High Functioning Anxiety: What Is It?

High functioning anxiety may not be officially recognized as a mental disorder by the American Psychiatric Association in their Diagnostic and Statistical Manual for Mental Disorders (DSM-5), but healthcare professionals increasingly recognize its prevalence. As more individuals seek treatment for the distress they experience behind their outwardly composed demeanor, we're beginning to understand its insidious nature.

Despite functioning well in areas such as work, home life, relationships, and finance, those with high functioning anxiety harbor a hidden struggle. Their external success often prompts disbelief from co-workers, friends, and family when the topic of mental health arises. They may ask, "How can someone who seems so proficient and in control be dealing with anxiety?"

This apparent discrepancy is the crux of the issue in identifying and addressing high functioning anxiety. Individuals grappling with this condition often project an image of positivity, organization, and control, seemingly unaffected by anxiety disorders. However, beneath the surface, they're often caught in a whirlwind of nervousness, fear, and internal chaos. Everyday situations, like the potential of being held responsible for a missed project deadline, can trigger cold sweats and panic attacks. The complexity of their experience becomes apparent when they finally seek help from a mental health professional. Suddenly, their well-maintained facade gives way to reveal deeply-rooted anxiety and obsessive thoughts—an unregistered severe anxiety disorder for which there is currently no approved treatment.

Did you know?

Stress hormones like cortisol and adrenaline can spike anxiety levels by activating the body's "fight or flight" response. To learn more about this, read Hormones That Cause Anxiety - Understanding and Managing Hormonal Imbalances.

'GAD' - generalized anxiety disorder

Someone with GAD (Generalized Anxiety Disorder) would be unable to hide his disorder. This inability to get through their daily lives would be very evident to their friends and immediate family. They would, in turn, use this knowledge to encourage the individual to seek help for his anxiety disorders.

Once he has done that, his anxiety disorder gets diagnosed as GAD, and he will receive effective treatment which includes meditation.

Meditation will help to calm his anxiety and he will be on his way to recovery.

Many mental health professionals support the idea of officially diagnosing high functioning anxiety as a form or type of GAD.

Getting high functioning anxiety officially registered as a type of GAD will, they claim, go a long way in removing the stigma associated with having to live with an unregistered mental illness.

The stigma

The problem is, once patients are diagnosed as having an unrecognized anxiety disorder they would have to live with the social stigma associated with having a mental disorder that the APA did not recognize as an official mental disorder.

They would be seen by friends, relatives, and co-workers as putting on an act and in ignorance, they would be told to stop acting, the doctor says "he can't find anything wrong with you".

Dealing with the stigma would be beyond their positive attitude and it would aggravate their already existing high functioning anxiety.

As this would severely negatively impact their self-esteem their natural response to their symptoms would be to 'hide' their disorder from mental health professionals and in doing so they delay the official recognition of their disorder as anxiety and the subsequent official treatment of the same.

As far as those with high functioning anxiety are concerned they are no more than perfectionists where others are not, and their attitude to life is don't wait for it to happen, make it happen. The last thing they want or need is to be diagnosed as having an untreatable mental disorder.

Do I have (HFA) high functioning anxiety?

As high functioning anxiety is not officially registered as an anxiety disorder there is no official diagnosis in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) that you can reference to establish if you have or have not.

However, if you know the basic causes, triggers, and anxiety symptoms of high functioning anxiety you can self-diagnose and make the decision to speak to your doctor and tell him or her about certain anxiety symptoms that you have and you would like to know how you can treat them. [1] If you're still unsure, why not try our Anxiety Test?

What's the difference between high-functioning anxiety and crippling anxiety?

