ANXIETY & DEPRESSION

Life With High-Functioning Anxiety: Can You Relate?

Constantly busy. Perfectionistic. Juggling a hundred different projects and responsibilities. Constantly scanning the future and laying the plans and groundwork for what you want or don’t want to happen. Feeling motivated and pulled forward by the hot energy coursing inside of you. Being described as super Type A. Having a mind that races and obsesses over your to-do list if you accidentally wake up at 4 in the morning. Covering up your daily anxiety with overthinking, overdoing, overperforming, over-preparing, over-everything…

These are just some of the ways someone might describe life with “high-functioning anxiety.”

While “high-functioning anxiety” isn’t an actual clinical diagnosis, it’s a phrase that’s become increasingly popular in the past few years and includes a cluster of symptoms that, in my opinion as a therapist, most closely aligns with Generalized Anxiety Disorder (GAD), a diagnosis that is found within the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Affecting roughly 40 million adults, anxiety disorders are the most common mental health issue in the United States. And “high-functioning anxiety” may be particularly common for ambitious, young, professional Millennials and Gen-X’ers living here in the Bay or in other major urban areas.

The tricky things is, those of us living with “high-functioning anxiety” may not recognize that it’s a problem.

And it’s one that needs support. Because it doesn’t look like more “textbook” anxiety disorders. Where daily life is a lot more noticeably impaired.

After all, you’re still getting a ton accomplished and holding it all together, right? So it’s easy to assume that the kind of anxiety you personally experience may not be a legitimate concern that requires support. But it is.

Indeed, while GAD affects 6.8 million adults – with women twice as likely to experience it as men – only 43.2% of folks are receiving treatment to support it. And this is an issue.

Because the reality is that “high-functioning anxiety,” like any other anxiety disorder, has considerable potential side effects and impacts on your physical and emotional well-being if left untreated. And, like other anxiety disorders, it’s also highly treatable.

So my goal in today’s post is to introduce you to the idea of “high-functioning anxiety” and its accompanying cluster of symptoms described in a way you may be experiencing them and to walk you through ideas of supports to help alleviate these symptoms if you think it may be time to get some help.

Common Symptoms of “High-Functioning Anxiety”

1) Excessive anxiety and worry most of the time.

Call it apprehensive expectation, anticipatory anxiety, worry, rumination, etc., it’s mental state that you experience more days than not for 6 months or more.

This worry can and likely includes everything. From worries about your career to your love life. The size of your thighs to the viability of your eggs. To not having saved enough for retirement to wondering how you’re going to cope with the family at Thanksgiving this year, etc. etc..

And, often, the amount and intensity of the worry you have is likely disproportionate to the event itself. In other words, everything feels like a really big deal when it, perhaps, isn’t. And even when you tackle and try to solve the thing that worries you, it never feels good enough.

2) You find it really HARD to control your worry.

You know all the tricks — three deep breaths, making lists of your worries, releasing it all on the yoga mat, meditating, etc. — and still, it falls short.

You live with worry daily and a lot of the time it seems to get the best of you because you have a hard time controlling it despite your self-care practices.

3) Your flavor of worry and anxiety comes with a side order of:

• Restlessness, feeling on edge, keyed up, tensed up.
• Feeling constantly tired, like no matter how much sleep you get you still feel an underlying level of exhaustion.
• Trouble concentrating whether it’s at work, on what your honey was saying, or finding that you had to re-read that page of your book three times because your mind wandered. You may find yourself in the future worrying about this or that or just going a bit blank. Bottom line: you may sometimes have trouble concentrating on what’s happening now right in front of you.
• Irritability. You’re living with a low capacity for stressors so the small stuff — the things you’re not “supposed” to sweat — really does make you sweat. Your patience is thin and your grumpiness is high.
• Tightness, constricting, and general tension in your muscles, in your body. If you’re emotionally and mentally wound up in knots, your body is likely holding onto the tension leading to a general feeling of tightness, etc..
• Problems with sleep. Whether that’s falling asleep, staying asleep, having restless or unfulfilling sleep, etc.. You may rely on a glass or two of wine or a Tylenol PM to mask it temporarily, but basically, you have sleep issues.
• You may also feel a heightened “startle response.” In other words, when you live with anxiety, your nervous system is on overdrive so when ambulance sirens flare up or someone accidentally slams a door at work, you jump or startle easily.

4) This anxiety is interfering with your daily life.

Not in the “can’t get out of bed about to lose your job because of it” way, but you definitely notice that your anxiety is making it harder for you to feel secure and competent at work or in your romantic relationship, your friendships, etc.. Others around you may not be able to see it, but inwardly, you’re living out a high-drama movie each day and it’s starting to wear on your quality of life.

So Why Is “High-Functioning Anxiety” A Problem?

Often, I find that those who live their lives with anxiety, particularly “high-functioning anxiety,” are like fish being asked, “How’s the water?” If water is the only thing a fish has ever known, how could she possibly know any different or what a contrast experience may be?

