What Is High Functioning Anxiety?

High-functioning anxiety is often hidden.
Getty / Ken Wramton

High functioning anxiety is not a recognized mental health diagnosis. Rather, it's evolved as a catch-all term that refers to people who live with anxiety, but who identify themselves as functioning reasonably well in different aspects of their life.

If you have high functioning anxiety, you probably notice that your anxiety propels you forward rather than leaves you frozen in fear. On the surface, you likely appear to be successful, together, and calm—the typical Type A personality who excels at work and in life—though the way you actually feel on the inside may be very different.

About 40 million adults deal with an anxiety disorder at any given time, according to the National Institute of Mental Health (NIMH). Of this approximately 18 percent of the population, some fall into this category of "high functioning"—essentially silent anxiety hidden behind a smile.

What It Looks Like

Someone with high functioning anxiety may be the picture of success. You might arrive to work earlier than everyone else, impeccably dressed, with your hair neatly styled. Coworkers may know you as driven in your work—you've never missed a deadline or fallen short in a given task. Not only that, you're always willing to help others when asked. What's more, your social schedule also seems busy and full.

What others might not know, and what you would never share, is that beneath the surface of a seemingly perfect exterior, you're fighting a constant churn of anxiety. It may have been nervous energy, fear of failure, and fear of disappointing others that drove you to success.

Though you desperately need a day off work to get yourself together, you're often too afraid to call in sick. Nobody would ever believe something was wrong, because you always portrayed yourself as being fine.

Do you identify with the characteristics of a person with high functioning anxiety? Let's take a specific look at what you might experience or what others might observe of you in this case.

Positive Characteristics

The positive aspects of high functioning anxiety are generally the outcomes and successes that you and other people observe. On the surface, you may appear to be very successful in work and life—and in fact this may be objectively true if you evaluate yourself simply on what you achieve.

Below are some "positive" characteristics you might see with high functioning anxiety:

  • Outgoing (act happy, tell jokes, smile, laugh)
  • Punctual (arrive early for appointments)
  • Proactive (plan ahead for all possibilities)
  • Organized (make lists, keep calendars)
  • High achieving
  • Detail-oriented
  • Orderly and tidy
  • Active
  • Helpful
  • Appear calm on the outside
  • Passionate (throw yourself 100 percent into tasks)
  • Loyal in relationships

Negative Characteristics

In the case of high functioning anxiety, underneath that veil of success lies a struggle. Success does not come without a cost, and sometimes the anxiety that you feel finds its way out.

Some of these characteristics might be perceived by others as "cute" or just part of your personality, but they may in fact be driven by underlying anxiety. Some of these characteristics are internal, and are never even noticed by others—but they are "over the top" nonetheless.

Since people don't know that these actions are caused by anxiety, they may view them as just part of your personality. Despite being "high functioning," you might face the following struggles:

  • A people pleaser (fear of driving people away)
  • Nervous chatter
  • Nervous habits (playing with your hair, cracking knuckles, biting your lip)
  • Need to do repetitive things (counting stairs, rocking back and forth)
  • Overthinking
  • Lost time (arriving to appointments too early)
  • Need for reassurance (asking for directions multiple times, checking on others frequently)
  • Procrastination followed by long periods of crunch-time work
  • Avoiding eye contact
  • Rumination and a tendency to dwell on the negative (What if? thoughts, dwelling on past mistakes)
  • Inability to say no and an overloaded schedule (fear of being a bad friend or letting people down)
  • Insomnia (difficulty falling asleep, waking early and unable to fall back asleep)
  • Racing mind
  • Others think you are difficult to read (stoic, unemotional, cold)
  • A limited life (turning down invitations)
  • Inability to enjoy the moment (expecting the worst)
  • Intimidated by the future
  • Tendency to compare yourself to others (falling short of expectations)
  • Mental and physical fatigue
  • Overly busy/full schedule (fear of saying no)
  • Loyal to a fault in relationships
  • Potential for alcohol or substance abuse as a coping method

Success, But With a Struggle

The typical high functioning person with anxiety appears to be an overachiever. This perception is short-sighted though, because it fails to take into account the struggle involved in getting there.

If you've been diagnosed with generalized anxiety disorder (GAD), or you tend to worry about a lot of different things, you may be more prone to high functioning anxiety. The thought of a messy house or a missed deadline might send your anxiety soaring—so this is what keeps you cleaning or working hard.

If you asked most people, they would probably not have a clue that you struggle daily with anxiety. However, you know that your life is limited by your anxiety in some important ways. Perhaps you achieve essential tasks but limit your life in other ways, such as not deviating outside your comfort zone. Your actions are probably dictated by your anxiety, such that you choose to fill your life with activities as a way to calm your racing thoughts, rather than based on what you might enjoy or what could help you expand your horizons.

You've also become adept at presenting a false persona to the world, because you never show your true feelings to anyone. Instead, you keep it all bottled up inside, and compartmentalize your feelings with a plan to deal with them later, but of course later never comes.

