Reviewed by Dawn Brown, LPC, NCC
Most people are no strangers to anxiety. Anxiety awareness has increased substantially, from commercials promoting anti-anxiety medication to family members and friends acknowledging their anxiety disorders. Most people are familiar with anxiety in some form or fashion, even if that familiarity does not involve a great deal of understanding. Although familiarity is an important way to improve the visibility of a disability or mental illness, there are still many aspects of anxiety that people, both with and without anxiety disorders, do not understand, including the scope of symptoms and their impact on daily life.
Laying The Groundwork: What Is Anxiety?
Anxiety is a condition with a complex set of symptoms, the particulars of which will vary based on the exact anxiety condition involved. Although the term “anxiety” is typically seen as another word for worry or stress, anxiety disorders are actually a rather substantial subset of mental disorders. Some of the more well-known anxiety disorders include General Anxiety Disorder, Social Anxiety Disorder, and Post Traumatic Stress Disorder, though Obsessive Compulsive Disorder, Panic Disorder, and phobias are also found under the umbrella of anxiety disorders.
Anxiety disorders do possess common symptoms, the most substantial of which is an excessive and chronic worry. Unlike stress, anxiety does not have a single, consistent trigger and can flare up entirely without warning. Anxiety is a condition characterized by the worry that goes far beyond standard concern and has reached a point that requires aid or intervention—a fact that is often obscured in high functioning anxiety.
High And Low Functioning Anxiety: A Definition
Assigning monikers such as “high” and “low” to a condition often has very little clinical significance. Still, it can have a genuine impact on how someone sees themselves and how they feel about seeking assistance. If someone is struggling to get out of bed every day, for instance, due to the state of their anxiety, they may not feel as foolish reaching out for help, and their loved ones may have been working for a long time to support them in that goal. However, if someone seems to be functioning well, family and friends might not be as eager to suggest intervention, and people may not recognize an immediate need for assistance themselves.
While there is no concrete definition of high or low-functioning anxiety from the perspective of a psychologist or medical professional, there are generally accepted definitions for each of these terms based on how thoroughly someone can disguise or work through their anxiety symptoms. Someone with low functioning anxiety is likely someone who is largely controlled by their symptoms. For instance, in Post Traumatic Stress Disorder, low functioning anxiety may manifest through extreme avoidant behavior and a seeming inability to maintain close relationships. In Social Anxiety Disorder, low functioning anxiety might be characterized by an outright inability to associate with anyone who is not a close family member or friend.
High functioning anxiety is often characterized in one of two ways: anxiety that is manageable enough to not yet warrant a diagnosis, or anxiety that has been diagnosed but is not taking over daily life. While it is easy to dismiss high functioning anxiety with a shrug and an “It’s not that bad,” the nature of anxiety renders this statement false; the longer anxiety goes untreated, the more likely it is to escalate and bleed over into other areas. Simply managing a condition is not the same as working through a condition, and people with high functioning anxiety may be more than capable of coping. Still, they may not be coping in healthy or productive ways. Someone with high functioning Post Traumatic Stress Disorder might force themselves to visit reminders of their traumatic incident and interact with people before going home and suffering through sleepless nights. An individual with high functioning Social Anxiety Disorder may go out of their way to find new social situations and make new friends prove to themselves that they are okay—all the while, feeling panicked, trapped, and apprehensive.
Living With High Functioning Anxiety: Unique Challenges
Living with high functioning anxiety presents a few unique challenges. Although anxiety is often very easily visible to the people closest to someone with anxiety, high functioning anxiety is often thoroughly cloaked. This can make finding support and a source of understanding difficult. Although someone with severe anxiety might be met with a “We know” when talking to a loved one about their condition, someone with high functioning anxiety is more likely to be met with astonishment, confusion, or even denial. This can be extremely invalidating for someone with high functioning anxiety and could present an obstacle to seeking recovery rather than a source of support.
