Anxiety is not something many people enjoy having.
Increased heart rate, that feeling in the gut, the constant thoughts of ‘what if’…it’s not exactly fun.
Yet, a lot of people go through these struggles without ever telling anyone.
Considering that 40 million adults suffer from an anxiety disorder in America alone, it’s likely that you’ve spent time or dated recently with someone who has ‘high functioning anxiety’: a term used to describe someone who experiences anxiety constantly, but it’s not so severe that it keeps them frozen. They’re actually performing normally (on the outside).
First, let’s talk about what high functioning anxiety is, then we’ll discuss 11 common signs of high functioning anxiety, and finally we’ll talk about strategies to deal with it.
What is high functioning anxiety?
First, it’s important to point out that high functioning anxiety is not officially recognized as a mental health diagnosis.
Rather it’s term that has evolved from people who consider themselves having anxiety but are still able to function in most aspects of their life.
In fact, the anxiety experienced may even propel someone with high functioning anxiety to take action.
According to the National Institute of Mental Health (NIMH), 18 percent of the population deal with an anxiety disorder and “some fall into the category of “high functioning” – silent anxiety hidden behind a smile.
For something to be considered a mental illness, there must be a disruption or impairment to life functions.
As a result, there is an argument to be made that there is no clear impairment for someone who is suffering from high functioning anxiety.
It’s common for someone with high functioning anxiety to be quite successful.
They’re usually dressed well, work longer and later than everyone else, highly driven and rarely miss a deadline for a given task.
They’re very helpful to others and have social lives that most of us would envy.
However, what lies beneath the surface is a different story.
What most people don’t know is that underneath a perfect exterior, they’re experiencing severe anxiety that would make most people uncomfortable.
For example, you may not know but at times they’re stomach is churning and they’re heart is racing 4 times faster than usual.
No one would ever believe this to be the case, however.
According to Lynne Siqueland, Ph.D. of the Children’s and Adult Center of OCD and Anxiety:
“As therapists, we talk about a lot of people even with diagnosed anxiety disorders as ‘high-functioning,’ and many of them are…They are doing really well in their jobs, in relationships and raising kids, despite having significant anxiety.”
Even though they probably need a day off work to refresh themselves, they never take a day off because they’re afraid of what other people think.
After all, they’re the perfect picture of success.
So what causes someone to have high functioning anxiety?
It could be the fear of failure, or fear of disappointing others.
According to research, people with an anxiety disorder perceive the world in a very different way.
This involves excessive anxiety and worry, even when there isn’t a rational reason for concern.
As their mind continually worries about what could go wrong, it can cause mental exhaustion.
After all, it requires a lot of energy to deal with anxiety, not only mentally but physically.
But people with high functioning anxiety may worry about not being successful or not living with integrity.
This causes them to appear as if they’re upholding these standards more than most.
Their anxiety is like a motivator to help them take action.
According to Siqueland:
“Much of anxiety is internal-uncontrolled worry or social evaluation, and no one would know unless the person has a lot of physical symptoms of avoidance…Many people with mild to severe anxiety will do the essential tasks but limit other experiences or opportunities, and this is what sometimes leads them to treatment.”
What’s it like to have high functioning anxiety?
It’s not as easy to manage as it looks. It’s different from high functioning depression.
While many people with high functioning anxiety will look fine on the outside, they may be severely struggling inside to simply make it through the day.
After all, they are able to accomplish tasks and appear to function well in social situations, but at the same time they may be experiencing physical sensations like a rapid heart rate or worrisome feelings.
If you have high-functioning anxiety, you’ve no doubt felt frustrated by the lack of understanding some people offer when you tell them you have anxiety.
There seems to be a stigma around how people classify their conditions and what the world thinks of those conditions.
Regardless of what you call it, anxiety is very real, and very upsetting to those who have it.
Anyone who suffers from anxiety knows hard it is to convey the physical and mental symptoms to someone who doesn’t get bogged down with their thoughts and emotions.
Here are five things people with high-functioning anxiety want you to know. This information can help you be more empathetic and understanding, but also, help those with anxiety feel less alone.
1) Work is great. Life may not be.
While someone with high-functioning anxiety might look like they’ve got their act together at work, when they get home from work, they tend to fall apart.
The might freak out in a bathroom stall a few times a day, but you won’t see that either.
