functioning anxiety.

Anxiety disorders can cause or aggravate chronic physical diseases. Some of the conditions associated with anxiety include:

• Cardiovascular disease
• High blood pressure and stroke
• Irritable bowel syndrome
• Chronic and intractable stomach troubles (Functional dyspepsia)
• Asthma and COPD

Uncontrolled anxiety produces tremendous unneeded anguish, and if left untreated for a lengthy period, it can decrease one’s lifespan.

When to ask for help?

If someone were to ask me this question, my answer would be, “Yesterday! And the second best time is today”. 

Despite suffering daily, here are some reasons you might not have considered taking help till now:

1. You see your anxiety as a two-edged sword, and you don’t want to lose the beneficial effect that anxiety has on your successes.
2. You are afraid your work will deteriorate if you are not always compelled to work hard out of dread.
3. You may believe that because you appear to be accomplishing (strictly from an objective viewpoint), you do not “need” or deserve treatment for your anxiety.
4. You may believe that everyone struggles in the same manner you do and that this is normal. On the flip side, you may assume that you are “poor” at handling life stress.
5. You’ve never shared with anybody your conflicts, and your silence has reinforced your belief that you can’t seek help.
6. Because they have not witnessed your hardship, you may assume that no one would support you in asking for or seeking help.

If this sounds familiar, I would strongly suggest seeking help immediately. But you don’t have to suffer.  

What can be done?

A trusted healthcare professional can assist you and recommend you to a mental health specialist for evaluation. If you have been diagnosed with an anxiety condition, such as generalized anxiety disorder (GAD) or social anxiety disorder, you should know that effective treatment options are available.

Anxiety disorders can be treated with Cognitive Behavioural Therapy(CBT), medications such as selective serotonin reuptake inhibitors (SSRIs), and even methods such as mindfulness training.

Many people who suffer from anxiety find that combining therapies helps them control their symptoms the best.

If your anxiety symptoms do not satisfy the complete diagnostic criteria for an anxiety disorder, counseling with or without medication may still be beneficial.

Daily tips for self-help with your High Functioning Anxiety

Even if you’ve already sought professional help or are still finding one, here are some self-help strategies you can use daily for anxiety reduction:

• Commit to working on your mental health for 10 minutes every day.
• Consider lifestyle adjustments such as avoiding coffee, eating a nutritious diet, and getting regular exercise before doing cognitive work (changing your ideas).
• Sleep hygiene is important, going to bed at the same time every night. Not staying in bed if you can’t sleep. Instead, get up and do something until you feel sleepy.
• Examine some of your cognitive processes. Anxiety, for example, contains a lot of pessimistic predictions (“What if I don’t meet this deadline?” or “I know I’ll embarrass myself during this presentation!”).
• When you detect negative thinking, attempt to counter it with something more practical or beneficial, such as “I always meet my deadlines, and even if I miss this one, it won’t be the end of the world.”
• Find coping solutions for anxious behaviors such as lip biting or nail chewing.
• Deep breathing or gradual muscular relaxation might assist you in regulating your tension.
• Learn how to combat your anxious tendencies by using a competing response. For example, To avoid biting your lip, you can do a behavior incompatible with the anxious habit, such as chewing gum.

Conclusion

High Functioning Anxiety is a two-edged sword. You may be reluctant to let go of something that seems like a part of your personality, but you don’t have to be secretly anxious to achieve and succeed. Not only does success not have to be the product of such hardship, but being open to your actual feelings and expressing them with others may help you have a more honest life experience and the world around you. If you want to know more about High Functioning Anxiety, I invite you to have a virtual coffee with me.