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You may find it hard to believe that someone who is successful, calm, punctual, and put-together is dealing with anxiety, but the truth is, not all anxiety looks the same—far from it, actually. High-functioning anxiety is a good example: If you have this condition, you may appear "fine" at the surface and operate productively in many areas of life, but underneath, you might feel the walls closing in on you, like you’re not good enough or should be doing more.
Despite being fairly common, high-functioning anxiety often flies under the radar and isn’t discussed openly, so we reached out to psychologists to shed light on the condition.
What is high-functioning anxiety?
“High-functioning anxiety is when someone's anxiety is severe enough to cause them a lot of emotional pain, but it's not visibly affecting their ability to succeed in life,” says clinical psychologist Aimee Daramus. She says sometimes people with high-functioning anxiety feel like a fraud because they don’t think they deserve the praise they receive, despite being a high achiever. “Other times, they might know that they're really good, but there's a vision of perfection in their heads that they want to achieve, but never truly can,” Daramus says.
How is this different from other types of anxiety?
Dede Ukueberuwa, a clinical psychologist and assistant professor at the Icahn School of Medicine at Mount Sinai, explains that high-functioning anxiety isn’t a clinical diagnosis, but a descriptive term used to describe the behavior of an anxious person. “Someone with any level of anxiety, from normal range to clinically elevated, could act in a high-functioning manner,” Ukueberuwa says. “It’s all about whether the person is able to be effective in their environment, and that can depend a lot on what their role is at work, school, home, or in relationships.
Clinical Psychologist Jamie Long says that someone with high-functioning anxiety may show symptoms commonly associated with generalized anxiety disorder, but not enough to be diagnosable because they’re still able to function in daily life. With other forms of anxiety, though, the symptoms will often interfere with work, school, relationships, and other parts of life, according to the National Institute of Mental Health.
“One in five people are diagnosed with an anxiety disorder, so this means that even more people suffer with functioning anxiety,” Long says. “Even though a person with high-functioning anxiety may not meet full criteria for a diagnosis, it’s still a serious mental health issue.”
What are some of the signs and symptoms?
The signs and symptoms of high-functioning anxiety are broad and varied, and fall into a number of categories. Clinical psychologist Carla Marie Manly describes some of them as follows:
- Nervous Habits: People with high-functioning anxiety may exhibit nervous habits like nail biting, eye blinking, hair twirling, throat clearing, or leg twitching.
- Perfectionism: This is a big one, and pretty common. “High-functioning anxiety may result in the pursuit of perfection, whether at work, in personal relationships, or in unrealistic expectations of one’s physical appearance,” Manly says.
- Overachievement: People with high-functioning anxiety may have a tendency to overachieve, constantly wanting to be the best at everything they take on.
- Underachievement: Sometimes, high-functioning anxiety can result in avoidance of certain activities in order to steer clear of disappointing oneself or others.
- Problems with sleep: People with high-functioning anxiety may have trouble falling asleep or not be able to fall back asleep after waking in the night. You can think of this as anxiety’s way of making its presence known after being covered up all day. “When an individual internalizes anxiety and functions well during the day, the anxiety may come out in the form of sleep disturbance,” Manly says.
- Trouble relaxing: If you constantly experience low levels of anxiety, you may have trouble relaxing and instead stay busy all the time. The exact mode of staying busy can take many forms, from exercise to work to cleaning your home.
- Controlling habits: “Given the constant level of anxiety, the individual may unconsciously resort to controlling habits in order to feel more in charge of life, Manly says. “Controlling habits are unconsciously utilized in that they allow an anxious person to control or anticipate any changes or variations that are likely to produce anxiety.”
Is high-functioning anxiety treatable?
High-functioning anxiety is most certainly treatable, experts say. One common route is to work with a psychologist who will use cognitive behavioral therapy and other techniques to help you learn to understand triggers, manage symptoms, and change deeply entrenched thought patterns, with the ultimate goal of breaking your anxiety cycle:
“Often with anxiety, there are underlying negative thoughts that pop up into the person’s head about terrible events that could occur if they do not act in a certain way,” Ukueberuwa says. “These thoughts then trigger “fight-or-flight” symptoms, where they rush to action, or avoid taking on any unfamiliar challenges with uncertain consequences.”
Medication (a very common form of treatment) can also be helpful to weaken the response of symptoms for some, Ukueberuwa says.
Why treatment is important
Someone with high-functioning anxiety may put off treatment because, that's just it—they’re high-functioning and feel like they don’t need to fix anything. Instead, they wait for their anxiety to get to the point where it’s extreme or to the point where failure occurs, in whatever form that may be. But for someone with high-functioning anxiety who is accustomed to success, failure can have devastating effects:
“Persistent anxiety can lead to lapses in concentration and memory, burnout, exhaustion, and even increased risk for serious health conditions related to chronic stress, such as cardiovascular and autoimmune problems,” Ukueberuwa explains. She says she frequently works with people who are high achieving and successful, but feel burnt out, stuck, tired, and unsure how to accomplish their life goals.
Daramus says that one of the biggest problems with high-functioning anxiety is that it will always come back to you in some way as a problem if left unresolved. Maybe your colleagues won’t want to work with you because they find you too controlling; maybe you fail to meet deadlines because your work never feels perfect enough to submit on time, or maybe you burn out in the quest for unattainable perfection. Either way, the eventual outcome of avoidance most likely won’t be good.
“A good therapist can teach you skills that will help you continue to excel, while turning down the volume on anxiety to reduce your angst," Daramus says. “If you want, that therapist can also help you understand how and why you developed this style of coping with life.”
Feeling like success is tied to your anxiety
Sometimes people with high-functioning anxiety resist treatment because they feel that anxiety is the secret to their success. “Even though they're suffering, they may have conflicts about being in treatment because they're afraid that if the anxiety goes away, so will the success,” Daramus says.
If you find it hard to believe that you can be just as successful without anxiety, this likely applies to you. Treatment can help you learn that anxiety may still kick in at times when you have a lot going on, while also helping you realize that a lot of the symptoms that come along with anxiety aren’t productive and are fine to let go.
How you can manage high-functioning anxiety
Our experts recommend a few practical steps for keeping your high-functioning anxiety under control, like taking a moment to pause during stressful situations, writing down your fears and negative thoughts, setting boundaries around work and other commitments, and engaging in mindfulness exercises or other grounding activities.
Overall, you’re far better off incorporating anxiety management strategies into your day than waiting until negative consequences arise. But remember, there’s no one-size-fits-all approach here—what works for one person may not be the best for another. It’s important to see a psychologist who can help you come up with strategies and techniques that make sense for your personality, goals, and life.
Another important way to manage anxiety is to learn techniques for managing your fight-or-flight response. Ultimately, this will vary from person to person. Daramus explains this could play out in the form of meditation, spending time with your pet, or listening to calming music. If calming music isn’t stimulating enough for you, Daramus recommends creating and listening to what she calls a “step-down playlist,” in which the first song matches your current energy level and the songs subsequently slow down until you’ve eased your way into a more relaxed mindset.
It’s also important to learn how to replace anxious thoughts with thought patterns that are more useful. “Learn to see where you're catastrophizing a bad situation, learn to do the good-enough job sometimes, or learn to replace imaginary fears with more healthy thoughts,” Daramus says. “Some thoughts, like the urge to double-check, might be useful at some times, but not at others, so you can learn to resist the urge to double- or triple- or quadruple-check when it isn't necessary.”
National Institute of Mental Health. Anxiety disorders. Updated July, 2018.