So it may go for those of us who have grown accustomed and acclimated to living life with “high-functioning anxiety.” It’s possibly become so normalized and so much a part of you that it’s hard to imagine how it might feel different or what else might be possible.

But something else is possible.

And, as a therapist, I think it’s important that those who identify with “high-functioning anxiety” recognize that it is an issue because, if left untreated, the accompanying cluster of side effects and symptoms can take a toll on your overall well-being both physically and emotionally.

Let’s face it: All of the symptoms of “high-functioning anxiety” can be uncomfortable. Really uncomfortable.

Not only that, but attempts to self-cope with those uncomfortable symptoms can lead to maladaptive behaviors like regular use of substances or addictive actions — such as multiple glasses of wine on the weeknights, nightly smoking, regular Netflix and Youtube binging, endless social scrolling, etc. — all in an attempt to self-soothe and tolerate the intolerable feeling states that may be brewing inside you.

But the compulsive use of those coping mechanisms isn’t healthy and can often lead to greater feelings of anxiety and contribute to the development of comorbid conditions such as depression, sleep disorders, eating disorders, substance use disorders, etc..

So How Can We Treat “High-Functioning Anxiety”?

The good news is that “high-functioning anxiety,” like with many anxiety disorders, is highly treatable.

The news that may not feel quite so good? Treating it often requires an investment of time, energy, and effort through a variety of means and modalities.

Below are some of the top modalities you may want to consider in treating “high-functioning anxiety”:

1) Psychotherapy:

I may be biased, but psychotherapy – or talk therapy – is still roundly considered a primary support for helping to treat anxiety disorders, including “high-functioning anxiety.”

Talk therapy helps address the roots of the issues that led to the anxiety disorder in the first place such as unresolved trauma, unprocessed grief, low self-esteem, etc..

Therapy will certainly help you develop some immediate coping mechanisms to deal with your anxiety, but most therapists will also place an emphasis on helping you to understand and help heal the roots of your anxiety, leading to more integral and sustainable long-term change. If you’re curious about starting therapy, check out this free guide I wrote about “10 Important Things To Know When Considering Therapy.”

2) Medication:

As a therapist, I have a moderate approach to medication. I completely understand that the choice to pursue medication to treat anxiety may not right for everyone, but sometimes it can be a terrific support to help bring your nervous system back into a “window of tolerance” and allow you to do the work you need to do inside and outside the therapy room to truly transform your anxiety. So talk to your doctor or psychiatrist about medication to alleviate your “high-functioning anxiety” if this feels right for you.

3) Diet changes:

I’m not a nutritionist and it’s outside the scope of my clinical license to give dietary advice, but, anecdotally, I’ll say that there’s a growing body of research connecting the gut and our brain that highlights how directly our diet and gastrointestinal health can correlate to our mental health. So, when appropriate, I often give my clients referrals to nutritionists I trust here in the Bay to help with this aspect of their overall anxiety treatment plan.

4) Behavioral changes:

As part of an overall anxiety treatment plan, I help my clients identify and focus on reducing, eliminating, or getting creative with the behaviors that contribute to their anxiety, whether this is reducing emotionally painful visits to family members, changing dysfunctional work environments, reducing time on social media, finding different ways to commute to work, cultivating different living arrangements that will feel more supportive, etc.. Anxiety treatment can be greatly supported by creative implementation of real-life actions that are designed to support your overall well-being.

5) Developing a new relationship with your anxiety:

Finally, another way you can support your anxiety treatment is to develop a different kind of relationship with your anxiety.

For instance, perhaps shifting from seeing your anxiety as a sign that “you’re broken” to a viewpoint that sees your anxiety as something inside of you that needs your attention and attunement. A sign you need to listen to yourself and get the supports you need. There’s no such thing as a “bad” feeling, all feelings contain clues for us, and so when I invite you to develop a new relationship with your anxiety, I’m inviting you to shift your attitude compassionately towards it and look at it as something to get to know and live with versus a problem within you to be “solved.”

It may be that you’ll never love your anxiety, but can you at least accept it and find creative ways to live with it?

Finally…

These are just some of the top ways I recommend beginning to work with to treat your “high-functioning anxiety.”

Now I’d love to hear from you in the comments below:

Leave a message in the comments below so our community of blog readers can benefit from your wisdom.

Here’s to healing relational trauma and creating thriving lives on solid foundations.

Warmly,

Annie

Frequently Asked Questions

This is part of our comprehensive guide on this topic. For the full picture, read: High-Functioning Anxiety: A Complete Guide.

You deserve a life that feels as good as it looks. Let’s work on that together.

References

• National Institute of Mental Health (2021). Any Anxiety Disorder. NIMH Website.
• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
• Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry.
• Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience.
• Muris, P., & Broeren, S. (2009). The relationship between cognitive development and anxiety phenomena in children. Journal of Child Psychology and Psychiatry.
• Ressler, K. J., & Mayberg, H. S. (2007). Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nature Neuroscience.
• Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry.
• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research.

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