The reason people with high-functioning anxiety are considered high-functioning is that they can get up and get shit down, but that doesn’t mean they aren’t experiencing signs and symptoms of anxiety all throughout the day.
If you know someone who has anxiety, make sure you check in on them after hours to see how they are doing.
2) It may not be ambition driving them.
You might admire someone who is full of ambition and drive only to find out they are riddled with anxiety.
Not all anxiety cripples people. Some of it makes people move really fast so they don’t have to deal with the thoughts and feelings they are experiencing.
Ambition can be driven by fear or anxiety and when things are done being rushed and frantic, they crash.
These people keep moving so they don’t have to face the fact that they need help. The feel great when they move, so they just keep moving.
3) Getting through the day is hard.
While people with high-functioning anxiety seem okay, they are usually worried about something under all the facade.
We all do that, though, don’t we? Try to keep up appearances? Whether or not someone has anxiety doesn’t dictate how hard they try to impress others.
Outward appearances are important for people with high-functioning anxiety because they don’t want to get bogged down by their thoughts.
And they don’t want your pity. But getting through the day, another rmeeting, another complaining customer – those moments are hard sometimes.
4) Interruption is a nightmare.
When someone has high-functioning anxiety, an interruption in their work can be difficult for them.
When they are focused on something, it is keeping their brain from thinking horrible thoughts that induce symptoms of anxiety.
When they are interrupted, their brain can light up again and make them feel anxious, worried, scared, or even fearful.
It’s hard to keep our brains on lockdown all day, but if you suffer from anxiety, you know the lengths you go to trying to ensure you don’t implode.
5) The thoughts keep on coming.
If there’s one thing that is true of everyone, not just high-functioning anxiety sufferers, it’s that we have thousands of thoughts a day.
The difference between someone with anxiety and someone without is that those thoughts can usually just show up and move on – almost without our knowledge sometimes.
But if you have anxiety, or you know someone with anxiety, those brains are on rapid fire all the time and become very overwhelmed by the thoughts that linger and come up.
Don’t ask an anxiety suffer what’s the worst that could happen – they’ll have lots to say about it. So be kind.
Understand that their brain is not your brain, and that some people need their space to process the world around them.
6) You often make up excuses to avoid social events
Social situations can be a huge source of anxiety for you. Having to experience this type of anxiety in public can be scary and tiresome.
Yet, when you are experiencing this anxiety, nobody realizes it. Whether it’s nervous chatter, or coming off as snobbish because you don’t want to engage fully in the conversation, you find ways to deal with it.
But because it’s not an enjoyable experience, you’ll often make up excuses to avoid social gatherings.
You only have a certain level of socializing you can experience each week.
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7) You overthink trivial things that others easily let go
Why was that person staring at me on the subway? Should I have said that to my co-worker? Why did he really send that text message?
You can spend hours analyzing these things because your over active mind believes there’s meaning in everything.
Even if you’re in a relationship, you can’t help but question whether they really do love you or not.
Anxiety transpires when you can’t find the answer. After all, your mind won’t let go unless there’s a solution, right?
Other people simply don’t understand how you can dedicate such time to analyzing small things. However, because you have high functioning anxiety, you generally keep these thoughts to yourself.
8) You’re a bad sleeper
Sleeping has always been an issue for you. It’s not exactly easy to get to sleep when you’re experiencing anxiety and your mind won’t stop.
To make matters worse, you frequently wake up early and the anxiety starts again so you find it impossible to go back to bed.
You don’t understand how some people can just magically get 8 hours of sleep every single night, no matter what environment they’re sleeping in.
However, even though you regularly lack the recommended daily dosage of sleep, you manage to get through the days just fine. Sometimes you wonder how in the hell you’re doing it!
9) You always think of the worst-case scenario
Enjoy the moment for what it is? Just live life without worrying? No way, hoozah.
You’re mind can’t help but imagine worst-case scenarios. You’re a hypochondriac and even the slightest hint of a cold causes your mind to go off in a whirlwhind of what it could be.
It’s not all bad though.
Imagining the worst case scenarios enables you to prepare for bad news better than others. And we all need someone who is prepared when shit hits the fan.
10) You constantly replay conversations in your head
Did I say the right thing? Why were they smiling when I said something serious?
These questions constantly run through your mind, even days after it happened.
This is why you hate confrontation. You don’t want to deal with those anxious thoughts every time you have a tense conversation with someone.
