This non-clinical term is prompting more conversations about anxiety

“High-functioning anxiety” is associated with perfectionism. (Unsplash: Vasilis Caravitis)

It’s not a clinical diagnosis, but the term “high-functioning anxiety” has become widely used.

For people who appear to be nailing it at work or achieving life goals, but worry it’s not enough, it seems like the perfect description.

“It’s kind of popped up in the Zeitgeist of social media and community conversations, people self-identifying as having ‘high-functioning anxiety’,” Luke Martin, clinical psychologist and senior advisor at Beyond Blue, says.

Taking care with the term ‘high functioning’ 

The term “high functioning” may be confronting to some as it is discouraged when describing autism, where its use can be harmful.

While not a formal diagnosis psychologists would use, Dr Martin says, in the context of anxiety, it’s a good thing if the term means we’re talking about anxiety more.

“We’ve gotten really good over the last 20 years talking about depression. And so, in a way, it’s kind of good that anxiety is now getting a chance in the conversation because it can be a really significant issue for people in their lives.”

Dr Martin acknowledges there is a risk that the term “high-functioning anxiety” creates unrealistic expectations of people with severe anxiety which makes it “really hard for you to keep turning up to life, to socialise, to attend, to work, even to leave your home”.

“We don’t want people with that experience of anxiety to feel worse about themselves because they’re not ‘high-functioning’,” he says. “Because we know that severe anxiety takes enormous strength to keep managing that experience and moving towards recovery.

“It’s a really resilient thing to do.”

But there are benefits to using the term if it prompts people to reflect on how they’re feeling.

“If you’re feeling as though your relationships are not the way you would want them to be, that you’re not getting enough time to recharge your batteries, and you always feel that you’re on, I think this recognition point that, ‘Oh, maybe I need to start doing different things differently in my life, to feel better in my life,’ is a good thing.”

What are the signs to look out for?

There are a few signs that all is not well under the surface.

Former ABC medical reporter Sophie Scott, who is now a mental health advocate, has written a book about the concept of “high-functioning anxiety”.

She describes it as a disconnect between your outward and inner self.

“So from the outside world, you might look super successful, confident, hard-working, you’re basically ticking every box in life. But under the surface, you have this inner turmoil, you feel a fear of failure.”

Perfectionists or people who experience impostor syndrome are prime candidates, she told ABC Radio Sydney.

“You always feel like, you know, the other shoe is about to drop, and it’s all about to fall apart.”

Ruminating and constantly having negative thoughts such as excessive self-criticism are also signs.

How does it fit with recognised anxiety disorders?

Anxiety disorders are extremely common with one in three Australians experiencing one at some stage in their life, according to the latest data from the Australian Bureau of Statistics.

Dr Martin says psychologists think of anxiety as a continuum. At one end there’s everyday worry we all experience when faced with a threatening situation like a job interview or speech.

Then it moves to mild, moderate or severe anxiety.

Dr Martin puts “high-functioning anxiety” at the mild to moderate end where people commonly put a mask of coping on, or in other words, put on a brave face.

“On the inside, we might be feeling very nervous or worried or on edge or worrying that things are going to fall over. But you put the mask on, and you keep turning up.”

Sarah Edelman is a clinical psychologist and author of No Worries, a book on understanding and managing anxiety.

Dr Edelman is not familiar with the term high-functioning anxiety, but she says she has certainly seen many people with anxiety who seem calm.

“It may not be obvious, but at the same time, these people are tense. So they’re experiencing a lot of physical tension in their body, they still are experiencing the mind darting to different areas, it’s much harder to be cognitively present.”

But you’re achieving goals, so what does it matter?

Ms Scott says this kind of anxiety, while less impactful than generalised anxiety, still takes a toll. If you’re frequently worrying, it’s hard to be in the present and enjoy what you’re doing.

“I think it does come to a point where the inner turmoil can feel like it actually does hold you back from really enjoying that success and enjoying the journey rather than just being focused on the destination.”

And you run the risk of burnout.

“You tend to overwork, your nervous system is stuck in that fight or flight and survival mode, you don’t really know how to relax on the weekends and down-regulate.”

Dr Edelman says anxiety “robs you of the ability to enjoy life”, strains relationships and makes it hard to be a good parent when your mind is constantly going in another direction.

And it can lead to physical symptoms. Many people don’t realise they have anxiety or even consider it crucial to their success, and come to her after experiencing physical symptoms such as heart palpitations.

What can you do about it?

Ms Scott says it’s important to recognise when you’re ruminating or having negative thoughts and then challenge them.

“Stepping back from them and not just accepting them as fact and saying, ‘Where’s the evidence that that’s true?'”

Self-compassion is key, she says, suggesting that you think about how you would treat a close friend.

“And speaking to yourself the way you would speak to a close friend and giving yourself that gift of self-compassion, and it can really make a massive difference.”

Deep breathing, limiting news consumption, especially in the morning, and daily movement, whether it’s a five-minute walk or gentle stretching, can help as well.

Dr Martin backs the importance of slow breathing and practising self-compassion, particularly because of the association with perfectionism.

“Perfectionism is a shield, which is really a fear of failure, and a really big internal critic, that when you make a small mistake, you can really give yourself a hard time about it. So being kind to yourself and self-compassion can really help people who are experiencing anxiety.”

Dr Martin also encourages people to contact Beyond Blue for help, the earlier the better.

“Because we know that people that talk about having “high-functioning anxiety”, it can be a pathway to more severe anxiety or burnout.”

This is general information only. For personal advice, you should see a qualified medical practitioner.