What Is It Like To Have High-Functioning Anxiety?

Anxiety is a natural and healthy emotion most everyone experiences. It is a vital feeling, because it alerts people to pay attention to important issues or warns of potential danger. But, with anxiety disorder, the fear response becomes exaggerated, and a person becomes anxious and fearful in situations that do not call for it. The fear and anxiety can become so great, steps are taken to avoid situations that trigger the feeling. Additionally, worrying about anxiety and the situations that cause the anxiety can result in further anxiety.

Common symptoms of anxiety disorder include rapid heart rate, sweating, lightheadedness or feeling faint, inability to concentrate or a feeling of “losing it,” trouble breathing, sleep disruptions, nausea, and an intense feeling of dread.

High-functioning anxiety is not an official diagnosis and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the prevailing guidelines for mental health diagnoses. According to the DSM-5, a required element of anxiety disorder is the anxiety must cause a disruption or impairment of life activities, and a change in behavior to avoid situations that trigger anxiety. Since disruption or impairment of life functions is a required element, there is an argument that if no clear impairment exists then anxiety disorder is not present. But many mental health professionals recognize that when a person suffers from anxiety disorder, they may experience varying degrees of impairment. Thus, when the impairment appears mild, it is simply characterized as anxiety disorder with mild impairment, rather than absent impairment. The prevailing thought is that this condition is mild anxiety, rather than high-functioning anxiety.

With mild anxiety, the individual experiences minor life impairment and is often characterized as having mild symptoms rather than being “high-functioning.” However, this reasoning does not address the conflict between how an individual feels internally, and how he or she displays those feelings externally. In other words, while the resultant impairment—the external manifestation of anxiety—might be mild, the way the person feels inside—the internal manifestation of anxiety—might be extremely high. The notion of high-functioning anxiety comes from this conflict between the intense internal feelings and the ability to function despite those feelings. The argument is not that the symptoms are mild, but that the individual suffering from high-functioning anxiety may be better able to manage how extreme symptoms appear to affect him or her, even though he or she is suffering silently.

Though high-functioning anxiety may not be officially listed as a mental health disorder, it does not mean that people who suffer from high-functioning anxiety do not experience intense symptoms. They may just be able to hide them well.

The term “high-functioning” generally means a person is operating at an elevated level, usually one that is above average functioning of others under the same or similar circumstances. The term is often used in relationship to developmental disorders, but it has often been used in relationship to mental health disorders to signify that a person is operating above whatever threshold is considered the norm.

With regard to anxiety disorder, the term high functioning has been the subject of much debate. While not an official diagnosis, the symptoms one feels are very real. But because people who suffer from high functioning anxiety appear not to have any disruptions or impairments of life functions, many people do not know anything is wrong, not even the person who is experiencing the anxiety. A person might look fine, even though his or her heart rate might be elevated, and intense feelings of doom and gastrointestinal distress are present. However, the ability to “power through to get the job done” is also high enough to overcome the anxiety while in public. Some of the same people later “crash” when in private. The exercise of controlling intense emotions can take a toll and require time alone, or periods of very low functioning in order to regroup. Other medical and mental health issues can develop under these circumstances.

Mental health professionals are beginning to acknowledge that difficulty functioning is not always easy to identify. For instance, David Roane, MD, chairman of psychiatry at New York’s Lenox Hill Hospital, maintains, “Sometimes you have to dig pretty hard to see how the anxiety is affecting life or work.” Although one may not be exhibiting significant life impairment, the struggle to control anxiety and perform can affect the overall quality of life. The question becomes whether one is thriving or just surviving.

Because a person is high functioning, they likely are not getting treatment. And without treatment, symptoms often only get worse. By the time someone with high function in anxiety meets the requirements for an official diagnosis, the issue has gone on far too long without treatment.

When anxiety goes untreated, the potential for developing other serious medical or mental health issues increases. Research shows anxiety affects cognition, specifically memory, the ability to reason, and make basic decisions. Additionally, when people with certain chronic medical issues also have untreated anxiety, the risk the medical issue will worsen or cause death also increases. The stress of anxiety on the body can be significant, especially when left unchecked for a prolonged period.

Common medical problems that can occur as a result of untreated anxiety include:

• Heart Issues—Several studies have shown a causal link between anxiety, heart disease, and related health problems. In one study, risk of heart attack or stroke tripled in men and women who had heart disease, and was twice as likely to occur than if no history of anxiety disorder was present. Another study showed women with high levels of anxiety were 59 percent more likely to have a heart attack and 31 percent were more likely to die from a heart attack.
• Respiratory Issues—Difficulty breathing is a common symptom of anxiety. The inability to breathe places stress on other body functions as each requires oxygen to function properly. Decreases in oxygen intake can interfere with cognition, muscle operation, and other body functions. Chronic respiratory problems have also been linked to anxiety disorder. Several studies have identified a correlation between a more severe level of distress and hospitalizations of people who have chronic respiratory disease and anxiety. Anxiety is indicated in a reduction of overall quality of life when coupled with respiratory issues.
• Gastrointestinal Issues—One of the main symptoms of anxiety is gastrointestinal distress, such as upset stomach or nausea. When anxiety goes untreated, gastrointestinal distress can become worse. Though there is little research to link the development of gastrointestinal issues with anxiety, anxiety disorder treatments have been linked to a decrease in symptoms of gastrointestinal distress.

People who suffer from untreated high functioning anxiety also are at greater risk for developing a substance abuse problem. Many people with untreated mental health disorders look to self-medication through alcohol and drugs. Anxiety disorders have a high co-occurrence rate with substance abuse issues.

It is important to seek treatment for high functioning anxiety to help prevent the development or worsening of other medical, mental health, or substance abuse issues.

Treatment for high functioning anxiety is like other anxiety treatments. A combination of psychotherapy and medication tends to show increased positive outcomes.

Cognitive behavioral therapy (CBT) is designed to help people deal with negative thoughts that lead to anxiety. Even though a person suffering from high functioning anxiety may not show outward signs of the issue, they are still struggling with internal negative thoughts and feelings. CBT can help identify the root causes of negative thoughts and feelings, and how to control or eliminate them. Alleviating the internal struggle may improve overall quality of life and allow a person who suffers from high functioning anxiety to thrive, rather than just survive.

Medication can also be beneficial treating high functioning anxiety. Usually, antidepressants—selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medications—benzodiazepines, and beta blockers are prescribed to decrease anxiety symptoms. SSRIs take a few weeks to begin working and carry some side effects. Benzodiazepines work faster and have few side effects but can be habit forming. Beta blockers are generally prescribed to reduce heart-related issues connected to anxiety.

Most people who suffer from anxiety disorders do not get treatment. The number is even higher for people with high functioning anxiety disorder, partly because it is not readily diagnosed, but more often because most people do not realize anything is wrong. Observers do not see any unusual behavior and sufferers are often used to dealing with the anxiety as “normal.”

Combining residential treatment with therapy and medication can further improve positive outcomes for controlling high functioning anxiety disorder. Residential treatment centers are live-in health care facilities that offer individualized treatment in a home-like setting, 24 hours a day, away from external stressors at home or work.

Residential treatment for high-functioning anxiety provides a safe and controlled environment that allows individuals to remove themselves from anxiety-causing situations that feel normal, and begin to learn how to function those situation in a healthier way. Typical periods of stay in residential treatment is 30-60 days or more.

Anxiety Treatment at Bridges