What to know if you're worried, panicked, or fearful but hide it well.
While high-functioning anxiety isn’t exactly a real medical diagnosis, it’s become a term people use to describe themselves and their emotions more and more.
The phrase could cover a range of experiences depending on who you are, but mental-health professionals are starting to have a clear picture of what is commonly meant by high-functioning anxiety.
“Typically when I hear people talk about high-functioning anxiety, it means they may have a lot of features of an anxiety disorder without the actual diagnosis,” says Jonathon Sikorski, PhD, director of wellness education and assistant professor of psychiatry at the University of Nebraska Medical Center in Omaha.
“Many people are walking around with extremely high levels of anxiety that are near meeting the criteria for anxiety disorders, but they’re white-knuckling their way through it,” adds Debra Kissen, PhD, co-chair of the public education committee for the Anxiety and Depression Association of America. “They’re still waking up. They’re still getting themselves to work.”
In other words, someone with high-functioning anxiety might experience symptoms like worrying a lot, racing thoughts, and losing sleep some of the time, but she gets through life anyway.
To be officially diagnosed with an anxiety disorder, you have to meet certain criteria laid out in the Diagnostic & Statistical Manual of Mental Disorders. These include feeling anxious and worrying more days than not for at least six months and other signs such as restlessness, trouble sleeping, muscle tension, and irritability.
Often, these problems need to be interfering with daily life to warrant an anxiety disorder diagnosis. “Generally, a psychiatric diagnosis is made when someone has ‘functional impairment,’” says David Roane, MD, chairman of psychiatry at Lenox Hill Hospital in New York City. But difficulty functioning isn’t always obvious, he adds. “Sometimes you have to dig pretty hard to see how [the anxiety] is affecting work, family, or relationship performance.”
But defining high-functioning anxiety so concretely is complicated. For starters, there are many different types of anxiety, from fear of snakes to not being able to leave your home. Plus, different people can cope with different levels of anxiety before it interferes with daily life.
There’s also the fact that society condones and even encourages busyness and stress. “There are times that anxiety is very motivating, very facilitating,” says Carmen Tebbe Priebe, PhD, a sports psychologist with the University of Iowa in Iowa City. “It makes people work hard, so it can seem as if they’re functioning well, but they’re not [always] disclosing everything that’s happening.”
Even if your anxiety symptoms aren’t interfering with your productivity at work or your relationship status, they can still be problematic if they take away from your overall quality of life, says Kissen, who is also clinical director of Light on Anxiety CBT Treatment Center in Chicago. “You’re experiencing somewhat frequent symptoms of anxiety, and it’s distressing and showing up more often than you would like,” she says. Treating feelings of anxiety–even if they don’t meet the criteria for a disorder–can help you live “a meaningful, satisfying life,” she adds. “It’s thriving versus just surviving.”
Typical treatment for anxiety is cognitive behavioral therapy, sometimes in combination with medication. But you don’t have to resign yourself to a life on the therapist’s couch to get better. “The goal, in general, is as short term as possible,” says Kissen. “Sometimes that might be one session just to understand some basic tools, or it could be a few sessions for severe symptoms.”
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Tools to deal with anxiety can include learning to identify catastrophic thinking (for example, reacting to mere minor mistakes with thoughts like “I’m going to get fired!”) and dialing it back; exposing yourself in small ways to face your fears; recognizing that you can handle more than you think you can; and practicing mindfulness and relaxation techniques.
The earlier you work on reducing high-functioning anxiety symptoms, the easier it will be to put these feelings behind you, Kissen says. “Meeting the official criteria just means it’s gone on too long.”