Why High-Functioning Anxiety Needs Intensive Treatment

Anxiety disorders comes in a variety of forms, including generalized anxiety disorder, social anxiety disorder, panic disorder, and specific phobias. The differences between these disorders lie primarily in the source of anxiety as well as their manifestations. However, there are significant overlaps in symptomatology amongst disorders, including:

• Overwhelming fear, worry, and uneasiness
• Shortness of breath
• Gastrointestinal disturbances
• Heart palpitations
• Sleep disturbances
• Sweating
• Numbness, particularly in the hands or feet
• Dizziness or lightheadedness

The psychological and physical experiences of anxiety can be profoundly distressing and interfere with your ability to feel a sense of security and stability. You may come to shape your routines around managing your feelings of anxiety, avoiding situations, people, places, and things that provoke symptoms. For some, both this attempted management and the continuing presence of symptoms eliminate the ability to participate in everyday activities, including socializing, attending school or work, or even simply leaving the house.

For people with high-functioning anxiety, however, the disorder is not overtly disabling. “Those with high functioning anxiety are often doing very well in many areas of their lives, including careers, relationship, and personal achievements,” explains Nicky Lidbetter, CEO of Anxiety UK. “However, they experience significant levels of anxiety despite this. Individuals who experience high-functioning anxiety are often very driven, high achievers, who set incredibly high standards for themselves.” Indeed, high-functioning anxiety can act as the impetus for achievement, driving you toward success based on your overwhelming fear of failure, worry about disappointing people (including yourself), or desire for control. But this does not mean that the disorder is a positive thing.

“My anxiety about making mistakes at work made me work twice as hard to avoid them,” says Julia, VP of engineering at a tech start-up. “My career and my employer benefitted immensely. But I walked around in a constant state of worry. Even when things were going well I was always imagining scenarios of potential failure. It was exhausting.” Brian’s anxiety, on the other hand, was not specific to work. In fact, it wasn’t specific to anything. And yet this general feeling of unease fueled both his personal and professional life. “During the day I threw myself entirely into my career. When I wasn’t at work, I spent all my time with friends, going out until late into the night,” he explains. “No one would have guessed I had anxiety, but my job and my social life were largely driven by the fact that I couldn’t sit with my thoughts. I had to be doing something in order to cope. But, of course, the anxiety was still there.”

The dangers of functionally disabling anxiety are obvious; the disorder robs people of the ability to participate in everyday activities, live up to their potential, and achieve their goals. At times, it even disrupts the ability to form meaningful relationships or engage in self-care. In these cases, anxiety becomes visible and more likely to be recognized by both those who suffer from it and those around them. It is an obvious problem.

High-functioning anxiety, on the other hand, often remains hidden. Without visible functional disruptions, those around you may not see your struggles. In fact, your personal or professional successes may stand in stark contrast to what most understand mental illness to be, even if those successes are the product of mental illness itself. Perhaps most importantly, you may not recognize the presence or severity of your disorder. Instead, you ignore feelings of deep and pervasive anxiety because, after all, if you can keep functioning and achieving, it can’t be all that bad. Even if you acknowledge the existence of your disorder, you may minimize it due to your fear of failure or disappointing others.

Without acknowledgment of your distress or social support for your recovery, you are left to grapple with your symptoms alone. This can be a profoundly painful and isolating experience, particularly if you deplete your inner resources trying to keep those symptoms hidden from view. Without support and treatment, it is also likely that your functionality will diminish over time as your disorder grows in severity or you just become too exhausted to keep up the facade of wellness. You may also turn to harmful behaviors, such as drug or alcohol abuse, in order to self-medicate in the absence of healthier interventions.

But even if your illness never progresses past its current state, untreated high-functioning anxiety can still take a significant toll on your mental and even physical health. Researchers have found that high levels of anxiety are linked to heart disease, gastrointestinal disorders, and respiratory problems. Additionally, anxiety may weaken the immune system, compromising your ability to fight off illnesses. There is also a growing body of evidence demonstrating that anxiety can have significant effects on cognitive function, including “working memory and neutral cognitive control.” As such, high-functioning anxiety has real dangers that must not be ignored.