Anxiety isn’t always obvious or crippling. It might look like staying on top of work, managing your kids’ activities, and making it to all your appointments. All while still feeling incredibly anxious. Enter: High-functioning anxiety. Which, spoiler, is not actually a medical term. It’s used to describe something a lot of people are dealing with: Appearing to have it together, but struggling with fear and worry under the surface.
We talked to clinical psychologist Claire Plumbly and Dylan Gee, associate professor of psychology and psychiatry at Yale University, to break down everything you need to know about high-functioning anxiety. Including what it really means and what you can do about it.
Claire Plumbly is a clinical psychologist and director of Good Therapy Ltd. She is based in Taunton, England.
Dylan Gee, PhD, is an associate professor of psychology and psychiatry at Yale University. She specializes in mental health disorders and stress disorders.
What is high-functioning anxiety? And how is it different from anxiety?
High-functioning anxiety (HFA) is when someone unintentionally masks their symptoms of anxiety, and seems to be on top of their game. That might look like someone who says ‘yes’ to every work project and has Marie Kondo-level organizational skills. All while feeling constantly anxious on the inside. Think of “a duck with the little legs underwater,” said Plumbly. Their legs are working overtime underneath, while appearing “quite serene” on the surface.
Anxiety disorders, on the other hand, are diagnosable mental health disorders listed in the DSM-5 (a mental health manual for doctors) with specific criteria for a patient to meet for a diagnosis. But even if someone with high-functioning anxiety hasn’t been diagnosed with an anxiety disorder yet, they may still meet the criteria for one, said Gee.
Gee also noted that anxiety disorders are more commonly diagnosed in women. And that gender norms and "societal pressures to be perfect and to be a certain way" may cause women to hide or mask their symptoms — causing them to appear high-functioning.
What does high-functioning anxiety feel like?
It may feel a little different for everyone. But the symptoms of HFA are similar to those of anxiety:
Excessive fear and worry
Anticipating the worst
And living with high-functioning anxiety could look like:
Difficulty saying “no” or people-pleasing
Frequent worrying or racing thoughts
Sounds familiar. What are some coping strategies for anxiety, high-functioning or otherwise?
After reading the symptoms above, you probably won’t be surprised to hear that someone with HFA might find it hard to ask for help. But if it’s affecting your sleep or getting in the way of doing things that make you happy (like seeing friends or taking vacation days), it might be time to take action.
Gee and Plumbly both suggested starting with therapy or speaking to a trusted friend or family member. Or, make an appointment with your PCP. Because they may be able to diagnose you with an anxiety disorder and/or prescribe you medication for anxiety. They can also determine if another mental health or physical condition could be contributing to your anxiety (like ADHD).
Plumbly also recommends following therapists on social media or picking up a book about coping with anxiety. Her recommendations: “Burnout” by Emily and Ameila Nagoski and “Set Boundaries, Find Peace” by Nedra Glover Tawwab. If you need some more ideas on how to cope with anxiety, we’ve got you covered here.
To some, the idea that you're able to be 'high-functioning' while experiencing symptoms of anxiety might sound contradictory. But to many, it's a lived experience that can impact their day-to-day life. If you think you might have high-functioning anxiety, there are ways to manage it. And your doctor can help you figure out next steps, too.
If you or someone you know is struggling with suicidal thoughts, call the National Suicide Prevention Lifeline at 988.
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