High-functioning anxiety and crippling anxiety are non-medical terms that people use to describe different ways that anxiety can impact a person's life. They're not official diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but they can help to paint a picture of how someone is experiencing their anxiety. Here are some general differences:

High-Functioning Anxiety

• Despite the distress and persistent worrying, individuals with high-functioning anxiety can still perform their daily tasks and maintain their responsibilities.
• They may be successful in work, academic pursuits, and personal relationships.
• High-functioning anxiety can manifest as perfectionism, constant worrying, a need for reassurance, or restlessness, among other things.
• Often, these individuals appear normal, even high-performing, to others. However, they are internally dealing with significant anxiety and fear.
• This can be harmful in the long term as the person may not seek help due to their ability to function seemingly well, leading to chronic stress, burnout, and other mental or physical health issues.

Crippling Anxiety

• This term is often used to describe anxiety that is so severe it impedes a person's ability to function in daily life.
• Symptoms of crippling anxiety can include intense fear or worry, panic attacks, avoidance behavior, physical symptoms like rapid heart rate and shortness of breath, or debilitating fear that prevents routine activities.
• In such cases, the anxiety is very apparent and often prevents the individual from maintaining work, social relationships, or even basic tasks like shopping or leaving the house.
• Crippling anxiety might align more closely with diagnoses like panic disorder, severe generalized anxiety disorder, or agoraphobia, depending on the specific symptoms. And if you're looking to learn more, we recommend reading Everything To Know About Crippling Anxiety.

Both high-functioning anxiety and crippling anxiety are serious and can benefit from treatment, including psychotherapy (like cognitive-behavioral therapy), medication, and lifestyle changes. The specific treatment will depend on the person, their experiences, and the specifics of their anxiety. If you or someone else is dealing with these issues, it's important to reach out to a mental health professional for help.

Causes and triggers

What generally triggers the alarm for people who unknowingly have a high functioning anxiety disorder is unexplained and unwarranted occasions of hyperventilation and the very probable panic attack that follows.

These frightening attacks alarm and frighten individuals to such a degree that they will immediately seek professional help for the cause and treatment of their hyperventilation and during that process, they will be diagnosed as having HFA.

People who un-knowingly have high functioning anxiety (HFA) disorder have been known to hyperventilate:-

• during job interviews,
• when being issued with a speeding ticket,
• when about to give a company presentation or make a speech.
• when they are late for an appointment and they cannot find their car keys.

As much as 80% of known HFA cases have come about as a result of individuals seeking treatment for other known anxiety disorders or mental health disorders. It is well documented that there is a very real link between anxiety and depression.

Contact the Anxiety And Depression Association of America ( ADAA) if you want more information identifying the symptoms you have.

While receiving treatment for these other known disorders, the patient opens up and reveals to their doctor that they are also experiencing severe anxiety symptoms that they manage to keep secret and hidden from everyone.

Based on that information, a health professional will carry out an anxiety disorder diagnosis and will recognize these other symptoms as indicative of a high functioning anxiety disorder and recommend the appropriate treatment. [2] [3]

Symptoms of high functioning anxiety

As there is not an official diagnosis for HFA, medical professionals, when consulting with a person suspected of having the disorder will as a minimum look for the symptoms of GAD (Generalized Anxiety Disorder), in order to confirm or deny their diagnosis for high functioning anxiety.

Many medical professionals believe that the causes of HFA (high functioning anxiety) are genetically and environmentally based and they closely align with those of GAD.

In addition to confirming that their patient is exhibiting symptoms of GAD, health professionals will want to gauge the severity of those symptoms:-

Typical GAD ( Generalized Anxiety Disorder) Symptoms are:-

• Excessive anxiety or worry on most days of the week for at least a six month period
• Restlessness
• Difficulty concentrating
• Being easily fatigued
• Irritability
• Muscle tension
• Sleep problems

Within GAD, anxiety is defined by the level of distress experienced by the patient. There are four levels of severity, mild, moderate, severe, and panic level.

Outwardly, a person with HFA will exhibit anxiety levels at the lower end of the GAD scale. Inwardly it is the exact opposite. If the patient says nothing, the doctor will diagnose him or her as having a mild to moderate form of GAD, and they would be treated accordingly.

