Reviewed By: Barbara Rexer, DSW, LCSW, LCADC, CCS, ICCS, DRCC
Anxiety doesn't always have a diagnosis, and it isn't always obvious. Some of the world's most successful people live with high-functioning anxiety. Here's what that means, how to tell if it affects you, and what you can do to treat it.
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Of the 40 million Americans who struggle with anxiety, not all will be diagnosed with a medical disorder. In fact, some may not appear to struggle at all. People with “high-functioning anxiety” actually include some of the world’s most successful figures, such as Oprah Winfrey, Stephen Colbert and Kim Kardashian. According to a recent report by health insurer Bupa Global, as many as 64% of business leaders also deal with anxiety.
Driven, organized, and high-achieving, these people appear to balance work, relationships and other responsibilities with ease. But appearances can be deceiving.
Plagued by crushing self-doubt and worry, people with high-functioning anxiety pay an emotional price for their achievements. Many also experience ruminating thoughts, sleeplessness and loneliness. Read on to learn exactly what life with high-functioning anxiety is like, and how you can help yourself or a loved one.
What Is High-Functioning Anxiety?
High-functioning anxiety refers to consistent feelings of stress, worry, or generalized anxiety that can have a big impact on emotional health, but are not severe enough to disrupt day-to-day life. High-functioning anxiety is therefore not a medical diagnosis. Many people who struggle with this form of anxiety hold steady jobs, graduate from school and fulfill general life responsibilities without needing treatment.
Comedian Jordan Raskopolous shared her experience with high-functioning anxiety in a humorous Tedx Talk that reveals what day-to-day life is like:
Traits of High-Functioning Anxiety
Despite an outward appearance of success, people with high-functioning anxiety often experience feelings of overwhelm and personal pressure. Those who struggle are also typically people-pleasers who have a hard time saying ‘no’ to friends, family and colleagues. Although every person experiences the condition differently, here are a few common characteristics:
- Helpful to a fault
- Difficulty letting go of perfectionism
- Tendency toward procrastination
- Intense fear of failure
- Likely to have nervous habits, such as nail-biting or lip-biting
- Tendency to be over-prepared for work or school
- Tendency to dwell on small mistakes
People who struggle may avoid stepping outside their comfort zone or trying new things. They might also have trouble letting go of unreasonable expectations, even at the expense of their health or relationships. These challenges can make it difficult to enjoy life, relationships, and hobbies.
Moreover, loved ones may recognize that a problem exists. When life seems to be going well, it can be easy for friends and family to dismiss anxiety as a personality quirk. This can make it difficult for people with anxiety to build a support system or have the confidence to seek professional help.
If you recognize the above characteristics in a loved one, understand that these traits are part of a condition that requires empathy and support. If a friend or family member expresses a need for help, take their concerns seriously.
High-Functioning Anxiety vs. Anxiety Disorders: What’s the Difference?
The difference between high-functioning anxiety and a diagnosable anxiety disorder is a matter of severity. For people in the high-functioning category, anxiety does not typically interfere with life responsibilities. When anxiety starts to disrupt a person’s ability to function in day-to-day life, doctors are more likely to diagnose an anxiety disorder.
Importantly, changes in a person’s life may affect their diagnosis. For example, a traumatic event or long-term stress might push someone with high-functioning anxiety to develop an anxiety disorder. Likewise, when someone completes treatment for an anxiety disorder, they may continue to live with high-functioning anxiety.
Mental health professionals agree that early intervention is beneficial for those who struggle with any level of anxiety. Developing healthy coping mechanisms through professional or self-directed treatment can help to prevent anxiety from becoming a serious problem.
Common Anxiety Disorders
High-functioning anxiety is associated with a number of anxiety disorders. Here are a few of the most common:
Generalized Anxiety Disorder (GAD)
GAD is an anxiety disorder characterized by persistent stress or anxiety that may not have a definable root cause. Some people with GAD worry excessively about their health, finances and relationships; others might fear a natural disaster, even if the odds are small of one occurring. Doctors diagnose GAD when the anxiety becomes uncontrolled for six months or more. About 3.1% of Americans suffer from GAD.
Social Anxiety Disorder
Social anxiety disorder is defined by an intense fear of judgement from others, even in everyday situations. People with social anxiety might worry about being negatively evaluated by the cashier at the grocery store, or viewed as awkward or boring by a casual acquaintance. Although they recognize that their fear is excessive, people with social anxiety disorder find that their anxiety is uncontrollable. About 7% of Americans suffer from social anxiety disorder.
Panic disorder is characterized by spontaneous feelings of uncontrolled terror without a threat of real danger. People with panic disorders suffer from hyperventilation, sweating, chest pains, chills and an increased heartbeat. Many people also fear recurring attacks. About 2.5% of Americans suffer from panic disorders.
Obsessive-Compulsive Disorder (OCD)
People with OCD experience obsessions, or intrusive, persistent thoughts that cause anxiety, coupled with a compulsion to perform behaviors that ease these thoughts. Common obsessions include cleanliness and order. The disorder affects about 1.2% of Americans.
Anxiety is also associated with eating disorders. A survey published in the American Journal of Psychiatry found that as many as two-thirds of individuals with eating disorders struggle with anxiety.
Anxiety and Substance Use Disorders
Research shows a high correlation between anxiety and substance use. Although the likelihood of developing a substance use disorder is higher with a serious mental illness (SMI), high-functioning anxiety leads to its own set of risks.
For example, people in this group are more likely to habitually use tobacco products, marijuana and kratom. Anxiety and fear of failure has also led to a rise in nootropics like Adderall and Ritalin, particularly on college campuses. Notably, all of these drugs only provide temporary relief and can make long-term anxiety worse.
People with high-functioning anxiety are also at risk of abusing prescription anti-anxiety medications, which are increasingly available on the street. Alarmingly, many anti-anxiety medications, such as benzodiazepines, are highly addictive and meant only for short-term, monitored use. It’s important never to take anxiety medication unless under a doctor’s care.
It’s also important to recognize the impact of drinking with anti-anxiety medications like benzodiazepines, even if you have a prescription — and even if you’re not abusing alcohol. Since benzodiazepines and alcohol are both depressants, mixing the substances can dangerously lower heart rate and depress the central nervous system. Notably, mixing alcohol with any medication can change the intended effect of that medication in a dangerous way.
The risk of unintended overdose or developing a substance use disorder make it important to seek professional treatment for anxiety, even if you’re high-functioning.
Getting Help for High-Functioning Anxiety
Many treatment options exist for anxiety, ranging from therapy to self-directed mindfulness techniques. Self-care is also important. Getting enough sleep, drinking plenty of water, and taking time to get outside can all help to lower anxiety levels.
If anxiety is part of your daily life, don’t be afraid to get professional help, even if you don’t think you have a diagnosable anxiety disorder. Treatment isn’t just about coping to manage basic life responsibilities; it’s about managing anxiety in a way that promotes your happiness and long-term mental health.
Professional treatment can also help you identify any co-occurring mental health disorders or conditions for which you may need medication. By working with a team, you can develop a plan for your anxiety that considers all important factors, including your medical history, goals, and time available for treatment.
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