What Is High-Functioning Anxiety—and What Are the Symptoms?

What to know if you're worried, panicked, restless, or fearful but hide it well

While high-functioning anxiety isn't a defined medical diagnosis, it's become a term people use to describe themselves and their emotions.

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," said Jonathon Sikorski, PhD, director of wellness education and assistant professor of psychiatry at the University of Nebraska Medical Center in Omaha.

What is High-Functioning Anxiety

"Many people are walking around with extremely high levels of anxiety that are near meeting the criteria for anxiety disorders," said Debra Kissen, PhD, co-chair of the public education committee for the Anxiety and Depression Association of America. But they're pushing through. "They're still waking up. They're still getting themselves to work," Kissen said.

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 they get 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—the "authoritative guide" on diagnosing mental disorders, according to the American Psychiatric Association. 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.

These problems need to cause clinically significant distress or impairment to warrant an anxiety disorder diagnosis, per the CDC. "Generally, a psychiatric diagnosis is made when someone has 'functional impairment,'" said David Roane, MD, chairman of psychiatry at Lenox Hill Hospital in New York City. But difficulty functioning isn't always obvious, he added. "Sometimes you have to dig pretty hard to see how [the anxiety] is affecting work, family, or relationship performance."

Types of Anxiety

Defining high-functioning anxiety concretely is complicated. For starters, there are many different types of anxiety. For example, if you have a phobia—a type of anxiety disorder, according to MentalHealth.gov—you could have a fear of snakes or a fear of leaving your home—also known as agoraphobia. 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," said 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, Kissen said. "You're experiencing somewhat frequent symptoms of anxiety, and it's distressing and showing up more often than you would like," she said. Treating feelings of anxiety—even if they don't meet the criteria for a disorder—can help you live "a meaningful, satisfying life," Kissen added. "It's thriving versus just surviving."

Treatment Options

Typical treatment for anxiety is cognitive behavioral therapy or another type of psychotherapy, sometimes in combination with medication, according to the National Institute of Mental Health. But you don't have to commit yourself to a life on the therapist's couch to get better. "The goal, in general, is as short-term as possible," Kissen said. "Sometimes that might be one session just to understand some basic tools, or it could be a few sessions for severe symptoms."

Tools to deal with anxiety can include learning how to identify catastrophic thinking (for example, reacting to minor mistakes with thoughts such as, "I'm going to get fired!") and how to dial 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 said. "Meeting the official criteria just means it's gone on too long."

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