Living with high functioning anxiety could also present a unique challenge regarding finding treatment; people may not feel they qualify for anxiety evaluation. Online tests might indicate that anxiety could be at play, but reading about low functioning anxiety cases could make it seem as though they are not severe enough to warrant evaluation and treatment. Then, people with high functioning anxiety need reassurance that any level of anxiety warrants treatment and that they are certainly worthy of investing in their mental health.
Living with high functioning anxiety can also be accompanied by a feeling of shame or discomfort. People with high functioning anxiety may feel they are leading a double life or are being duplicitous. This can lead to additional anxiety and create another frustrating and difficult cycle, further preventing seeking help.
Finally, living with high functioning anxiety can be difficult because it can almost feel as though anxiety is actually a source of praise; a need to control outcomes can lead to work performance that is considered exemplary and can lead to children, students, and partners who are seemingly perfect. Unfortunately, that perfection is often driven by anxiety and a need to maintain strict control—but is often rewarded by parents, teachers, and partners or peers. Constantly having anxiety-driven behavior rewarded, encouraged, and reinforced can add an additional layer of difficulty in seeking help.
Treating High Functioning Anxiety
Treating high functioning anxiety may differ slightly from treating more severely symptomatic anxiety disorders;. However, many practitioners will focus on limiting anxiety symptoms as quickly as possible in low functioning anxiety and begin the process of finding an anxiety medication that will work best for their client. Someone with high functioning anxiety may be encouraged to first seek out psychotherapy and lifestyle interventions, to effectively and safely cope with anxiety.
Most commonly, someone with high functioning anxiety will start out with Cognitive Behavioral Therapy, a type of psychotherapy that focuses on changing existing thought patterns to promote a healthier perspective and a more grounded, supportive behavior pattern. In CBT, a therapist might help a patient identify the source of their anxiety, whether that is a faulty understanding of how they appear to the world or an inaccurate view of how they are supposed to behave or be seen in social situations. CBT is an empowering and self-healing modality. It teaches individuals with mental health issues on how to effectively take control of their own thought patterns and apply healthy, effective coping techniques.
People with high functioning anxiety might also be encouraged to try lifestyle interventions, including dietary changes, exercise changes, and sleep changes, to mitigate some of the more common symptoms of anxiety. Limiting caffeine intake, increasing or decreasing exercise and getting outside, and implementing healthy sleep habits can help ease anxiety symptoms.
High Functioning Anxiety: Knowing How And When To Ask For Help
Asking for help is never easy but can be particularly difficult when you have high functioning anxiety. Having high functioning anxiety is easily confused for effectively managing anxiety, but the two are not the same; high functioning anxiety means being able to cope with having anxiety in a way that makes anxiety not readily visible, while effectively managing anxiety means coping with anxiety with ways that are healthy and geared toward healing. Although high functioning anxiety is often inadvertently reinforced and encouraged by teachers, partners, peers, and parents, it is just as problematic as low functioning anxiety. It can have genuine and long-lasting repercussions.
Knowing how and when to ask for help with high functioning anxiety is often a compounding issue of letting go of guilt, shame, and a feeling of inadequacy; people with high functioning anxiety may feel as though they are not bad enough to ask for help and avoid it out of a sense of guilt. People with high functioning anxiety might also feel ashamed of how they feel. They may assume they are uniquely unable to handle life’s challenges, rather than recognizing the presence of anxiety. High functioning anxiety can also create feelings of inadequacy, as it may seem as though if someone only worked hard enough, tried hard enough, or “got over” enough, they would be able to feel better. However, none of these are true; any type of chronic anxiety is cause for concern, even if it may not be readily visible to the outside world.
Asking for help can be as simple (though it may not be easy) speaking to a primary care physician during a routine check-up and acknowledging that your anxiety has reached a level you consider unmanageable. Asking for help could involve reaching out to a dedicated mental health counselor and describing your symptoms. It could also mean reaching out to a friend or family member, and acknowledging that you are struggling, to ask for support in seeking help. High functioning anxiety may not require months and months of intensive mental health treatment. Still, it can benefit tremendously from mental health intervention. Many mental health professionals can offer coping techniques and tools to ease anxiety symptoms and move from high functioning anxiety to successfully managing anxiety.