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High-functioning anxiety is a term used to describe individuals who experience anxiety but are able to maintain a certain level of productivity and success in their daily lives. While they may appear put-together and accomplished on the outside, internally they may experience excessive worry, self-doubt, and stress.
It’s important to recognize that high-functioning anxiety is not necessarily a positive attribute and can be overwhelming and harmful to one’s mental health. Seeking support and care for anxiety is crucial, regardless of one’s level of functioning.
High-functioning anxiety is not recognized as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Still, it is characterized by symptoms of anxiety that do not prevent someone from being successful and productive in their lives.
On the outside, someone with high-functioning anxiety appears to manage well; they may be highly successful in their careers and academically and have a full social life.
However, they experience internal struggles of anxiety, such as excessively worrying, being restless, having racing thoughts, and feeling as if something bad is going to happen.
The Problem With the Term ‘High Functioning’
While reading this article, it is important to keep in mind that the term ‘high functioning’ can be problematic. Below are some reasons why the term ‘high functioning anxiety’ comes with issues.
It minimizes the struggles people face
Firstly, the term ‘high functioning anxiety’ suggests that anxiety is a positive thing that can help people perform better, which is not necessarily true.
While some anxiety can motivate people to work harder or be more productive, it can also be overwhelming, debilitating, and harmful to one’s mental health.
Just because someone with anxiety can ‘function’ well in many areas of life, does not mean they do not struggle in other areas.
It implies that some types of anxiety are desirable
The term ‘high functioning anxiety’ implies that there is a hierarchy of anxiety disorders, with high-functioning anxiety being somehow better or more desirable than other forms of anxiety.
This can lead to a lack of understanding and empathy for those with different types of anxiety and can contribute to stigma and shame around seeking help for anxiety.
It pressures others to be as ‘successful’
The term ‘high-functioning’ is often used to describe people who are able to maintain a certain level of productivity or success despite their mental health struggles.
While it’s important to acknowledge and support people who are able to function well despite their anxiety, this term can also perpetuate the idea that people with mental health challenges need to constantly “prove” their worth or value.
High functioning = contributing to society
Often, people are described as having ‘high functioning anxiety’ if they are contributing to society, such as being successful at work.
The term suggests that their anxiety is positive because it propels them to perform well at work and be productive to society. It may ignore the potential impact on other aspects of their life, such as their relationships, personal interests, and overall well-being.
This narrow focus on productivity and success can create pressure for individuals to prioritize work over their mental health and can perpetuate the idea that one’s worth is based solely on their ability to perform well in their job.
In summary, while the term ‘high-functioning anxiety’ may be well-intentioned, it can have negative implications and contribute to misunderstandings about anxiety and mental health.
It’s important to recognize and address anxiety regardless of how well someone can function in their daily life.
Signs of High-Functioning Anxiety
These are the signs of high-functioning anxiety, as identified by Dr. Julie Smith, a clinical psychologist:
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You experience high anxiety levels, but that feeling drives you forward. Therefore, you still meet everyone’s expectations, and they are unaware of the intense fear you often experience.
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You function really well in day-to-day life. The problem arises when you have to slow down or stop and rest. Among your friends, you might be known as a workaholic.
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You appear calm on the outside, but you’re constantly worrying and doubting yourself on the inside.
Below are some additional signs that may indicate that someone has high-functioning anxiety:
- Always looking busy, having a full schedule
- Not having much downtime to relax
- A strong desire to work on something until it is completed
- High achieving, often going beyond what is expected
- Always early for work or working late
- A need to always be in control
- Traits of a perfectionist
- Fear of failure
- Spend a lot of time planning and preparing
- Always wanting the best possible outcome
- May be very talkative and sociable
- Often agrees to help others out
What Is Low-Functioning Anxiety?
Low-functioning anxiety is not a clinically recognized term, but it can be used to describe individuals who experience anxiety that significantly impacts their ability to function in daily life.
Unlike high-functioning anxiety, individuals with low-functioning anxiety may struggle to maintain productivity, engage in social activities, and complete routine tasks due to their anxiety.
They may experience intense and overwhelming feelings of fear, worry, and panic that make it difficult to carry out daily responsibilities.
