Signs You Could Have High-Functioning Anxiety

To the outside world you might look like you've got it all together, but internally you may be struggling to feel as confident and worry-free as you appear to be to others. If this is the case, then you may have high-functioning anxiety. This form of anxiety is relatively hidden behind achievements and the ability to excel at one's responsibilities in life, reports Forbes. High-functioning anxiety is often difficult to identify because people who experience it are often successful and well put together. However, it shouldn't go unaddressed because high-functioning anxiety can bring with it excessive worrying, added stress, and other disruptions to a person's well-being.

According to Banner Health, high-functioning anxiety is not an official mental health disorder registered in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, otherwise known as the DSM-5. But just because it isn't listed in the DSM-5 doesn't disqualify high-functioning anxiety from proper identification and needed treatment. "It's not recognized as a DSM-5, but it is essential to recognize and treat because these signs and symptoms can affect people's quality of life," says Srinivas Dannaram, M.D., a psychiatrist at Banner Thunderbird Medical Center. To ensure that people with high-functioning anxiety receive the support they need, here's what you should know about the symptoms of high-functioning anxiety and how to manage them.

Symptoms can be hidden

Identifying high-functioning anxiety can be tricky. The symptoms are often hidden behind high-achieving and high-functioning behaviors, according to Cleveland Clinic. Many people with high-functioning anxiety are very accomplished and acclaimed, but their successes can mask their anxious tendencies. Those who experience high-functioning anxiety can often be described by others as being outgoing, extremely organized, very detail oriented, and proactive. But when high-functioning anxiety is present, a person's inner dialogue doesn't match their outward persona. "An individual with high-functioning anxiety may appear calm on the outside but feel very anxious internally. These individuals may try to mask their symptoms by taking control of the situation," says Adam Borland, PsyD, a psychologist at Cleveland Clinic. 

When someone is living with high-functioning anxiety, their internal dialogue with themselves may be wrought with second-guessing themselves, overthinking or overanalyzing, excessive focus on perceived failures, and feeling an intense need to keep their insecurities hidden from others (via Bridges to Recovery Beverly Hills). To conceal self-doubt and insecurities, a person with high-functioning anxiety may studiously focus on work, which can develop into workaholism. They may also put on a forced persona of optimism and sociability. People with high-functioning anxiety often have habits such as nail biting, knuckle cracking, hair twisting, and other anxiety-related mannerisms like muscle tension and restlessness. Insomnia, irritability, and discomfort in opening up about vulnerable topics are also symptoms of high-functioning anxiety. But like any condition, signs and symptoms can vary from person to person.

Risk factors for high-functioning anxiety

There are over 40 million people in the United States who suffer from anxiety disorders, placing anxiety-related conditions at the top of mental health diagnoses, reports the National Alliance on Mental Illness (NAMI). Anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder, phobias, and panic disorders. Symptoms of anxiety disorders vary per diagnosis and individual person, but frequently include excessive worrying, insecurity, panic, and physical sensations such as headaches, muscle aches, and dizziness. Having a family history of any kind of anxiety disorder can increase your likelihood of being diagnosed with an anxiety disorder, while also increasing the likelihood of experiencing high-functioning anxiety (via Cleveland Clinic). Still, many people who don't have family histories involving anxiety experience high-functioning anxiety.

Additional factors that can contribute to an inclination towards developing high-functioning anxiety include being placed in highly demanding, stressful situations like working an overly exacting job or being strenuously pushed to succeed in school as a child, per Bridges to Recovery Beverly Hills. Traumatic experiences, extreme adversity, and abuse can also inspire high-functioning anxiety. 

There are a handful of other conditions that can be comorbid with high-functioning anxiety, so recognizing the signs of these conditions can help a person identify the presence of high-functioning anxiety. Coexisting conditions include substance use disorders, depression, and disordered eating. They may also include chronic medical conditions like irritable bowel syndrome (IBS), heart disease, chronic obstructive pulmonary disease (COPD), and asthma. Cleveland Clinic denotes that thyroid issues can also make someone more likely to experience high-functioning anxiety.

Creating a treatment plan

It may feel like detective's work to identify high-functioning anxiety, but doing so can help a person receive the opportunity for treatment and improve their quality of life. Treatments for high-functioning anxiety overlap with treatments for other anxiety disorders, frequently involving a combination of talk therapy and medication to manage symptoms, per Forbes

Cognitive behavioral therapy (CBT) is a form of talk therapy that can be extremely effective for learning how to identify and manage symptoms from which stress and anxious behaviors stem. CBT, as well as other forms of talk therapy, are excellent options for learning coping mechanisms and calming activities for when intrusive thoughts from high-functioning anxiety present themselves. Another form of therapy that can be helpful in treating high-functioning anxiety is solutions-focused brief therapy (SFBT), as reported by Cleveland Clinic. SFBT involves using tools that a person already possesses to seek solutions to unwanted behaviors and thought processes. Mindfulness and deep breathing are also highly recommended in the treatment of high-functioning anxiety.

In addition to talk therapy and mindfulness techniques, prescription medications can help to create a balanced treatment plan (via Forbes). Medications effective in treating the symptoms of high-functioning anxiety include selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, beta-blockers, and antidepressants. If you have questions about the treatment options that will work best for you, always consult with your healthcare provider.