High-functioning anxiety is a phrase we’re seeing more and more as conversations about mental health become increasingly mainstream. However, understanding what it is and where it sits amongst other mental health conditions is a little trickier.
While there isn’t a clinical definition as such, it comes under the umbrella of anxiety disorders. What sets high-functioning anxiety apart is the person’s ability to function. “It tends to be people who appear successful but behind the scenes are very anxious,” psychotherapist Hannah Paskin explains. High levels of perfectionism is at its core. “People with high-functioning anxiety are prone to overthinking, obsessing and trying hard to control everything,” Heather Darwall-Smith, a psychotherapist and sleep specialist, notes.
Often high-functioning anxiety comes alongside other mental health conditions. “About 50% of people also suffer from depression whereas substance abuse and eating disorders often also come hand in hand,” Darwall-Smith described.
Hard to diagnose and often unmissed for many years, people with high-functioning anxiety are often very successful in the workplace, and classic Type A high achievers. This often only fuels their anxiety further. “They often receive a lot of positive reinforcement via promotions, bonuses or praise which encourages the unhealthy behavior to continue,” Paskin describes.
One of the first giveaway signs is a feeling of restlessness.“People often describe how they can’t ever relax or switch-off,” Paskin notes. This is coupled with obsessive thought patterns.
“There’s continuous anxiety in the background. A sense of never feeling good enough, worrying about making mistakes and struggling to say no,” Paskin says. Darwall-Smith describes the condition as “exhausting.” “Your mind is in constant rumination. Thinking about what has gone wrong and what could go wrong. It’s relentless,” she adds.
The emotional effects of high-functioning anxiety eventually manifest as physical symptoms. These vary hugely from person to person and can crop up in many different ways. “I see heartburn, indigestion, ulcers, acne, eczema, headaches, migraines and stomach issues like IBS,” Paskin says. Insomnia or sleep conditions are also classic repercussions of such a disorder.
Seeking help with high-functioning anxiety
Due to the high-functioning nature of this condition, it often takes years for people to access help. Often it’s the emotional fallout of this behavior pattern via the breakdown of close relationships or the physical symptoms which prompt people to get help.
Talking therapy is particularly important in helping those with high-functioning anxiety understand why they have developed these behaviors. “Psychotherapy can help unpick those negative thought patterns,” Darwall-Smith advises. Often this can link back to early life and events of their childhood. For example, high academic achievement in school.
For Paskin, therapy can also help people change their unhealthy working patterns and behaviors. “I help clients put in boundaries. For example, encouraging them to restrict their work hours, take their annual leave and lunch break to try and get the balance back,” Paskin recommends.
How to deal with high-functioning anxiety
While professional help can be transformative, implementing daily routines and rituals is hugely beneficial too. Darwall-Smith suggests using mindfulness techniques to slow an overactive brain.
Firstly, breathing exercises. “Anxiety is a state of stress. Your nervous system is hyperarousal and it can be physically uncomfortable. Breathing activates the parasympathetic nervous system and is really useful in slowing yourself down,” Darwall-Smith explains. She suggests incorporating three-minute breath breaks into your day. For example, you can try Mark Williams’ Mindfulness Meditation 3 Minute Breathing Space.
Darwall-Smith also vouches for the five senses technique. “This can really help bring you into the present moment,” she says. In anxious moments, take a step back and name five things you can see, four things you can touch, three things you can hear, two things you can smell and one you can taste.
Scheduling time for worrying can also be really effective. “I get my clients to practice journaling either throughout the day or at the end of it,” Darwall-Smith says. This provides an excellent way to braindump everything on your mind. The act of putting pen to paper is particularly powerful. “Writing uses the left side of the brain which is the rational side and therefore overrides the right creative side which is likely to catastrophize or tell us false stories about the situation we find ourselves in,” she adds.
High-functioning anxiety isn’t a life sentence but it does take commitment and work to overcome these tendencies. However, with professional help, lifestyle changes and day-to-day action, relieving this level of anxiety is certainly possible.