The term ‘low-functioning anxiety’ can be stigmatizing because it implies that individuals with anxiety who struggle more severely to function in their daily lives are somehow inferior or less capable than those with high-functioning anxiety.
Individuals who struggle to carry out daily tasks due to anxiety may feel shame and inadequacy if they are not seen as productive to those who can ‘function’ despite their anxiety.
How Can Anxiety Help People function?
High-functioning anxiety is thought to help propel individuals towards functioning well.
Some of the ways in which this can present as discussed below. It is worth bearing in mind that many of these are external presentations and may not reflect how an individual feels on the inside.
Appearing successful
On the outside, people with high-functioning anxiety may appear driven in their work, rarely miss deadlines, arrive to work early, or may stay late to complete projects, and seem to be working hard in general.
They may be more likely to be considered for promotions, achieve high grades, and work in higher-paid jobs for their strong work ethic.
Strong relationships
Someone with high-functioning anxiety may have a full social life and will likely agree to as many social events as they can manage.
They are usually willing to help others or offer help without being asked. Because of this, they may have a lot of strong friendships as people value how helpful and loyal they are.
Happy personality
Someone with high-functioning anxiety may have a calm exterior that they present to the world. They may have outgoing personalities such as being chatty, always happy, smiling, and laughing.
Friends and co-workers may often enjoy spending time with this type of individual if they are a very positive person to be around.
Detail-oriented
Having high-functioning anxiety may mean that someone is very organized, has lots of plans put in place, and is generally tidy. They may notice small details that others do not and may follow and stick to their schedules.
They may be the person that makes all the plans since this is something they are good at, and they plan for all possibilities, so they are prepared for almost anything.
Highly productive
Someone with high-functioning anxiety may be very good at making things happen due to their high productivity levels.
They can usually be relied on to complete many productive tasks and are the go-to person for many tasks. They can excel at staying on top of tasks and remembering what needs to be done.
Motivated and driven
People with high-functioning anxiety may see their symptoms as something which pushes them to be motivated and driven to perform at high levels.
They may believe that they would not be able to accomplish their goals without their anxiety.
According to Yerkes-Dodson Law, some anxiety levels positively correlate to increased performance at work, school, or home. This means that some anxiety is necessary to reach goals that an individual cares about.
The Consequences Of High-Functioning Anxiety
Despite their outward appearance of being a well-rounded, successful person, a person with high-functioning anxiety has a lot of internal struggles.
A lot of their observably ‘positive’ behaviors are often driven by anxious thoughts.
Some of the struggles of high-functioning anxiety include:
Overthinking
Those with high-functioning anxiety are prone to racing thoughts. They may overthink situations and overanalyze people.
They may ruminate on things that happened in the past and feel distressed and unable to control their thoughts. Due to overthinking and being unable to switch off, they may find they have difficulties going to sleep.
People pleasing
While someone with high-functioning anxiety may come across as outgoing and helpful, this is often because they are anxious about being seen in a negative way.
They may have people-pleasing tendencies meaning they always agree to help others out due to fears of feeling like they have let people down. They never want to say no to people even if they are burnt out, or it inconveniences them.
Likewise, they may be too scared to call in sick for work for fear of disappointing others.
Not being able to relax
Someone with high-functioning anxiety may find that they cannot relax or enjoy an activity that they do not consider ‘productive.’
They might not be able to sit and do nothing without feeling guilty that they are not working or increasing their skills, such as learning a new language or reading an informative book.
They may always be pressuring themselves to do something they consider worthwhile and valuable.
They may also have many nervous habits that stop them from relaxing, such as biting their nails, tapping their fingers, pacing, and rocking back and forth.
Having high expectations
Since a lot of people with high-functioning anxiety are high achievers, they may have a lot of pressure put on them to constantly be achieving more.
This pressure can come from others, such as parents, teachers, and employers, or it can come from within the individual. They may have a strong fear of failure, so they keep agreeing to do more and more tasks.
Their expectations can be so high that they feel as if they can never do enough to meet them.
Pressure to achieve
As they are often seen as high achievers, people with high-functioning anxiety may always feel immense pressure to achieve high levels of success.
While they may be viewed as highly successful, outsiders may not have any clue as to the struggle required to achieve that level of success or why they are high achievers.
