“High-functioning anxiety,” like “high-functioning depression,” is not a clinical diagnosis. But when people refer to it, they tend to imagine the following: someone who finds success in life — usually professionally, academically, and/or financially — regardless of their struggles with anxiety. But Marty Cooper, Ph.D., a psychologist based in New York, asks: Are they doing well regardless of anxiety, or in part because of it? Whenever Cooper is working with clients who have high-functioning anxiety, he thinks of the Yerkes-Dodson curve, which identifies relationships between stress and performance. That is, he acknowledges that sometimes people feel they need a level of anxiety to do a task well. “[Some] may be ‘high-functioning’ because they’re buzzing off a certain amount of anxiety most of the time,” he says. But that curve also identifies a breaking point. Too much anxiety can get in the way of doing well. That’s why high-functioning anxiety could be dangerous, Cooper says: You could be constantly at your breaking point and lacking the tools to manage it. People with high-functioning anxiety also likely meet some of the criteria for generalized anxiety disorder (GAD), the symptoms of which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book clinicians use to diagnose mental health conditions. No matter what it’s called, however, people experiencing anxiety can often benefit from professional help. Just because you or a loved one seem to be successful doesn’t mean you don’t need or deserve a mental health check-in. Not sure if you have high-functioning anxiety? Here are 5 signs that you might, and tips from Cooper on how to work through them.
1. Your Body Is Giving Physical Warning Signs
Some of the most noticeable symptoms of anxiety are physical. “Often our body communicates to us before that acute moment,” Cooper says, before the anxiety might result in burnout, a panic attack, or a health condition such as cardiovascular disease. “If we can learn to listen to our bodies, we can learn to intervene beforehand.” To get an idea of what they might look like, the DSM-5 identifies the following physical symptoms of anxiety:
Restlessness or feeling keyed up or on edgeBeing easily fatiguedDifficulty concentrating or mind going blankIrritabilityMuscle tensionSleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
This list is not exhaustive. “[It could be] shoulders get tense when you’re getting to the end of your rope. You start getting headaches. Your eye starts twitching,” Cooper says. “There’s a ton of these signs; they show up differently for everyone.” But it can be hard to identify physiological signs of anxiety if you’re so used to feeling them. And missing these cues can lead to crisis moments. “What I’ve seen on the far end are patients who didn’t catch the cues and actually needed to take medical leave of absence from work,” Cooper says. Other clients of his have come to therapy after their doctor suggested their anxiety was contributing to another health problem. “Before I saw these individuals, they were knocking it out of the park professionally. They were killing it,” he says. “But they were also killing themselves.”
2. You Feel a Gnawing Emptiness
A lot of the time, Cooper says, clients who are expressing some form of high-functioning anxiety come into his clinic confused about why they don’t feel as great as they think they should. “They don’t feel fulfilled, yet they’re doing all this stuff,” he says. This unfulfilled feeling is because anxiety is leading them to over-prioritize certain aspects of life, while leaving a feeling of under-satisfaction in others. This makes it so that some with high-functioning anxiety originally come to therapy not for the anxiety itself, “but for the dissatisfaction that we come to learn is anxiety that keeps you functioning,” he says, “but there’s parts of your life that are missing.”
3. You’re Neglecting Your Personal Life
Most of the time, Cooper sees clients not with full-blown anxiety-related health problems, but rather ones who have some physiological symptoms and perceive an imbalance in their lives. “I find more commonly that people are really great about accomplishing all the things they need to accomplish,” he says, “but when you start to inquire about their personal life, that’s harder for them.” It’s almost as if the anxiety keeps their mind on the task in front of them, and it’s harder to remember the importance of friendships, hobbies, and other interests. In other words, people with high-functioning anxiety often excel in one area of their life — usually professionally — and let other aspects, such as family and friends, fall to the wayside.
4. Your Coping Mechanisms Aren’t Enough
Needing to be anxious in order to do a task can be a sign of high-functioning anxiety, Cooper says. That’s because doing well because of anxiety reinforces a need for it, which can eventually lead it to spin out of control and do harm. “High-functioning anxiety [can] help people achieve a lot, and certainly as a clinician, I don’t want to take that away from them,” Cooper says. “I want them to achieve all the things they’re achieving, but I also want to help them understand what their signs are when it’s too much.” A lot of the time, we might manage our anxiety via coping mechanisms such as exercise, art, or hanging out with friends and watching a movie. However, if the usual coping strategies aren’t working, or they’re getting in the way of other things in life — such as relationships, community, hobbies, and health — it may be time to look for help.
5. Your Anxiety Has More Than One Focus
People with high-functioning anxiety are more likely to have GAD than other anxiety-related disorders. GAD-related symptoms are generalized. That is, they revolve around perceived anxiety or worry occurring most of the time for at least 6 months, and about various things. However, if your worry ends up focusing on one thing most of the time (e.g. social situations, gaining weight), then you may not have GAD, but a different anxiety-related disorder, such as a social phobia or an eating disorder, respectively.
How To Get Help for High-Functioning Anxiety
To figure out if you need help for high-functioning anxiety, it can be helpful to try and map where you fit on the Yerkes-Dodson curve? “At what point does it feel like the anxiety has moved past [your] best performance, where we might need to intervene?” Cooper asks. Someone with high-functioning anxiety is likely so used to feeling the physiological signs, he says, that they might not recognize when they become too much. This can make it difficult to determine where you fall on the curve. That’s why it can be important to get help. Clinicians help identify these signs, such as a tightness in the chest, restlessness, and trouble sleeping, before they do too much harm to your health and quality of life. A therapist or other type of mental health professional can also teach you new coping mechanisms to deal with your anxiety, such as breathing exercises. Sometimes Cooper utilizes anxiety tools that the person already has. That is, people buzzing off of anxiety most of the time tend to be very good about scheduling and checklists. “We can actually capitalize on that,” he says. For example, if bike-riding helps calm anxiety, “let’s put it on your calendar.” Medications are another option for people who need them, as determined by a licensed provider. Even if you are able to balance work with other interests despite your high-functioning anxiety, it can still be helpful to speak to a professional. Sometimes, talking with someone and re-evaluating priorities can help tame the buzzing in your brain. “We can look around our lives and see that people are so busy,” Cooper says, “ but they do manage to make it to the gym. They do get a mani-pedi.” Whatever it is, you just have to figure out what’s important to you other than work so you can start to prioritize things that anxiety doesn’t drive you to do too.
