What Is “High Functioning Anxiety?”

By: Jon Jaehnig

Updated June 04, 2020

Medically Reviewed By: Whitney White, MS. CMHC, NCC., LPC

When most of us talk about "anxiety" we talk about it as though all cases of anxiety were the same. This is not the case.

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"Anxiety" - when used to discuss a disorder rather than just the feelings of anxiety that everyone gets from time to time - is usually used as shorthand to refer to a large number of anxiety disorders and related conditions.

All of the many different kinds of anxiety disorders share some common symptoms including increased incidence and severity of panic attacks, and inappropriate, debilitating, or constant feelings of fear. That doesn't mean that all anxiety disorders are the same. When the symptoms appear, how they manifest, and other factors all mean that each anxiety disorder impacts the individual differently.

In this article we will discuss High Functioning Anxiety Disorder including its symptoms and how it is diagnosed and treated.

What Does "High Functioning" Mean?

Hearing "high functioning" may make it sound almost as though this kind of anxiety is a good thing, that it somehow makes it easier to do things or be successful. That's not quite right.

When "Functioning" or "high functioning" is included in a diagnosis or the name of a condition, it relays information about the kinds of people that have it and the ways in which it impacts their day-to-day lives. People with these conditions are not prevented from achieving great things and the condition may be at least in part because of the great things that they are able to achieve. This does not mean that they don't have problems and it certainly doesn't mean that the condition is the cause of their success.

High Functioning Anxiety Vs. Other Anxiety Conditions

One of the most easily recognizable symptoms of most anxiety conditions is the "anxiety attack" or "panic attack." During an anxiety attack, the individual's heart rate increases, and their breath becomes fast and shallow. They may feel chest tightness or even chest pain. The individual may feel as though he is going to throw up or pass out - and he may actually do so. Anxiety attacks can also include unusual thoughts and feelings like the feeling that you are losing your mind or that your life is outside of your control

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Individuals with high functioning anxiety may not experience anxiety attacks, or may not experience them in this way. The kinds of anxiety attacks experienced by people with high functioning anxiety have been called "silent anxiety attacks." Anxiety attacks of this kind may not include the physical symptoms like shortness of breath but do include the emotional symptoms like feelings of loss of control.

In some cases, people with high functioning anxiety disorder don't get the same kind of anxiety attacks as can typify other kinds of anxiety disorders, period. In other cases, people with high functioning anxiety disorder may simply be better at avoiding things that trigger their attacks. One of the common traits of people with high functioning anxiety disorder involves crafting their lives around avoiding the things that make them uncomfortable,

Another common element of anxiety disorders is fear. In most anxiety conditions, this may prevent the individual from doing things or pursuing opportunities. However, in the person with high functioning anxiety, this fear can drive them to always work or always work harder. As a result, they may experience success in their professional lives but don't have time or energy left over to maintain healthy relationships or to take care of their own physical or emotional health.

Who Gets High Functioning Anxiety Disorder?

Anybody can get high functioning anxiety disorder, or any other anxiety disorder for that matter. Like other emotional disorders like depression, anxiety disorder can be the result of chemical imbalances, life events, or a combination of the two.

This is one of the reasons why questions about the causes of high functioning anxiety disorder are so complicated. People with high functioning anxiety disorder are usually very successful people but the fact that they are usually diagnosed as adults means that it can be difficult to determine whether they are successful because their anxiety drove them to push themselves or whether they developed anxiety because they pushed themselves to be successful. Whether the chicken or the egg came first, most cases of high functioning anxiety disorder are probably a result of life circumstances combined with a biological predisposition to anxiety.

How Is High Functioning Anxiety Disorder Diagnosed?

As mentioned above, high functioning anxiety is often diagnosed in older adults, where most anxiety disorders are diagnosed in teens or young adults. This is largely because high functioning anxiety lacks many of the most recognizable symptoms of other anxiety disorders. As a result, high functioning anxiety is often diagnosed when the individual sees a therapist or counselor about another, seemingly unrelated issue, like relationship counseling.

Further, because people with high functioning anxiety are often perfectionists and insist on specific routines, they may seek a diagnosis for a better-known disorder like obsessive compulsive disorder. Their attempts to avoid things that trigger their anxiety may also make some of their symptoms look like symptoms of disorders like depression. Many people with depression also have anxiety, so being diagnosed with another disorder may lead to the discovery of an individual's high functioning anxiety.

High functioning anxiety may also be initially noticed by a primary care provider because chronic stress, like that suffered by those with anxiety disorders, can lead to physical symptoms that may turn up in a routine checkup. These include high blood pressure, heart problems, poor immune system, digestive problems, muscle pain, weight loss or weight gain, and other symptoms.

Of course, as information becomes more readily available and the stigma associated with mental and emotional disorders goes away, more and more people are seeking out diagnoses for their anxiety conditions rather than waiting for someone else to discover these conditions.

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How Is High Functioning Anxiety Disorder Treated?

Once high functioning anxiety disorder is diagnosed, it is treated in the same way that other anxiety disorders are treated.

Depending on the preferences and circumstances of the individual, treatment may consist of just medication, just talk-therapy, or some combination of the two.

Medication on its own can help to ease the symptoms of individuals with high functioning anxiety. However, anxiety medication also makes talk therapy more helpful. As a result, the combination of talk therapy and medication may last for months or even years but can eventually come to an end. Talk therapy or medication often lasts for the life of the patient.

Consequently, many people with anxiety disorders are wary of beginning medication. They fear that medication will change who they are as a person, or negatively impact their relationships with others. In the case of high functioning anxiety, many people also fear that medication will "dull" them or take away their drive and ability to succeed.

While this is not the case, people with these concerns can choose to only go through talk therapy if they wish. Many research studies demonstrate therapy to be successful in treating anxiety without medication.

Therapy For High Functioning Anxiety

The main goal of therapy in the case of people with high functioning anxiety disorder is to help them to stay calm. This involves recognizing when their thoughts are "spiraling" and getting them back on track.

People with high functioning anxiety disorder often worry about the future including things that they can't change or even realistically anticipate. Talking with a therapist can help these people learn how to identify when their thoughts are about something that they should deal with and when their thoughts are distracting them from things that they can do in the moment.

Many people with high functioning anxiety also have irrational fears about how others perceive them. A counselor can help them determine when these fears are founded and can also help them to determine how important these things really are to their daily lives.

A more recent development in therapies for people with high functioning anxiety has to do with mindfulness. Mindfulness is all about learning to understand your thoughts and feelings as they relate to the present moment. Incorporating mindfulness into cognitive therapy helps the counselors of people with high functioning anxiety to give their patients the tools that they need to keep themselves grounded in their own thoughts and feelings in the moment rather than worrying about what other people think or what may happen in the distant future.

Despite the earlier mentioned fears that controlling high functioning anxiety will make the individuals less productive, it actually makes them more productive by directing their energy away from unfounded and unhelpful fears towards things that they can actually control.

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