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March 31, 2023

People with 'high-functioning anxiety' often mask their struggles. Here's how to spot someone that needs help

Those with the mental health condition often appear driven and keep full social schedules. But inside they're frequently stressed and worried

Mental Health Anxiety
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A person with high-functioning anxiety typically is a high achiever, very organized and detail-oriented. These are good qualities, but underlying fear and worry can prove problematic, mental health experts say.

The term high-functioning anxiety gets bandied about quite a bit, usually in reference to someone who is very successful. 

High-functioning anxiety is not an official mental health diagnosis, but it generally refers to people who manage busy schedules without revealing their underlying anxieties. On the outside, they appear calm and collective, but internally they are stressed and worried.

At work, they may appear driven, working overtime and never missing a deadline. In their personal lives, they are quick to help others, often afraid of letting down their friends and family members. Their social schedules tend to be as full as their work planners. 

"A person with high-functioning anxiety is fully functional and usually successful," Dr. Sasha Hamdani, a psychiatrist at the Psychiatry Associates of Kansas City, Kansas, told Forbes. "They'll perform well at their job, handle all of their finances, balance their home life, maintain relationships, but they're still struggling with anxious feelings and thoughts."

People with high-functioning anxiety typically are high achievers, very organized, detail-oriented and proactive in dealing with issues. They usually have outgoing personalities. Though these are all good qualities, underlying fear and anxiety can be problematic, mental health experts say. 

Signs of high-functioning anxiety

More than 40 million adults in the U.S. have been diagnosed with an anxiety disorder, according to the National Alliance on Mental Illness. Because of their high functionality, it is often hard to recognize that someone is struggling with high-functioning anxiety. They often mask how they are feeling by taking control of stressful situations, according to Cleveland Clinic psychologist Adam Borland.

"With high-functioning anxiety, there tends to be more of a fight response, where an individual pushes themselves to work harder in order to combat the anxiety," he explained in a blog post.

Signs that a person may have high-functioning anxiety include being a "people pleaser" or an over-thinker. Subtle nervous habits, like filling in silence with nervous chatter, avoiding eye contact, playing with one's hair or biting one's lips, also are cues. 

People with high-functioning anxiety may not realize they have an anxiety disorder, or they may suspect it but consider it a sign of failure to seek help. They also have a tendency to ruminate on negative thoughts. 

The most common types of anxiety disorders include general anxiety disorder, panic disorder, social anxiety disorder and phobias. People with high-functioning anxiety often exhibit symptoms of generalized anxiety disorder, which include excessive anxiety, restlessness, fatigue, irritability, muscle tension, concentration difficulties and sleep struggles. 

Other signs of anxiety include fear of the worst outcome or being judged by others. Some people with anxiety need frequent reassurance from others about how they perform daily tasks at work and at home.

Both genetic and environmental factors can influence whether a person develops an anxiety disorder. Risk factors include a family history of anxiety, negative or stressful life events, substance or alcohol use and having shy or nervous personality traits.

Many people with an anxiety disorders also develop depressive symptoms, such as feeling that life is no longer worthwhile, having trouble getting out of bed and losing interest in the things they once enjoyed. Left untreated, anxiety can lead to digestive problems, high blood pressure, obesity or a substance use disorder. 

How to treat anxiety

High-functioning anxiety is treated the same way as other anxiety disorders – with therapy, prescription medication or a combination of the two. Cognitive behavioral therapy can help people change negative thinking patterns and better understand their behaviors. Therapists also may encourage healthy coping strategies, like deep-breathing exercises and physical activity, to help reduce stress and anxiety.

An antidepressant, such as a selective serotonin reuptake inhibitor or a tricyclic antidepressant, may be prescribed, but benzodiazepines and beta-blockers also are sometimes used to treat anxiety.

People who feel that they are able to keep their anxiety in check may decide they don't need therapy or medication. But self-care, exercise, a healthy diet and a good work/life balance are still important to manage symptoms.

How to know when to seek help? 

There is no one-size-fits-all answer, but mental health experts say people should seek help if their work/life balance is out of whack, if they are struggling to get through the day or if they are having trouble sleeping or eating.

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