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The Hallmarks of High-Functioning Anxiety

Signs you may be struggling with not showing that you're struggling.

You may have heard of the buzzword term, "high-functioning anxiety." But what does it actually mean? What does it look like...or rather not look like?

Let's break it down.

High-functioning anxiety can have all the usual core features—difficulty sleeping, irritability, poor concentration, feeling restless, and worry that feels out of control—it's just that it may not impair daily living to the degree that it does for others.

That's a key point.

That's because two hallmarks of diagnosis include that the symptoms are distressing for the person and they're experiencing dysfunction in their lives due to the symptoms. With high-functioning anxiety, this last marker about dysfunction may not be present—at least not on the surface.

That's not to say that others are weak in any way if they're struggling to manage it more than someone else. It's just that for various reasons, some folks can continue to seem "fine" on the outside while others may be showing more readily apparent cues.

This is problematic given that it may be easier for some to fly under the radar. Others may not notice signs of distress, and even the person experiencing symptoms may minimize what they're experiencing because they're still "functional."

Cue the volcano effect where we suppress for so long until we explode in massive distress.

Of note: High-functioning anxiety is not actually a clinical term that you'll find in the DSM-5. Like imposter syndrome, gaslighting, and other psychology buzzwords, it's not a technical diagnosis. Generalized anxiety disorder is a clinical diagnosis, though.

While the classic symptoms of anxiety can be present, high-functioning anxiety can often include people-pleasing, a fear of making others angry, and obsessions about what others think about them.

High-functioning anxiety can have a lot to do with keeping appearances up. Letting people see a peek behind the curtain can be anxiety-provoking in itself. The idea of being vulnerable, needing help, and struggling to keep up with expectations are not seen as human, they're seen as faults—often unconsciously—by the person with high-functioning anxiety. People with high-functioning anxiety can be the first to encourage and not judge others for getting help, but then they're the last to get help for themselves.

Sound familiar?

Because they can put off getting help for so long, the body can manifest symptoms as a cry for help. This can include several gastrointestinal issues—diarrhea, constipation, nausea, and vomiting are not uncommon (especially getting sick in the morning when cortisol is the highest). They may also get several headaches, body aches, and experience brain fog because they are emotionally suppressing their stress.

Where does this come from?

High-functioning anxiety often goes back to the messages we learned as children. When we associate our worth with our achievements, we learn that our value is in what we do, not who we are. When this happens, the striving for success is like a bucket with a hole in it. It's never enough.

This becomes a vicious cycle with folks looking for that "high" that comes with each award and accolade; all the while they are burning themselves into the ground as they grind to get there. However, when we use the evaluation of others as a metric for our self-worth, we're bound to continue the cycle. The high-functioning anxiety is the fuel that keeps the fire going when someone would otherwise burn out.

No one is immune from developing high-functioning anxiety, but women, mothers, caregivers, high-achievers, and people-pleasers are all more likely to meet the mark for high-functioning anxiety. We can also see minorities outwardly excelling but struggling with high-functioning anxiety because they have to do that much more to keep up when others have privilege to push them ahead.

So many people suffer in silence with high-functioning anxiety because they are so afraid of people perceiving them as failures if they don't achieve or if they need a break.

You can see how quickly imposter syndrome goes hand-in-hand with high-functioning anxiety. When we doubt our abilities, high-functioning anxiety tells us that it can be the frenemy to get us where we want to go.

So if this is sounding like the textbook of your life, give yourself permission to rest. In fact, assign yourself self-care as a task to complete. It may sound silly, but rest is productive—especially with high-functioning anxiety. You cannot continue on long-term if you truly do not stop to recover and restore yourself.

Also, practice saying "no." See what it feels like to sit with someone else's disappointment—and see that it doesn't have to derail your world. Before you say "yes" give yourself a solid 24 hours before you respond. That way you're not responding out of the need for approval but because you genuinely want to accept the offer.

The path towards the resolution of high-functioning anxiety is to learn that you can live with distress and discomfort. You can handle disappointing others. You can handle other's frustration when you set boundaries. You can sit with the unease of rest. It's a practice that you build with time and one that is certainly worth your while.

More from Lauren Cook PsyD, MMFT
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