Smiling on the outside, while breaking on the inside. It’s a trope often visualised in campaigns to raise awareness of mental health, so maybe it feels a touch trivial to imagine, but for or someone with high functioning anxiety, this is daily reality.
So what is “high functioning” anxiety?
Scientifically speaking, it’s not officially recognised as being its own issue. It’s anxiety, but some people experiencing the condition at a mild or intense level still feel they can function well in life, which might look like excelling at work or being an attentive friend.
Essentially, they can hide their anxiety symptoms well enough that they appear to be unimpacted.
“When a person presents as capable, functioning and even excelling (such as in work, social, family or educational settings), but are actually hiding and internalising the fact they are experiencing all the chronic and debilitating symptoms of anxiety disorders, including fear, impending doom feeling, over worrying, hypervigilance and importantly the physical responses such as high heart rate and blood pressure, insomnia, gastro-intestinal issues (usually labelled as IBS),” Dee Johnson, an accredited Priory psychotherapist tells Glamour.
That ability to hide and even thrive in external life means that for some people, post-lockdown life provides the perfect context in which high functioning anxiety can exist.
It’s possible that people experiencing this can be missed or thought of as not suffering from a mental health issue – we only need to look to celebrities and those in public positions of power, such as Prince Harry, to see that mental health conditions can be hidden.
According to mental health charity Mind, in any given week in the UK 6 in 100 people are diagnosed with generalised anxiety disorder, the most common form of anxiety.
Getting back to normal might well lead to an increase in anxiety diagnoses.
Dee explains: “Being exposed again to ‘the outside’, no longer always working from home and having to reconnect with people, losing control of their inner world again could trigger this.
“In the early days of lockdown, having the physical pressure removed of not having to pretend in front of people that you are doing just fine probably suited a lot of high functioning anxiety suffers for a while.
“The fear of not being good enough now and having to prove themselves again now that many changes have occurred means that there will be a real insecurity that they may not be accepted anymore, so this drives the performance anxiety even deeper.”
With high functioning issues, there is a façade to be wary of as the affected person might more likely to not get the help they need.
What does high functioning anxiety look like?
Due to high functioning anxiety being characterised by a degree of pretense and keeping up appearances, signs can look to be unrelated to anxiety on a first glance.
A common one, Dee says, is presenting as a “perfectionist” and someone that is “always fearful of not being good enough or getting things wrong”, and they can also be workaholics.
At a toxic end of the spectrum, she warns: “This can manifest as
controlling behaviour when actually its fear driven rather than ego based, but when you are at the receiving end of such behaviour it’s really difficult to see anything other than control and power.
“People will try to avoid allowing themselves to feel their emotions and find ways to block them out (in case their emotions will inhibit them).”
Other signs can include but are not limited to: restlessness, being irritable, an inability to put assert boundaries, always being busy and full-on, insisting they are happy in difficult times.
“These people may have a history of depression, trauma in their past, low confidence and feelings of unworthiness, fear of rejection, substance use disorders (addiction) or an eating disorder – these are all examples of things that can drive high-functioning anxiety,” Dee adds.
If these words ring true, there are some things to consider:
- Ask for help, including professional help (though Dee says “this is not in their nature and hard to do as they will see this as a failure)
- Look at your belief systems and challenge them
- Learn to say no and that the drive for perfectionism is one of destruction
- Put in boundaries, limiting time you spend on trying to achieve everything.
- Engage in ‘slowing’ down activities, such as walking, yoga, dancing, gardening, holistic therapies, and anything creative “as this shuts down the anxiety response in your brain” Dee adds
- Telling people that you trust you are struggling, and this can include your GP who can refer for further support including psychotherapy, CBT, and mindfulness.
- Quit negative self-talk. “Stop insulting and punishing
- yourself with harsh and unkind words – and if at first you cannot find anything nice to say about yourself, at least stop saying the harsh stuff – nurture takes time,” Dee says.
High functioning anxiety doesn’t have to be a life sentence, but it requires dropping the act enough to acknowledge the need for change – functioning well on the outside while struggling internally can only be sustained for so long.
“Being human is being flawed – if something is flawless it doesn’t let the light in,” Dee says, “go easy on yourself.”