High-functioning anxiety is not a clinical disorder. But it creates problems with anxiety that can be chronic and at least partially debilitating. People suffering from high-functioning anxiety tend to keep it hidden, but that only deepens the stress and anxiety they experience and prevents healing from occurring. Even though it is not a clinical disorder, high-functioning anxiety is a treatable condition, and those who reach out for help and are serious about recovery can expect significant improvement in their symptoms.
What is High-Functioning Anxiety?
People with high-functioning anxiety experience many symptoms associated with anxiety disorders. But they do not meet the criteria for an anxiety disorder diagnosis, even though their overall quality of life may be significantly impacted by their condition.
Their tension and the stress they feel are not severe enough to disrupt their lives in obvious, observable ways, and as a result the suffering of men and women with high-functioning anxiety remains largely hidden from the world. But despite their continued ability to hold down jobs, attend school, handle family duties, and manage their personal and financial affairs, people with high-functioning anxiety are still in pain and functioning at less than their full potential.
Over time, high-functioning anxiety takes a heavy physical, psychological, and emotional toll on those it affects, and if these individuals don’t ask for help they may develop more severe and debilitating psychiatric conditions later in life.
High-Functioning Anxiety Facts and Statistics
High-functioning anxiety is not a recognized psychiatric condition, and its rate of prevalence remains unknown. But studies of full-fledged anxiety disorders have unmasked an epidemic:
- 40 million Americans aged 18 and over will suffer from an anxiety disorder in any 12-month period. This represents more than 18 percent of the adult population.
- The lifetime incidence of anxiety disorders for American adults is 28.8 percent.
- Rates of 12-month incidence for specific anxiety disorders are:
- Specific phobias: 8.7 percent
- Social anxiety disorder: 6.8 percent
- Post-traumatic stress disorder (PTSD): 3.5 percent
- Generalized anxiety disorder (GAD): 3.1 percent
- Panic disorder: 2.7 percent
- Obsessive-compulsive disorder: 1.0 percent
- Among people suffering from the symptoms of anxiety disorders, only 36.7 percent will receive treatment for their conditions—and that number is known to be much lower among people with high-functioning anxiety.
High-functioning anxiety sufferers don’t meet the criteria for an actual disorder. But the unpleasant symptoms they experience still align with one or more of the recognized anxiety disorders, and for every person diagnosed with a specific condition there will be many others experiencing similar symptoms and suffering because of it (while firm data is scarce, there is no doubt people with high-functioning anxiety outnumber those with full-fledged anxiety disorders, possibly by a significant margin).
Symptoms and Diagnosis of High-Functioning Anxiety
Unlike clinical disorders, high-functioning anxiety does not produce intense physical symptoms of anxiety that influence behavior. Anxiety is experienced, and it may include some physical dimensions (elevated heart rate, sweaty palms, butterflies in the stomach, etc.), but they usually aren’t strong enough to limit activity or be noticed by outside observers.
High-functioning anxiety is sometimes compared to generalized anxiety disorder because of its omnipresent yet somewhat vague nature.
But there are overlaps with other anxiety disorders as well, and in contrast to GAD high-functioning anxiety doesn’t create debilitating physical responses, attach as quickly to specific triggers, or cause significant avoidant behaviors. High-functioning anxiety sufferers generally push through their feelings and do what they have to do, even though they frequently feel discomfort before, during, and after their encounters with people or environments that cause them stress.
The emotional and behavioral symptoms of high-functioning anxiety include:
- Feelings of worry and anxiety that ruin attempts to relax, or that appear even when things seem to be going well
- Perfectionism and feelings of constant dissatisfaction with performance
- Workaholism, or a need to keep moving or doing even when at home
- Overthinking and overanalyzing everything, and frequent second-guessing after choices are made
- Discomfort with emotional expression, unwillingness to discuss true feelings
- Frequent anticipatory anxiety before a wide range of events or encounters
- Obsession with fears of failure or of the negative judgments of others
- Superstitions (the need to repeat certain behaviors or patterns over and over to stave off disaster)
- Periodic insomnia, inconsistent sleeping habits
- Irritability and quickness to become frustrated or discouraged in the face of setbacks
- Difficulty saying no, no matter how time-consuming, inconvenient, or complicated the request
- A false sunny disposition: secret pessimism that conflicts with public expressions of optimism
- A range of unconscious nervous habits (fingernail biting, hair pulling or twisting, idle scratching, lip chewing, knuckle cracking, etc.)