False persona
Someone with high-functioning anxiety may be very skilled at portraying themselves as a calm, happy person who is always in control even if they do not feel this way.
They may often keep all their true feelings bottled up not to disappoint others.
They may have a false persona that is presented to the world, which they have been so skilled at keeping up that they may have lost sight of who they are.
Low self-esteem
People with high-functioning anxiety may feel as if they are not a worthy person without all their achievements.
They find it hard to see their value in other areas of life and may believe that other people will not want to be around them if they aren’t successful. They may think that if they decline to help someone out, then that person will not like them anymore.
They may feel as if their life has little value if they are not constantly on the go and striving to achieve more.
Being held back
Others may not realize that people with high-functioning anxiety struggle with their anxiety every day. Anxiety often holds people back from doing things outside their comfort zone.
Someone may put all of their focus on achieving success academically or at work that they miss out on other opportunities in life due to feeling too anxious to do anything other than what they know.
Unhelpful coping strategies
As is the case for many people who struggle with anxiety, those with high-functioning anxiety may turn to unhelpful coping strategies to help them manage their anxious feelings.
They may become dependent on alcohol or drugs to cope, risking substance-use disorders.
What Causes High-Functioning anxiety?
While there is often not one known cause for why someone may develop anxiety, it is thought that, in most cases, a combination of genetic and environmental factors can play a part.
Genetics
Someone may have a strong biological disposition to developing high-functioning anxiety, especially if they have an immediate relative, such as a parent, who also has anxiety or another mental health disorder.
Personality
The temperament of someone may make them more prone to developing high-functioning anxiety.
Those who were shy or timid as a child, are more socially withdrawn, or are less likely to take risks may be more likely to develop anxiety.
Negative childhood experiences
Exposure to adversity in childhood, such as trauma, abuse, neglect, and family chaos, could put someone at risk of developing anxiety.
Moreover, if a child is brought up around close family members who struggle with their mental health, they may have experienced a more unstable home life which could result in them developing high-functioning anxiety.
Being a high-achieving child
In many cases, there may not be a genetic predisposition or any negative life stressors that have caused someone to develop anxiety. It could be that someone was very gifted as a child and achieved a lot in a short amount of time.
Consequently, they may have received pressure from family, teachers, or themselves to achieve above and beyond what is typically expected.
The pressure may not intend to have caused any distress, but it can still cause someone to have unattainable expectations.
Treatment Options
A lot of people with high-functioning anxiety may not want to seek treatment as they find they may rely on their anxiety to propel them toward achieving their goals.
However, treatment should be considered if someone is experiencing any of the following:
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If their symptoms of anxiety are causing significant distress
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They find they cannot control their anxiety
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The anxiety affects their relationships, health, or occupation
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The anxiety is impacting their self-worth and confidence
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They are using substances as a way to manage their symptoms
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They are developing other symptoms associated with mental health issues such as depression
Treatments for anxiety usually involve psychotherapies and medications or a combination of both. Likewise, there are some ways in which an individual can manage their anxiety through lifestyle changes.
Therapy
Psychotherapies are often an effective treatment for anxiety as they delve into the root cause of someone’s distress and help change negative thoughts and behaviors.
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Cognitive behavioral therapy ( CBT ) – a common type of psychotherapy that involves working with the therapist to identify unhelpful thought patterns and behaviors and instead identify healthy and realistic ones.
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Dialectical behavior therapy ( DBT ) – a type of CBT that teaches behavioral skills to help someone manage their stress and emotions, teach acceptance, and improve relationships with others.
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Acceptance and commitment therapy (ACT) – a therapy that is focused on helping people live in the moment and accept the present without judgment as a way to cope with discomfort.
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Eye movement desensitization reprocessing ( EMDR ) – a way to reduce the distressing thoughts commonly linked to anxiety through bilateral stimulation.
Medication
Below are some of the most common medications that can be prescribed for someone who is struggling with the symptoms of anxiety:
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Some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)
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Buspirone, which is an anti-anxiety drug
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Benzodiazepines, which are often prescribed for short-term relief of anxiety
How to Manage High-Functioning Anxiety
Below are some ways in which high-functioning anxiety can be managed in your everyday life:
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Spend some time every day dedicated to your mental health – this can involve journaling, using a mood diary, or completing a short, guided meditation session.
