High-functioning anxiety is a less noticeable but more dangerous type of anxiety. Unlike the common form, people with high-functioning anxiety are adept at hiding their concerns and outwardly appear quite calm

Unlike other anxiety disorders, the high-functioning type is not an official clinical term, and you won’t find it in the standard classification of mental disorders in the USA (DSM-5). Rather, it is a term that has recently become popular, rather than a mental diagnosis. And although the symptoms can resemble other forms of anxiety (such as social anxiety, panic attacks, and more), adding “high-functioning” simply means that you may be better at hiding it.

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Despite the fact that feeling overwhelmed is, unfortunately, a natural part of our lives, anxiety can become a serious problem, affecting physical, emotional, and mental health. If you have recently felt signs of anxiety but are still quite successful and love being productive, this article might be for you. In it, we have gathered the opinions of psychologists on potential signs, causes, and ways to cope with high-functioning anxiety.

What is high-functioning anxiety?

And although it is not a clinical diagnosis, high-functioning anxiety has the same symptoms as generalized anxiety disorder. This includes worry, a sense of fear, or dread. You may also experience sleep difficulties, irritability, restlessness, and poor concentration. People with high-functioning anxiety often appear successful and well-functioning (hence the name), but frequently struggle with anxious feelings and thoughts.

“They will handle work and home tasks well, manage their finances, and maintain relationships, but they are still struggling with anxious feelings and thoughts,” says Dr. Sasha Hamdani, psychiatrist.

“Two distinguishing features of the [anxiety] diagnosis are that the symptoms cause distress to the person and that they experience dysfunction in their life,” says Lauren Cook, Psy.D., clinical psychologist. “But in high-functioning forms, anxiety, and dysfunction may be less noticeable and easily hidden behind a successful facade. For various reasons, some people may continue to appear quite ‘normal’ on the outside while feeling like they are drowning inside.”

Why does high-functioning anxiety occur?

According to research by the National Institute of Mental Health (NIMH), various biological and environmental factors can cause anxiety. Meanwhile, high-functioning anxiety may have roots in early childhood. “It happens when we begin to think that our value lies in what we do rather than who we are,” says Dr. Cook. “You may feel like you are constantly striving for praise or chasing success. But in reality, you are just burning yourself out.”

Remember, high-functioning anxiety is not a real diagnosis. So, if you have been diagnosed with an anxiety disorder and feel like you cannot cope with the symptoms, it does not mean that you are weaker than others. In some ways, situations with high-functioning anxiety can be just as problematic — if not more so — because they can go unnoticed, and others may not understand that a person needs support.

Signs of high-functioning anxiety

Psychologists believe that the key aspect of high-functioning anxiety is constant concern about what others think, the desire to please them, and the fear of making them angry.

Mental symptoms of high-functioning anxiety can include:

– Excessive thinking and analysis

– Fear of disappointing or upsetting others

– Lack of self-confidence

– Chaotic thoughts

– Inability to relax

– Excessive attention to details

Physical symptoms can include:

– Gastrointestinal issues (diarrhea, constipation, nausea, and vomiting)

– Frequent headaches

– Body aches

– Confusion (brain fog)

– Excessive sweating

– Muscle tension

– Rapid heartbeat

– Sleep difficulties

– Tingling or numbness in fingers or toes

According to Dr. Hamdani, when it comes to high-functioning anxiety, some of these symptoms are more obvious than others. She often notices or hears from patients complaints about constant feelings of nervousness, muscle tension, headaches from jaw clenching, slouching, and irritability.

And Dr. Cook believes that successful people regularly have difficulty seeking psychological help, but the longer they wait, the more likely it is that anxiety will manifest physically.

“Since you may delay seeking support for a long time, the body will manifest symptoms as a cry for help,” she says. “You may also find that you often feel unwell in the mornings when cortisol, the stress hormone, is at its highest level.”

Who is at risk for high-functioning anxiety?

Experts believe that all types of anxiety can occur in anyone. But high-functioning anxiety is more likely to manifest in successful people, as well as women, mothers, and caregivers.

People who face imposter syndrome—when you doubt your skills, talents, and achievements—may also be more susceptible to high-functioning anxiety. In some cases, imposter syndrome can be very motivating for you to succeed at work and in life—but constant self-doubt can also exacerbate anxiety in the long run.

How to manage high-functioning anxiety

And although high-functioning anxiety is not a condition that is officially diagnosed, experts offer several strategies that you can apply to manage it on your own.

Learn to say “no”

If you are used to pleasing people, you likely have difficulty setting boundaries in relationships. This happens when high-functioning anxiety intensifies because we are so busy meeting others’ demands that we have no time to meet our own needs. The more we practice mindful consideration of what to say “yes” to and what to say “no” to, the more we learn to set boundaries and cope with the fact that others may be upset when we set these limits.

By saying “no,” you also learn to deal with others’ disappointment and understand that setting boundaries will not destroy your world. A way to break the cycle of high-functioning anxiety is to realize that you can be both a loving and kind person who does not do everything for everyone all the time.

Whenever possible, try to give yourself 24 hours to respond to a request — this way, you will not respond out of a need for approval. Of course, you shouldn’t ignore an important email from your boss for that long, but if it’s a less urgent matter from a friend that can wait, don’t be afraid to postpone it.

Give yourself permission to rest

If you have a busy schedule with no time for relaxation, try scheduling rest as a task. It may seem silly, but rest is productive—especially with high-functioning anxiety. You cannot continue working in the long term if you do not stop to recover. Stress relief methods such as music, physical exercise, and a break from social media will help you relax and recharge.

Talk to a therapist

Therapy is an excellent option for treating high-functioning anxiety, as it will help you understand your behavior, get support, and achieve tangible changes in the future. To find a therapist, you can use platforms like Psychology Today, Inclusive Therapists, or Open Path Collective, which allow you to search for specialists by postal code and your requests. If you have insurance, you can also look for specialists who are in your network, or, if you need a more affordable option, try a virtual or in-person support group in the community.

Discuss medication with your doctor

If your doctor believes it is a good option, taking anxiety medications can also help. Medications can be useful support if you find that you are plagued by panic attacks or insomnia and cannot concentrate to get through your day.

Anxiety (high-functioning or not!) is not the most pleasant feeling, but you do not have to fight it alone. If you have started to notice the same physical or mental symptoms appearing for many weeks, months, or years, and outwardly you are generally functioning well, it may be a sign that you are dealing with high-functioning anxiety. In whatever form it manifests, do not be afraid to ask for help and support.

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