It is normal to feel anxious from time to time, especially in a stressful situation. But for some people, excessive and persistent anxiety can be difficult to control and often interferes with daily activities. This can be a sign of an anxiety disorder.
Anxiety disorders are common and affect millions of people worldwide. About 6.8 million American adults are diagnosed with generalized anxiety disorder, but the number of people who suffer from anxiety is probably much higher.
High-functioning anxiety disorder is a subset of generalized anxiety disorder that often goes unnoticed or undiagnosed. It occurs when a person has symptoms of anxiety, but rather than withdrawing from situations or interactions, works hard to face their fears and is adept at masking the symptoms.
Defining high-functioning anxiety
High-functioning anxiety is not recognized in the Diagnostic and Statistical Manual of Mental Disorders. Instead, it is usually diagnosed as generalized anxiety disorder.
The term “high-functioning anxiety” refers to people who exhibit symptoms of anxiety while maintaining a high level of functionality in various aspects of their lives. They are often successful in their careers or other roles, but inside they struggle with persistent feelings of stress, self-doubt, and fear of missing out. They feel extremely uncomfortable inside and struggle with significant self-criticism.
To an outside observer, people with high-functioning anxiety may appear excellent and in control. They don’t seem to avoid or withdraw from life. They may have successful careers, participate in many volunteer or community activities, and have strong personal relationships. Yet behind this facade, these people have constant thoughts of worry, fear and high levels of stress or feel on edge.
Symptoms of high-functioning anxiety
There are emotional and physical symptoms associated with generalized anxiety disorder. Symptoms of high-functioning anxiety reflect many of these, but some may be more pronounced.
In addition to general nervousness, worry, and feelings of tension, people with high-functioning anxiety may internally struggle with:
- Fear of criticism or significant self-criticism
- Fear of appearing inadequate or stupid to others
- Feeling on edge or on the verge of losing control
- A sense of impending doom
- Significant stress
People with high-functioning anxiety may also experience physical symptoms, such as:
- Excessive sweating
- Feeling of loss of balance or dizziness
- Headaches or migraines
- Intestinal problems, such as diarrhea or ulcers
- Muscle tension
- Rapid heartbeat
- Rubber or jelly feet
- Sleep disorders
- Tingling or numbness in the toes or fingers
The intensity of these symptoms varies depending on the person’s level of functioning.
Who is in danger
High-functioning anxiety can affect people of any age and gender, but some people are at a higher risk of experiencing it. Women are twice as likely as men to develop generalized anxiety disorder during their lifetime. This can be due to social pressures, gender roles and relationship concerns.
Others at risk of developing high-functioning anxiety include people:
- Experiencing significant stressors
- Having a genetic predisposition to anxiety
- Who grew up in families where they felt less safe
- Who had caregivers who were also concerned or had high expectations of them
Impact on everyday life
High-functioning anxiety can significantly affect various areas of a person’s life, despite outward success and achievement. People with high-functioning anxiety tend to over-function. They can work extra hours, volunteer for extra tasks, or try to do all tasks perfectly. They look for clues about how society defines success and put pressure on themselves to meet or exceed these often unrealistic expectations. This intense effort can lead to burnout due to their constant pursuit of overachievement and fear of failure.
People with high functional anxiety can also put their personal relationships at risk because they spend so much time focusing on other areas in their lives. Criticism, even constructive feedback, can be particularly difficult for people with high functioning anxiety. They can overreact to any criticism and harshly internalize it. They may neglect self-care such as sleep, exercise and diet and face physical health problems related to chronic stress.
Managing high-functioning anxiety
It is important to remember that there are good qualities that come with anxiety. People with anxiety are often caring, empathetic, peacemakers, rule-followers, and good citizens. Many have a strong desire to overcome their challenges. I believe that anxious people are great. They just need to believe in themselves and develop the tools to become more confident and self-accepting. Identifying their core values will help them set goals that truly match what’s important to them.
Counseling and therapy play a key role in helping people with high-functioning anxiety effectively manage their symptoms. Going to therapy does not mean that the person is weak or unable to function. It is a strong sign that the person is intelligent, humble, teachable and proactive.
Cognitive behavioral therapy works by helping people learn to reframe their thoughts about life and transform the behaviors that may be feeding their anxiety. Instead of being self-critical and looking for what could go wrong, a person with high-functioning anxiety learns to manage their thoughts, look for solutions, and navigate through feelings of anxiety.
Instead of being afraid of anxious feelings, a person can be taught to accept it and say something like, “I have anxiety and that’s okay. My anxiety doesn’t make me a bad person. It’s just the way my body and mind react to situations and I can deal with it.”
In addition to therapy, coping strategies to alleviate anxiety symptoms include:
- Forgetting comparisons
People with anxiety tend to compare themselves to others, feel the need to improve, and want to be more like others. Comparing can rob you of joy and satisfaction. - In search of a healthy lifestyle
Each person has different needs and energy levels. Some people thrive when they are constantly moving, while others need time to decompress. Your needs for sleep, self-care, nutrition, exercise and work-life balance will differ from others. You’ll know you’ve found the right flow when you feel at peace with yourself with the amount of busy vs. rest and work vs. play. - Creating a support network
People with high functioning anxiety may believe that they have to deal with their behavior alone because they fear criticism or negative outcomes. A positive support network of people who care about you, regardless of the outcomes, can help alleviate anxiety symptoms. - Identifying core values
Some people with high functional anxiety become fixated on success as defined by society, such as having a “real” job, car, house, and material possessions. These items are often important only because other people believe they are important. A therapist can help you discover what’s important to you beyond society’s expectations and align your thoughts and actions with your core values. - Practicing mindfulness
This is the practice of deliberate awareness and focus on the present moment. Concentrating on one thing or moment can increase feelings of calmness and peace. - Establishing healthy boundaries
This can improve relationships with others and establish rules for yourself. The importance of saying “no” often is discussed as part of setting boundaries. This is because many people overexert themselves. But some people with high functional anxiety should also accept saying yes to opportunities that increase their comfort level. Their lives grow in experience and fulfillment the more they face their fears. - Learning to accept criticism
This can be difficult for many people, but especially for people with high-functioning anxiety. They can fight back or defend themselves. A therapist can help you find ways to step back in the moment and evaluate the feedback in a neutral, unemotional way.
Medications can help some people with high-functioning anxiety, but they should only be used in combination with other coping strategies and under the supervision of a healthcare professional.
Although high-functioning anxiety may not be a recognized diagnosis, it represents a significant subset of people who experience anxiety symptoms while maintaining a high level of functioning. These people face internal struggles such as constant self-doubt, fear of failure, and constant striving for perfection and to please others, which deeply affects their daily lives.
Talk to your health care team if you experience symptoms of anxiety such as constant self-doubt, fear of failure, and constant striving for perfection. I can connect you with therapy and help you develop coping strategies so you can foster healthier ways to manage your anxiety and lead a fulfilling life.
Linda Hubbard is a psychotherapist in Psychiatry and psychology in clear waterWisconsin.