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Limit your caffeine intake as this is known to increase physical symptoms of anxiety
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Eat a healthy, balanced diet.
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Engage in regular exercise such as aerobic exercises which can help relieve excess anxious energy.
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Try progressive muscle relaxation exercises.
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Stick to a regular bedtime routine – if you find that you cannot sleep because your mind is racing, get up and do something else until you feel tired.
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Try to identify negative thought patterns when they occur, so you are made aware of what you are thinking. Ask yourself why you are having these thoughts and try countering them with something more realistic or helpful.
For instance, if you find you have a thought such as ‘I must not make any mistakes,’ counter this with ‘If I do make a mistake, then it will not be the end of the world.’
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Try to identify why you hold onto your anxiety. For example, do you worry that you will not be able to succeed as well if you are not anxious? Once you can address your reasons, this can help you identify what needs changing.
Frequently Asked Questions
Is high-functioning anxiety similar to ADHD?
Oftentimes, anxiety can be mistaken for attention deficit hyperactivity disorder (ADHD) and vice versa. Some traits overlap between ADHD and high-functioning anxiety, including:
– The inability to relax, feelings of restlessness
– Difficulty concentrating or sustaining attention
– Having racing and scattered thoughts
However, they are not the same disorders. The reasons for their shared symptoms are where they differ.
Someone with high-functioning anxiety may not be able to relax because they have given themselves such a busy schedule that they cannot fit in any rest time.
Whereas someone with ADHD may feel restless because they feel like they are driven by a motor and need a lot of stimulation.
A person with high-functioning anxiety may have difficulty with concentrating or sustaining attention because they have a lot of racing anxious thoughts, whilst a main trait with ADHD is that they have dysregulated attention and can find it hard to focus on one thing at a time.
Can high-functioning anxiety be linked to depression?
Whilst they are different conditions, there may be a link between high-functioning anxiety and depression.
The National Alliance for Mental Illness (NAMI) indicates that around 60% of people with anxiety will also have symptoms of depression.
It is often seen that anxiety and depression go together, and having one condition may put someone at a higher risk of developing the other.
Likewise, if people do not seek treatment for anxiety, they may be at more risk of developing depression.
Those with high-functioning anxiety may be less likely to seek treatment than those who outwardly appear to be struggling.
This could be partly because some people with high-functioning anxiety find their anxiety helpful to motivate them to succeed. Over time, not managing their anxiety could worsen their symptoms, and it may develop into depression.
Do people with high-functioning anxiety mask their struggles?
People with high-functioning anxiety may often mask their struggles.
They may appear successful, organized, and capable, but they may also be experiencing intense anxiety and stress internally. They may try to control their environment, avoid making mistakes, and seek constant reassurance from others, all while appearing calm and collected on the outside.
This masking can make it difficult for them to seek help or support, and can also lead to feelings of isolation and shame.
References
Ayano, G., Betts, K., Maravilla, J. C., & Alati, R. (2021). A systematic review and meta-analysis of the risk of disruptive behavioral disorders in the offspring of parents with severe psychiatric disorders. Child Psychiatry & Human Development, 52(1), 77-95.
Christiansen, D. M. (2015). Examining sex and gender differences in anxiety disorders. A fresh look at anxiety disorders, 17-49.
Government of Western Australia. (n.d.). The Vicious Cycle of Anxiety. Centre for Clinical Interventions. Retrieved 2021, November 19, from: https://www.cci.health.wa.gov.au/~/media/CCI/Mental-Health-Professionals/Panic/Panic—Information-Sheets/Panic-Information-Sheet—03—The-Vicious-Cycle-of-Anxiety.pdf
Nikčević, A. V., Marino, C., Kolubinski, D. C., Leach, D., & Spada, M. M. (2021). Modelling the contribution of the Big Five personality traits, health anxiety, and COVID-19 psychological distress to generalised anxiety and depressive symptoms during the COVID-19 pandemic. Journal of Affective Disorders, 279, 578-584.
Zhang, F., Baranova, A., Zhou, C., Cao, H., Chen, J., Zhang, X., & Xu, M. (2021). Causal influences of neuroticism on mental health and cardiovascular disease. Human Genetics, 1-15.
