High-Functioning Anxiety and Depression

It can be difficult for people to understand what it’s like to have both high-functioning anxiety and depression.

Generally, people who have anxiety or depression disorders display significant disruptions in their ability to work, go to school, or participate in social functions. But with high-functioning anxiety and depression, although those disruptions are not as apparent, they still can occur. The signs and symptoms are often overlooked, because sufferers are able to manage daily activities, but they are suffering in silence. To the outside world, people living with high-functioning anxiety and depression seem fine and often excel at accomplishing tasks and goals.

Anxiety and depression are the most common mental health disorders. In the U.S., approximately 19 million people suffer from anxiety and 18 million from depression. Additionally, it is estimated that about 85 percent of Americans with depression also suffer from an anxiety disorder, and almost 54 percent of people with an anxiety disorder also have major depression.

The co-occurrence of anxiety and depression is one of the most frequent comorbid mental health disorders.

It follows, then, that those who are living with high-functioning anxiety may experience high-functioning depression as well, and vice versa.

What is High-Functioning Anxiety?

Anxiety is a normal and healthy emotion all people experience. It signals us to be alert to important situations and to be ready for impending danger. But when worry and fear become significantly more intense than is warranted and begin to interfere with life functions, anxiety disorder is likely the reason.

The most common signs of anxiety disorder include:

  • A racing heart
  • Difficulty breathing
  • Muscle tension
  • Sweating
  • Trouble concentrating
  • A feeling of impending doom or of “going crazy”

To be diagnosed as having anxiety disorder, a person must experience excessive worry on more days than not for at least six months.

People living with high-functioning anxiety often feel these same extreme emotions. However, while they may be overcome with fear and worry when alone, they are able hide it and “power through” outwardly managing responsibilities in their life.

How Is Depression Different From Anxiety?

Depression is different from anxiety. Rather than feeling anxious and nervous, feelings of gloom and melancholy overwhelm. Feeling sad or down after experiencing a loss or disappointment is an emotion that everyone feels at one time or another. But when low mood and sadness is severe and lasts for long periods of time, it could be due to depression.

There are two main types of depression: Major Depressive Disorder and Persistent Depressive Disorder (dysthymia). While the signs and symptoms of both are similar, the intensity and duration differ. Symptoms of both Major Depressive Disorder and dysthymia include:

  • Sleep disruptions
  • Difficulty concentrating
  • Low energy or fatigue
  • Weight loss or gain
  • Loss of interest in activities that were previously pleasurable
  • Persistent feelings of sadness, emptiness, helplessness, worthlessness or guilt

To be diagnosed with Major Depressive Disorder, a person must experience at least five of the recognized diagnostic symptoms, and one of them must be a loss of interest in activities that were previously pleasurable, or an overwhelming sense of sadness or gloom.

Additionally, the symptoms must last for two or more weeks and cause significant disruption of life functions. But to be diagnosed with dysthymia, a person need only have two of the recognized diagnostic symptoms, one of which is a mood that is persistently dark or gloomy, and the symptoms must be present on most days for at least two years. It is possible to have periods of time that are “symptom free,” but the break cannot last longer than two months.

Because the symptoms of dysthymia tend to be considered milder than those of Major Depressive Disorder and do not require a disruption in life function, many mental health professionals consider high-functioning depression to be a form of dysthymia.

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What Is It Like to Have High-Functioning Anxiety and Depression?

People living with high-functioning anxiety and depression usually do not fit the stereotype of either disorder. In fact, many appear to be overachievers. The anxiety can serve as an energizer, driving the person towards achieving his or her goals. It’s later, when in private, that the symptoms of depression tend to emerge. Feelings of self-doubt and self-criticism, fatigue, helplessness or guilt, moodiness, and a desire to avoid interaction with others become intensified. Because the stereotypical image of depression or anxiety doesn’t match up with what people living with high-functioning anxiety and depression “look like,” it is hard to spot, even for sufferers to recognize in themselves. However, the symptoms of high-functioning anxiety and depression are the same as for non-high functioning anxiety and depression. The main difference is the ability to suppress or diminish the appearance of disruptions in life activities.

Many people living with high-functioning anxiety and depression are described as Type-A personalities or overachievers. They often excel at work or appear to be “super mom/dad” and seem to have it all under control. Other people may notice signs of high-functioning anxiety and depression but characterize the behaviors as “anal retentive” quirks or bad habits. And, many times, signs and symptoms of high-functioning depression and anxiety that others observe are given positive attributes, rather than being seen for what they are. For instance, anxiety and worry may be expressed as dwelling on minor details and viewed as perfectionism. What observers generally do not see are the private struggles with stress, sleeplessness, digestive issues, self-criticism, or feelings of sadness and gloom that had to be overcome to attain achievements.

Recognizing the Signs High-Functioning Anxiety and Depression

The signs of high-functioning anxiety and depression can get hidden within seemingly reasonable justifications. Even though one might be holding down a job, going to school, or in a healthy relationship, he or she experiences disruptions in life activities that may not be necessarily obvious. Some of these hidden disruptions can be seen in behaviors such as declining social invitations with the excuse that work has been busy or stressful, sleeping more or sleeping less, and an overreliance on coping mechanisms like excessive exercise, overeating, or overindulging in alcohol or illicit substances.

Other signs of high-functioning anxiety or depression are:

  • Pervasive self-criticism
  • Excessive worry or guilt over past or future decisions
  • An Inability slow down or to feel real joy

The symptoms of high-functioning anxiety and depression, like other forms of anxiety and depression, only get worse over time when not treated.

Complications High-Functioning Anxiety and Depression

Only about one-third of people with anxiety or depression seek treatment.

That number tends to be even lower for those who have high-functioning anxiety and depression. Although they may be suffering, they may not realize there is a problem.  When high-functioning anxiety and depression is left untreated, a sufferer’s life can diminish to the point where they are surviving rather than thriving.

Another potential complication is that chronic high-functioning anxiety and depression can lead to a variety of other medical and mental health issues when left untreated. Research has shown a correlation between mental health disorder and chronic illness. Evidence points toward changes in the way certain body systems function when mental health disorders are present. Some changes include fluctuations in heart rate and circulation, increased inflammation in the body, metabolic changes, and irregularities with stress hormones. There are also increased risks of diabetes, stroke, cardiovascular disease, and substance abuse. Getting treatment quickly can help prevent high-functioning anxiety and depression from getting worse, or developing into additional medical and mental health issues.

Treatment for Co-Existing High-Functioning Anxiety and Depression

People living with high-functioning anxiety and depression may appear fine, but they are far from being as emotionally and mentally healthy as they could be. Seeking treatment is an important step to improving overall emotional and mental health to its potential level. High-functioning anxiety and depression is very treatable, but often the difficulty is in identifying the signs and symptoms and realizing there is a problem.

High-functioning anxiety and depression is treated the same way as other anxiety and depressive disorders, through psychotherapy and medication. Cognitive behavioral therapy (CBT) combined with antidepressants or antianxiety medications can be very effective and shows improved outcomes over treatment that employs only therapy or medication. Residential treatment can also be beneficial for people living with high-functioning anxiety and depression. Residential treatment allows for individuals to get care in a home-like setting, but in a controlled environment away from home, possible triggers, and the rigors of daily life.