On any given day, you could be out to dinner with a group of girlfriends or having drinks with your coworkers and not even realize that the person who always appears perfectly content, in control, and thriving, is riddled with worries and constant thoughts, feeling incapable of coping, and struggling to get through today. Those are just a few of the many ways high-functioning anxiety can manifest. While the term might sound like a bit of a contradiction, it’s absolutely a real thing. It doesn’t typically have a formal diagnosis from a mental health professional, but has gained traction with more people, specifically women, identifying with it.
Here’s why: “Since the beginning of time, women have been socially conditioned to function through discomfort and pain,” said Morgan Reid, M.S.Ed, CEO and Founder of A Little Mental, Mental Health Professional. “So it makes sense that something so internal like feelings of overwhelm, stress, and fear of disappointment are passed off as non-existent because women still make things happen, no matter the cost.”
So what exactly is high-functioning anxiety, what does it look like, and what are some ways to cope with its symptoms? We chatted with mental health experts, and here’s what they had to say.
What is high-functioning anxiety?
The term “high-functioning anxiety” describes the experience of excessive worry, perfectionism, overthinking, and the need to keep functioning found in people who appear successful and composed or high-functioning. “The anxiety is a maladaptive coping mechanism meant to quiet internal turmoil,” says Michelle Rose, PhD, LPC, ACS, Director of Clinical Mental Health Counseling at the University of Western States. “Those with high-functioning anxiety feel inwardly distressed and seek constant activity to manage the maladaptive thoughts and feelings. While others may see them as accomplished and highly efficient, the person’s inner experience is quite different from how others may perceive them.”
While 6.8 million adults in the United States, or 3.1% of the population, have generalized anxiety disorder (GAD), high-functioning anxiety is not officially recognized as a condition. This is because a fundamental requirement of most diagnosable mental health disorders is that symptoms cause significant and ongoing impairment in key areas of functioning such as work, school, social relationships, according to Rose. Those who experience symptoms of a diagnosable anxiety disorder generally do not function well in one or more of those situations. “So far, no version of the DSM (the American Psychiatric Association’s standard classification of mental disorders used by mental health professionals in the United States) recognizes perfectionism or overthinking as symptoms of the large variety of anxiety related disorders such as GAD. However, a mental health or medical professional can rely on their professional judgment to diagnose this cluster of symptoms as an Unspecified Anxiety Disorder.”
What are signs of high-functioning anxiety?
Physical symptoms of high-functioning anxiety could include headaches, stomachaches, insomnia, excessive sweating, or racing heart beat, Reid says. While internal or mental symptoms could include perfectionism, excessive worry, fear of disappointment, racing thoughts, fear of losing control, significant self-criticism, fear of impending doom, overthinking or overanalyzing, and an inability to relax.
“It’s a bit more difficult to determine when someone has high-functioning anxiety because they present as calm, successful, and without issues,” says Reid. “That being said, high-functioning anxiety can be considered a problem when it manifests into physical symptoms that lower your functionality, like headaches growing into migraines.”
It can also become a problem when it leads to hyper-fixation on tasks or projects, past the point of productivity.
Ways to treat and cope with high-functioning anxiety
The first step in determining any version of care, physical or mental, is figuring out where the pain or trigger comes from. Reid suggests to ask yourself, Do you feel more anxious at work? When do you notice your thoughts start to repeat themselves? Is there a particular situation that you find makes you perspire more than others? “Collecting this information will make it much easier for you to recognize loss of function and try to address the issue yourself and communicate it to a mental health professional for additional support,” says Reid.
If you are striving to address the anxiety yourself, start by practicing relevant self care practices. This can look like holding boundaries with the time you spend on certain tasks. It could also mean identifying a friend or family member who can help validate your emotions in those tougher moments and support you through them. If your anxiety is still significant or you aren’t sure what will work, going to see a mental health professional is a great option, according to Rose.
Similar to treatment for diagnosable anxiety-related disorders, evidence-based treatment is an option, says Rose. It should include a discussion about medication with a medical provider, psychoeducation about the brain and how it creates anxiety in the central nervous system (so individuals can understand it is not a flaw or a character issue), meditative breathing and mindfulness exercises, review of the cognitive biases that lead to excessive worry, and the development of healthier problem-solving strategies.
Yoga, regular exercise, balanced diet, good sleep hygiene, and regular self-care are fundamental to successful treatment, adds Rose. So is affirming what’s going on. “Just because it’s not technically in the DSM, does not mean that your experience doesn’t matter,” says Rose. “A lot of people experience high-functioning anxiety and there are plenty of resources and sources of support that can be used to address it.”