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What is high-functioning anxiety — and what can you do about it?

Hearing more and more about high-functioning anxiety lately—but not exactly sure what it is? This kind of anxiety can often flies under-the-radar, in part because the outward symptoms don’t always mirror traditional anxiety symptoms, says Audrey Schoen, a Licensed Marriage and Family Therapist and Owner of Audrey Schoen, LMFT — but it can manifest as overthinking, people-pleasing, procrastination and more. 

Here, Schoen ID-s what high-functioning anxiety is, signs to watch for, and what can help: 

Q. Let’s start at the beginning: What is high-functioning anxiety?

High-functioning anxiety is where a person seems to have everything together, continues to function well in their life — and at times might even be a high performer — while on the inside they suffer from a variety of anxiety symptoms. This type of anxiety often goes undiagnosed, as those who struggle with it seem “fine” on the outside, which leads to the internal symptoms of anxiety being dismissed, brushed off, or otherwise masked.

Q: How is it different from other types of anxiety?

The coping mechanisms that come with high functioning anxiety lend to success, and are socially prized. These over-performers can do it all — and do it well. On the outside they are driven, organized, detail oriented, proactive, helpful and appear calm and collected. Moreover, they are often not plagued with some of the more classic symptoms of anxiety, like debilitating worry or panic attacks.

Instead their anxiety fuels them, constantly pushing them to reach increasingly unrealistic standards. Inside, however, nothing ever feels good enough, and it’s just a matter of time before someone sees through the facade and finds out just what a mess they are inside. It’s not uncommon for clients to come to me saying that their life is ‘pretty good’, and they just don’t understand why they don’t feel OK inside.

Q: Have you seen a rise in this type of anxiety recently — or is it that people are more aware of it these days?

I think it’s a bit of both. Increased awareness of mental health, along with having more language to better describe our experiences, allows us to better label the different ways that anxiety can present.

Additionally, the increased demands of modern life and the pressure to do it all (and do it perfectly) means there is just more to manage. It is easy to fall into the trap of needing to create an IG worthy life and Pinterest-perfect parties, while simultaneously keeping up with work, kids, school, extracurriculars — and don’t forget self-care. The more we attempt to over-function, the more likely we are to develop high functioning anxiety.

Q: What are some signs to watch for that might signal you’re dealing with it?

  • Perfectionism. You set high expectations for yourself. They don’t seem THAT unreasonable, but often fail to take into account realistic factors like time, energy, and resources.
  • Self-criticism. When you fall short of those perfect expectations, you’re often hard on yourself. Others may sing your praises, even be impressed with what you have done, but to you, it’s mediocre at best.
  • Overthinking. You find yourself replaying every word or interaction, questioning what others are thinking about you, and analyzing every little detail. This is often accompanied with a sense of shame, certain you did or said something wrong.
  • People pleasing. You tend to say yes to everything, always the first to volunteer, and you’re quick to accommodate others’ needs or requests. This often results in being overloaded, over-scheduled, and stretched thin.
  • Sense of impending doom. Every day you carry a sense that something is about to go wrong, the other shoe is about the drop.
  • Procrastination. You always get things done, it just might be at the last minute. The mountain of obligations can get overwhelming, so you might avoid it for a while, but when the time comes, you buckle down and push through.
  • Irritability and inflexibility. I often find those who struggle with high-functioning anxiety become easily irritated when their plans or schedule change unexpectedly. Their days are so carefully choreographed that any little change throws their whole system out of whack.
  • Insomnia: It’s common for the rumination and racing thoughts to make it difficult to fall or stay asleep.

Q: What advice do you have for people who think they might have high-functioning anxiety?

The hardest part of overcoming high functioning anxiety is confronting the fear that ‘If I get better, will I still be as successful?’ ‘Will I still be able to get things done?’ ‘Will people still value me?’ ‘Will I be good enough?’ As mentioned, many of the traits are desirable, even prized by others, and likely contributed to your success. It can be scary to even think about letting any of that go.

But I can tell you, as someone who struggles myself and [who has] worked with countless exhausted clients, it’s worth it. You will still be driven, successful, helpful, organized, and valuable. And you will also feel calm and present while doing it. Ultimately, we have to dismantle the core belief that your value is determined by your productivity. You are a human BEING, not a human DOING.

  • Slow down. I mean this in every way possible. Walk slower, breathe slower, move through the world with a deliberate cadence that allows you to be more present in this moment right now.
  • Say no. You have to get really real about your actual capacity and ditch the ‘shoulds’. “I should be able to do this bigger, better, faster… at all.” There are only so many hours in a day and you get to decide what is important enough to make it onto your calendar.
  • Schedule down time. This is crucial. Wherever possible, we have to block out pieces of our day where nothing is required of us. Scheduling down time like this serves two purposes. First, it creates protected time and space for you to really take care of what you need, even if that’s just to lie on the floor in silence with your eyes closed. Second, it acts as a buffer zone for when things really hit the fan.
  • Practice nervous system regulation skills. These can include exercise, yoga, deep breathing, mindfulness, dancing, meditation, and more. Deep breathing in particular is a quick practice that can very quickly slow your central nervous system, and with practice, can bring a sense of peace and calm to your body.
  • Tell a trusted friend. Show the messy underbelly to someone you trust. Have an honest conversation about the fact that you don’t have it all together, and there is a tornado raging inside of you. You might be surprised to find out others around you feel the same way too.
  • See a therapist. I get it — you SHOULD be able to figure it out yourself, just like everything else. But part of recovering from high-functioning anxiety is admitting that you, in fact, cannot do it all. Nor should you have to do it alone. Talk therapy can help teach you new skills and challenge unhelpful patterns, while interventions like Brainspotting or Accelerated Resolution Therapy can quickly heal your nervous system at a deep neurological level, allowing you to more easily implement your new skills.

Q: Anything else we should know?

We cannot talk about high-functioning anxiety without addressing the cultural pressures that contribute to it. While all people can struggle with anxiety, women are twice as likely to get diagnosed with an anxiety disorder than men.

Women are expected to work like they don’t have a family and mother like they don’t have a job. The same is not true for most men. We contend with a daily barrage of subtle messages about how we are supposed to be able to “do it all”… so why do so many of us feel like we are falling short?

When working with clients I am inevitably presented with the very real dilemma, “but if I don’t, no one will,” a phrase I have uttered to my own therapist many times. The problem is, you might be right. There are too many homes where partners are not acting like partners, and in some cases aren’t even willing helpers. Expectations on women to “do it all” and carry the brunt of the mental and emotional load of managing a home come not only from society, but the very partners we created the home with.

Overcoming high-functioning anxiety might also come with a shake-up in your home and relationship, as you step back from your role as manager of all the things and invite your partner to the table of equity.

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