It is not until people with HFA open up to their doctor about all the excessive inner stress and anxiety that they experiencing that the doctor will investigate further.

Typically other symptoms the doctor will look for in order to confirm if his patient has or has not got an HFA disorder will include but not be limited to:-

• A family history of anxiety disorders
• Exposure to negative or stressful life events
• Certain physical health issues
• Alcoholism or substance abuse.
• Shyness or nervousness from a young age.

Prime candidates for high functioning anxiety are those people who very early in their adult lives, have achieved extraordinary success in their careers, and or their businesses.

If you see yourself as having any of the personality characteristics mentioned below or you have exhibited any of these symptoms for a prolonged period of time, make an appointment to see your doctor and discuss your symptoms with them.

Risk factors will obviously vary from person to person and from situation to situation so there is no reason to assume that because you exhibit symptoms or have experienced excessive anxiety over a long period of time you are suffering from a high functioning anxiety disorder or any other form of significant anxiety.

If you have any concerns about your mental health, don't keep them a secret, speak to your doctor and get a professional opinion on your condition and how to deal with it.

Seven personality traits that indicate you may have HFA

Here are seven personality traits that indicate you might have High Functioning Anxiety.

You're a perfectionist

At home, at work, and in your personal life, you only have one standard. Getting it right is not something that you are prepared to leave to chance. It is something you will go out of your way to make sure happens.

You have trouble sleeping

Not only do you have trouble sleeping but you have a problem wanting to go to sleep. There is always just one last thing you need to do then you will go to bed.

Finally, in bed, your eyes may be closed but you are not sleeping, and you won't be for the next 2 hours. There is just too much going on in your head.

You can't relax

You see what others call 'relaxing' as a waste of time. You cannot sit and relax for an hour. You are constantly thinking of what you could be doing instead of wasting time because you have been told you are burning yourself out and should relax more.

Meditating also helps you to relax.

Here are some products on mediation, and some products help to help relax you:

• Mindsight 'Peaceful Pebble' Guided Visual Meditation Tool for Mindfulness
• Mindsight 'Breathing Buddha' Guided Visual Meditation Tool for Mindfulness
• TRINIDa Sleep & Relax Lavender Candles Gifts for Women

You're apathetic

People accuse you of having no feelings. Outwardly to the world, nothing gets you upset or makes you cry. Inwardly you are crying your heart out.

You have annoying habits

You're constantly chewing gum, a matchstick, or a toothpick. You bite your nails even when there is nothing left to bite. You never give a straight answer or make an instant decision.

You always have to think about it and your standard response is "I'll get back to you"

You bottle up your emotions

You put your feelings on hold, and like a pressure cooker, the anger or the frustration builds up inside you. Then something happens.

To others, it is an everyday occurrence that is easily dealt with. To you it was alarming enough to push you over the edge, you explode and you have a panic attack.

You worry you're not good enough

In your strive for perfection in every facet of your life, you will take on more than others believe you can possibly manage. "Don't worry I'll do it, or leave it to me" becomes your standard response to their concerns.

Short Video

How to handle high functioning anxiety

The most important thing you can do for yourself is to acknowledge you have a mental health issue. You will not know it as a high functioning anxiety disorder but you will have known for a long time that mentally something is not quite right or normal with you.

Be honest with yourself

Have the courage to separate normal behavior from abnormal behavior. You know it is not normal to check and rewrite a speech many times over before you will accept that it will pass all criticism.

You definitely know it is not normal to stay late and rewrite it just so that nobody in the office will see what you doing. So ask yourself honestly,

• Why am I behaving like this?
• What am I worried or scared about?

Treat anxiety or your mental problem the same way you would normally treat any physical problem you might have. If you twisted your ankle would you pretend that everything was normal and you would refuse help getting up and down a flight of stairs? Or would you see your doctor and get treatment for a twisted ankle and use a walking stick to climb the stairs.