Asking for Help

There are many reasons you may not have sought help if you have high functioning anxiety:

  • Perhaps you consider it a double-edged sword, and don't want to lose the positive influence of your anxiety in terms of your achievements.
  • Maybe you are worried that your work will suffer if you are not constantly driven to work hard out of fear.
  • You might think that you are not ill enough to ask for help, especially since you seem to be achieving, strictly from an objective standpoint.
  • You might think that everyone struggles the way that you do, or that you are just bad at dealing with life stress.
  • Most likely, you've never told anyone about your internal struggles, which just reinforces the feeling that you can't ask for help. If nobody ever sees your pain, why would they support you going to a doctor for anxiety?

Part of the problem is that many of us have an image of what it means to have an anxiety diagnosis. We might envision a person who is housebound, can't work, or struggles to maintain relationships of any kind.

We don't think of an internal struggle as being reason enough to seek help, no matter how much inner turmoil we experience. It is very much a life of denial. You might even convince yourself that there is nothing wrong—you're just a workaholic, germaphobe, list-maker, and so on.

What does all this mean? We really need to call high functioning anxiety just anxiety. It's different, sure, in that you are making your way through life relatively well. But the anxiety is the same, it's just hidden.

Reducing Stigma (You Are Not Alone)

With a rise in people identifying themselves as having "high functioning" anxiety, it may become easier to seek help. If you feel less isolated and alone in what you are experiencing, it's more likely you will feel comfortable getting better. In addition, thinking of anxiety in both its positive and negative terms may help to reduce stigma. We all need some anxiety to get things done in life.

Rather than view anxiety as a weakness, one thing that this "movement" has done is to highlight that people with anxiety can still live full and productive lives.

Famous People With High Functioning Anxiety

It's helpful sometimes to identify famous people who are coping with the same illnesses that we face. In the case of high functioning anxiety, we can think of stars such as Barbra Streisand and Donny Osmond, and athletes like Zack Greinke and Ricky Williams. Scott Stossel, editor of The Atlantic, wrote extensively about his own experiences with anxiety and how he still managed to show up and achieve. These individuals have found their way through their anxiety to succeed.

What Determines Who Will Be High Functioning?

Unfortunately there really is very little research on this topic. We know that there is an optimal level of anxiety that helps fuel performance (according to the Yerkes-Dodson Law)—and it's somewhere in the middle of being too low or too high. Therefore, it makes sense that if you suffer with mild or moderate anxiety as compared to severe anxiety, the odds of you functioning at a higher level would be better. IQ may also play a role, as a 2005 study found that financial managers who were high in anxiety made the best money managers if they also had a high IQ.

Treatment Options

If you've never been diagnosed as having anxiety and recognize yourself in the symptoms above, it's best to make an appointment with your family doctor for an assessment or a referral. If you are diagnosed with an anxiety disorder such as generalized anxiety disorder (GAD) or social anxiety disorder (SAD), many effective treatment options exist such as cognitive-behavioral therapy (CBT), medication (such as selective serotonin reuptake inhibitors; SSRIs), and mindfulness training.

Other Solutions

Perhaps you are not ready to seek help for your anxiety, or you are looking for alternative measures that you can implement on your own:

  • Try spending 10 minutes a day working on your mental health.
  • Before you do any cognitive work (changing your thoughts), make sure that your lifestyle is in order—limit caffeine, eat a healthy balanced diet, and get regular exercise.
  • Sleep hygiene is important too, such as sticking to a regular bedtime, and not staying in bed if your mind is racing. Instead, get up and do something else until you feel tired.
  • Once you feel your lifestyle is in order, it's time to take a look at some of your thought patterns. Anxiety involves a lot of negative predictions—"What if I don't make this deadline" or "I know I will make a fool of myself during this presentation."
  • Start by recognizing the thoughts you have. When you notice a negative thought, try countering it with something more realistic or helpful, such as "I always make my deadlines, and even if I miss this one it won't be the end of the world."
  • Do you live with nervous habits such as biting your lip or chewing your nails? Try using coping strategies such as practicing deep breathing or progressive muscle relaxation to get your tension under control. You could also try engaging in a competing response—something else you can do that is incompatible with the nervous habit, such as chewing gum so that you will not bite your lip.

Are there any reasons why you hold on to your anxiety? Are you fearful that if you're no longer driven by your anxiety, that you will stop being an overachiever? These are real concerns that you will need to address as you work towards reducing the impact of anxiety on your life.

However, don't give in to the thought that you can't accomplish things without your anxiety. Years of being an expert list-maker won't be lost on a less-anxious you. It may take some adjustment, but you will find a new groove that balances your mental well-being with getting things done.

A Word From Verywell

High functioning anxiety is indeed a double-edged sword. While you may fear letting go of what might feel like part of your personality, know that you don't need to be secretly anxious to achieve and succeed.

Hold on to your positive traits through the habits that you've developed, but let go of the tension and internal struggle. You might be pleasantly surprised to learn that not only does success not need to be the result of struggle, but that opening yourself up to your feelings and sharing them with others will help you to have a more authentic experience of the world around you.

Sources:

Anxiety and Depression Association of America, Facts and Statistics. Updated August 2016.

Global News. ‘High-Functioning’ Anxiety: It’s not a Diagnosis, But Many Say it’s Real.

National Institutes of Mental Health, Anxiety Disorders. Updated March 2016.

Perkins AM, Corr PJ. Can Worriers Be Winners? The Association Between Worrying and Job Performance. Pers Individ Diff. 2005;28(1):25-31.

Stossel, S, The Atlantic. Surviving Anxiety. January/February 2014.

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