High-functioning anxiety sufferers lack self-esteem and self-confidence, and they attempt to compensate for their insecurities by constantly pushing themselves to do better or to please others. Unfortunately, their goals are often unrealistic, and their failure to meet them only reinforces their chronic feelings of tension and inadequacy.
Diagnosing High-Functioning Anxiety
When stress and anxiety are reported, and life-altering effects are present, mental health professionals will attempt to establish whether a true anxiety disorder can be diagnosed. If it cannot, they may turn to a high-functioning anxiety “diagnosis” by default.
This will not be a diagnosis in the clinical sense, since high-functioning anxiety is not an officially recognized disorder. But it still represents a real condition, with symptoms that are emblematic and shared by sufferers.
If a physician, psychologist, or psychiatrist believes a patient is suffering the effects of high-functioning anxiety, they will discuss various options with that individual and offer ideas for further action. Despite its non-clinical nature, high-functioning anxiety is a condition that causes notable distress and leaves sufferers desperate to find relief, and since it responds well to psychotherapy most medical professionals will recommend that route to recovery.
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Causes and Risk Factors
People with high-functioning anxiety are responding not to external circumstances, but to internally-generated fears that take on a life of their own. The roots of anxiety can often be traced back to past experiences, or to certain personality traits that may have been present since the beginning.
Some of the common risk factors for high-functioning anxiety include:
- Shyness in childhood
- Demanding, highly critical parents
- Childhood abuse (physical, sexual, emotional)
- Exposure to traumatic events, either as a witness or experiencer (violence, sudden loss of a loved one, diagnosis of a serious illness, warfare, natural disaster, etc.)
- History of anxiety disorders in the family, especially among parents
- Personal history of depression
- Highly stressful jobs
- Long-term financial or legal problems
Men and women with high-functioning anxiety are sensitive to a wide variety of triggers, many of which would not bother most people.
Co-Occurring Disorders or Complications
Even when the criteria for an anxiety disorder diagnosis are not met, chronic anxiety can have a negative and long-lasting impact on mental health and physical wellbeing:
- Depression is the most common co-occurring disorder among people with high-functioning anxiety, developing in at least half of all cases.
- Substance use disorders are two-to-three more likely to be diagnosed in men and women with a history of anxiety problems.
- Eating disorders often overlap with anxiety problems, and they are a clear risk for people with high-functioning anxiety.
- Chronic physical illness can be brought on or worsened by anxiety problems. Some of the conditions connected to anxiety issues include:
- Heart disease
- Irritable bowel syndrome (IBS)
- Chronic obstructive pulmonary disease (COPD)
- Functional dyspepsia (chronic stomach troubles)
Unchecked anxiety causes an enormous amount of unnecessary suffering, and it can shorten lifespan if left untreated for an extended period of time.
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High-Functioning Anxiety Treatment and Prognosis
Treatment rates for anxiety sufferers are low, and this affects those with high-functioning anxiety since many could benefit tremendously from expert medical assistance. This is especially true when other mental or behavioral health disorders are present, but even if they aren’t the symptoms of high-functioning anxiety remain highly amenable to therapeutic intervention.
Treatment for high-functioning anxiety revolves around psychotherapy, which can be administered to anxiety patients in mental health treatment facilities on an outpatient or inpatient basis, the latter of which is likely to deliver far better results in the early stages of recovery.
When patients enter residential rehab programs for anxiety, they will be exposed to invaluable learning opportunities, in their individual and group therapy sessions, in life skills and coping skills classes, and while practicing holistic stress management techniques like meditation, biofeedback, yoga, Tai Chi, art therapy, and equine therapy. Medication may also be prescribed for use during inpatient healing programs, usually in the form of anti-depressants (SSRIs) or anti-anxiety medications (benzodiazepines) that have a proven track record of effectiveness against the symptoms of anxiety.
Regardless of its clinical status, high-functioning anxiety is a real problem with a real solution. Well-planned and faithfully followed treatment regimens can change the lives of anxiety sufferers for the better, allowing them to move past the worries, fears, and concerns that have limited their happiness and capacity to achieve for far too long.