You know that the best thing you can do in a social situation is be nice, because otherwise you’ll be worried about offending someone.
Therefore, people think you’re excellent at social situations, which is a major trait of people with high functioning anxiety.
11) When someone shows concern for you, you start to worry even more
When somebody asks if you’re okay, you start to get even more worried.
“Maybe I’m not okay?!”
It’s annoying as well. You were feeling great until your friend put a negative thought in your head. It’s this kind of thing that sets your brain off wondering whether you’re really okay or not.
12) You fear the future, rather than look forward to it
While most people get excited about what lies ahead, you can’t help but be fearful of what’s going to happen.
You hate change and you’re always wondering what could go wrong. This is especially the case when you’ve finally found some peace.
The last thing you want to do is think about what obstacles lie forth in your path.
13) You’re a perfectionist
People always tell you that you’re going above and beyond what you really need to do. They might poke fun at you for caring so much.
But the reality is, you hate not finishing something or not doing something exactly the way you’ve envisioned. Things like doing a bad job or not trying your best in a creative project make your stomach churn.
This is partly why you’re so high functioning!
14) You have little ticks that manifest physically
Nail biting, hair twirling, lip chewing. These are all little symptoms of your anxiety. People think they’re bad habits , but really it’s just your anxiety internalized.
15) You find it hard to say no
You don’t know your limit and you don’t want to disappoint anyone. So you constantly say yes until things pile on top of each other and you left feeling completely overwhelmed.
You stretch yourself too thin but then somehow you try to take on more.
16) You compartmentalize your emotions
No one would ever able to say you’re someone who wears their heart on their sleeve. In fact, you do the opposite. You’re trained to behave like everything’s okay, even though it couldn’t be further from the truth.
No one would understand that you’ve become a professional level faker of being fine. You rarely show how you actually feel. Instead you bottle it up and hope it goes away.
Treatment for high functioning anxiety
Treatment for high functioning anxiety is like other treatments for anxiety.
Cognitive behavioral therapy (CBT) enables people to better deal with negative thoughts and irrational fears.
After all, even though someone with high functioning anxiety appears like they are performing well, they are still having to deal with negative thoughts and feelings inside.
Using CBT to deal with misguided thoughts can help the person with high functioning anxiety to thrive rather than just survive.
And that’s really the main goal of treatment.
Other treatments can include meditation, antidepressants, anti-anxiety medications.
However, anti-anxiety medications, like benzodiazepines and beta blockers can be habit forming and have side effects.
Of course, a big problem is that many people with high functioning anxiety do not seek treatment as they are still functioning well on the outside.
However, what needs to be known is that there is treatment available and therapies like CBT and SSRIs can be quite effective.
Hidden dangers of high functioning anxiety
The main problem with high functioning anxiety is that there’s an increase risk of developing other medical and mental health conditions.
According to research, anxiety can negatively affect cognition, memory and decision making.
It could also lead to medical conditions such as:
Heart conditions: Some studies have shown a link between anxiety and heart disease: “About 5% of adults in the general population meet the criteria for generalized anxiety disorder. But the incidence is higher among people diagnosed with coronary artery disease (11%) or with heart failure (13%).”
Respiratory issues: There’s a complex interaction between respiratory issues and anxiety. The symptoms of panic attacks and pulmonary disease overlap, so that panic anxiety can reflect underlying cardiopulmonary disease and dyspnea can reflect an underlying anxiety disorder. According to a study, successful treatment of panic can improve functional status and quality of life by relieving anxiety and dyspnea.
Gastrointestinal Issues: The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation, all of these feelings can trigger symptoms in the gut. Therefore, a person’s stomach or intestinal distress can be the cause or the product of anxiety and stress.
Therefore, even if one is functioning well with anxiety, if the anxiety is constant and intense, it makes sense to seek treatment to avoid the above kinds of health problems.
High functioning anxiety can be a double-edged sword.
While it’s difficult to let go of anxiety when it becomes a significant part of your personality, it’s important to realize that you don’t need anxiety to be successful.
Hold onto your personality and traits that you admire, but let go of the internal struggle. You don’t need to be attached to it.
You might be pleasantly surprised to understand that you don’t need to struggle with yourself, and that you can be more honest with your feelings with those around you. Expressing yourself fully and being who you truly are with those around you might help you release a lot of the tension.
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