Have the same positive attitude toward your high functioning anxiety disorder and remember to love yourself.

Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is the most widely used therapy for anxiety disorders. CBT works on the premise that it is our thoughts, not external events that trigger our responses.

Mental health professionals use CBT to help you identify what exactly causes your anxiety and why.

As an example. Are you worried that the speech you are writing is grammatically incorrect and full of technical errors, or are you worried, because you have seen it happen to others, that no matter how perfect your speech is, some members of the audience will still laugh and ridicule you?

CBT will help you realize your anxiety disorder is not about your ability to write or not write the perfect speech. Your fear or mental health disorder is about being laughed at and ridiculed no matter how good your speech is. It is that fear that is causing your functioning anxiety and other anxiety disorders. [4] [5]

Personal Stories' From People With High Functioning Anxiety

Julianne

The journey of Julianne with high functioning anxiety began at the age of seven, when she had her first unrecognized panic attack. As a child, she was often labeled as "overly sensitive" and was quick to tears and worry, symptoms that became exacerbated after her mother's battle with cancer and her parents' divorce. Despite the dismissive attitudes often directed towards children's struggles, Julianne's mother recognized her struggle, intervening and starting her on therapy at an early age, a move Julianne attributes to helping her thrive later on. Even as she grew older, her battle with anxiety persisted, yet she gradually honed her ability to detect its onset and found ways to cope.

As Julianne matured, she channeled her energy into her passions for music, performance, and writing, pursuing them fervently in an attempt to stay one step ahead of her persistent anxiety. However, this quest for perfection and acceptance came at a cost, with the anxiety peaking during her high school and university years, where even her love for music morphed into a source of stress. Following an especially tough year at university, she sought help from her doctor, leading to her formal diagnosis of generalized anxiety and depression, and the initiation of medication for her mental health. Despite the challenges and her constant need to prove herself, Julianne persevered, working hard to improve her grades and performance, eventually making it onto the Dean's list in her final year, a victory that, ironically, brought more questions than satisfaction.

Read Julianne's story.

Heather Rider

In the bustling tech hub of Austin, Texas, a career-driven woman strived tirelessly in the technology sector, juggling her responsibilities as a primary caregiver to her two young daughters and her professional pursuits. Amidst her daily grind, she misinterpreted the constant busyness and endless cycle of tasks as merely stress, a common misconception shared by many leading hectic lives. However, beneath the surface, she was grappling with high-functioning anxiety, an often unnoticed condition characterized by relentless overthinking, fear of failure, and concerns about societal perception, despite maintaining a successful exterior. This mirrored her situation perfectly, her overthinking extending beyond daily chores to every facet of her life, and eventually leading to both mental and physical fatigue, triggering a severe autoimmune reaction.

Confronted with this health crisis, she embarked on a healing journey, employing holistic methods involving diet alterations, journaling, energy healing, and deliberate self-care. This process led her to understand and acknowledge her state of high-functioning anxiety. For those grappling with similar conditions, healing can be facilitated using techniques like the 'feet on the floor' method, which promotes mindfulness and presence, and creating abstract art as a form of therapeutic expression. It's crucial to remember that healing is a journey, filled with both good and challenging days. Embrace the positive moments, be patient, and in time, it's possible to navigate through the mire of high-functioning anxiety.

Read Heather Rider's story.

Conclusion

If you can identify with any of the symptoms and or personality traits, share your fears. There is a lot of truth in the saying a problem shared is a problem halved. Build a support team. Family, friends. co-workers and your doctor are all there for you, you only have to ask.

FAQ

References

1. Us.News: High Functioning Anxiety
2. Web MD: Panic Attack Symptoms
3. Anxiety and Depression Association Of America
4. Efficacy Of Cognitive Behavioral Therapy For Anxiety Disorders
5. Help Guide: Therapy For Anxiety Disorders

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