What is high-functioning anxiety?

Some people just seem to have it all together all the time, don’t they? These high-achieving folks always seem to know what to do and get a lot done. They never miss a deadline and always turn up on time — early even — for work and social engagements. Sure, they might have a perfectionist streak and sometimes can be a little hard on themselves or demanding of others, but they always seem to succeed and meet those high standards.

If that description describes yourself or someone you know, you might be talking about a person with high-functioning anxiety. And what’s going on behind the facade of competence and organization can be an emotional roller coaster of anxiety, self-consciousness and fear.

“Technically, high-functioning anxiety is not a diagnostic category listed in the Diagnostic and Statistical Manual of Mental Disorders- 5th Edition (commonly referred to as the DSM–5), a handbook used by mental health professionals to diagnose clinical disorders,” says Charmain Jackman, a psychologist and founder and CEO of InnoPsych, Inc., an organization on a mission to disrupt racial inequities in mental health. “However, high-functioning anxiety has been used to describe people who have symptoms of anxiety that, on the surface, do not impact their functioning.”

Lawrence Needleman, a psychologist in the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus, says that “some people are both high achievers — at least in some areas — and anxious.”

Typically, anxiety disorders can make completing tasks and achieving goals very difficult. People with anxiety often exhibit symptoms such as fears or worrisome thoughts that can lead to physical reactions including:

A racing heartbeat.

— Headaches.

— Restlessness and agitation.

— Disrupted concentration.

— Panic attacks.

— Muscle tension.

— Increased blood pressure.

— Gastrointestinal symptoms.

Sleep disturbances that interfere with your ability to function normally.


— Avoidance of situations that trigger fears.

[See: 12 Proven Strategies to Stop Overthinking and Ease Anxiety Now.]

People with high-functioning anxiety “may experience some of these symptoms,” Jackman says, “but they’re able to function and achieve in their lives.” In fact, for some folks with high-functioning anxiety, the anxiousness and fears they feel may actually drive them to greater heights.

For example, a fear of failure or poverty “actually contributes to high achievement by motivating them to work extremely hard,” Needleman says, pointing to oil baron John D. Rockefeller as an instance of high-functioning anxiety leading to financial success.

However, “success driven by anxiety, can be at the expense of functioning well in other areas, like relationships.” And that could be to the detriment of their overall health and wellness in some cases.

The Anxiety and Depression Association of America reports that anxiety disorders are the most common mental illness in the United States, affecting some 50 million adults over the age of 18 every year. That’s about 18% of the population. While anxiety disorders are very treatable, only about a third of people with them receive treatment.

What’s more, the ADAA reports that people with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who don’t have an anxiety disorder. Anxiety disorders also heighten your risk of developing depression.

Signs of High-Functioning Anxiety

People with high-functioning anxiety may show certain characteristics such as:

— Being extremely organized.

— Demanding control over situations.

— Being a perfectionist.

— Nail-biting.

— Bouncing legs.

— A harsh inner critic or unrelenting standards.

— Disproportionate irritation or anger when things don’t go as planned.

— An inability to delegate tasks or trust that others will complete tasks effectively.

[See: Top Medications for Anxiety.]

These characteristics and behaviors aren’t all bad, and indeed, many are also hallmarks of high achieving people who get a lot done. But they can have a darker side. For example, “when situations don’t go as planned, people with high-functioning anxiety may feel dysregulated and may take extraordinary measures to regain a sense of control,” Jackman says.

While it might seem that high-functioning anxiety offers some benefits in that the person with it is still able to achieve, the roil of emotions underneath — such as the overthinking and the need for constant affirmation — can set up situations that could be dangerous for mental and physical wellness. High-functioning anxiety is still a form of anxiety, and you should talk with a mental health care provider about your feelings and behaviors.

In some people with high-functioning anxiety, their safety-seeking behaviors employed during times of high anxiety can be counterproductive and interfere with life, Needleman says.

Some common counterproductive safety-seeking behaviors include:

— Avoidance.


— Escape.

— Compulsions.

Addictions of various sorts.

“When these behaviors are used excessively, they can interfere with functioning, for example, at work or in relationships,” Needleman explains.

It can also be very difficult for people with high-functioning anxiety to unwind and rest, which can take a physical toll over time. “They may also have a hard time relaxing,” Jackman says. “For example, taking a vacation can actually cause stress and the individual may plan all aspects of their downtime because it’s so hard to unplug.”

This tendency to control every moment doesn’t bode well for long-term mental health and wellness. “For your well-being and the well-being of the people in your life, it can be important to see whether there are ways to decrease stress in your life, to make sure you have a healthy lifestyle and to learn to relax and slow down,” Needleman says.

[See: What Type of Anxiety Do You Suffer From?]

What to Do to Combat Anxiety

If you think you might have high-functioning anxiety, Jackman recommends assessing your stress levels with screening tools provided by Mental Health America. “If your symptoms are high, consider meeting with a therapist to help with your symptoms. Strategies such as cognitive behavioral therapy are excellent in treating anxiety disorders.”

Needleman agrees that CBT, a type of talk therapy that focuses on changing behaviors, is a good tool for combating the downsides of high-functioning anxiety. “CBT is an empirically-validated approach to teaching people with anxiety to cope and function better. Clients learn adaptive coping strategies, decrease counterproductive safety-seeking behaviors and develop new perspectives for functioning well as a whole person and decreasing unnecessary suffering.”

Practicing mindfulness, a technique that focuses on breath, being focused in the present and self-compassion may also help. Jackman says this practice “works well for stress reduction and managing aspects of life that can contribute to feelings of anxiety.”

Needleman adds that taking some time to “stand back and explore your values and perspectives to see if you’re living in a way that’s consistent with the type of whole person you want to be” can also be a useful exercise in coping with high-functioning anxiety.

More from U.S. News

11 Foods and Beverages That May Promote Calm

Tips to Support Someone Having a Panic Attack

Top Medications for Depression

What Is High-Functioning Anxiety? originally appeared on usnews.com

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