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Do You Have High-Functioning Anxiety?

The extent of functional impairment in anxiety may be related to its severity.

Key points

  • The severity of anxiety can vary widely from person to person.
  • Although not a clinical diagnosis, high-functioning anxiety refers to anxiety that, on the surface, doesn't seem to impair a person's life.
  • Individuals with high-functioning anxiety still need and deserve support and treatment.

Anxiety is an extremely common problem. According to the National Alliance on Mental Illness, more than 40 million adults in the United States have an anxiety disorder. The 40 million includes individuals with all types of anxiety problems, some of which are unfortunately very disabling. Other people, however, seem to be able to function at a high level, despite their distressing feelings of anxiety.

Anxiety is essentially fear, which is, of course, a basic but unpleasant emotion. To our misfortune, anxiety features all too frequently in our lives. We feel anxiety very often simply because we need this emotion to stay alive. When fear is dulled or inhibited by chemicals such as alcohol, we do unwise things or fail to take notice of potential dangers.

Anxiety is an alarm, and like any other alarm, it is impossible to ignore. You may decide to "conquer the fear" by powering through it, but you will still feel it. Unfortunately and very unfairly, some equate feeling anxious with lacking courage and moral fiber, or being cowardly, when in fact those who get up in the morning despite their anxiety are arguably more courageous than those who don't feel the fear in the first place. And those who can't even get up in the morning because of their anxiety deserve our help and sympathy.

Fight or Flight

Fear produces the "fight or flight" response in humans. When confronted with a threat, animals (including ourselves) fight only when they think they can win; otherwise, it makes better sense to flee. Either way, our body and mind become aroused during the fight or flight response. This arousal allows us to gather very quickly all the bodily energy and mental focus necessary for either fighting or running away.

These two options (fighting or fleeing) correlate with the different responses we find in anxiety. On the one hand, a feeling of fear typically promotes avoidance, the equivalent of the "fleeing" response, while other individuals may push through the fear and move forward regardless.

This would be the "fight" response that is found in "high-functioning anxiety." Although high-functioning anxiety is not a formal diagnosis and is not in the DSM-5, the term has been used to characterize those who experience anxiety sensations that, on the surface, have no negative effects on their functioning. These high-functioning individuals may have a good job and a successful life but feel constantly tense and apprehensive. They may struggle to relax, have frequent indigestion, or find it difficult to sleep at night.

The Anxiety Spectrum

It is helpful, I think, to see anxiety as a dimension or spectrum, with normal, unavoidable, and intermittent anxiety at one end of the spectrum, the high-functioning sufferers probably somewhere in the middle (some of whom might still merit a more formal anxiety diagnosis), and the full-blown clinical, and certainly diagnosable, anxiety disorders at the opposite end of the spectrum. I am making a distinction between the different points in the spectrum simply because I think it is important to make it clear that whether a given individual is able to function or not is a sign of the severity of their anxiety rather than a personal option, or a question of personal courage and stamina.

Anxiety is awful, even when it is a normal part of life. The sufferer will need support and treatment when it gets even worse. We should not assume that the high-functioning anxious individual doesn't need this support. Even less, we should not blame the functionally challenged and severely anxious person for their challenges by implying that they lack the courage to confront their fear.

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