Mayo Clinic Q&A: High-functioning anxiety

DEAR MAYO CLINIC: I have always been very successful, both personally and professionally. But I struggle with a whirlwind of worries and thoughts, constantly questioning myself and striving for perfection. I’ve heard the term high functioning anxiety and it feels like that’s what I’m experiencing. How can I navigate and cope with this?

ANSWER: It’s normal to feel anxious sometimes, especially in stressful situations. However, for some people, excessive and persistent anxiety can be difficult to control and interfere with daily activities.

There are several types of anxiety disorders. The term high-functioning anxiety represents people experiencing symptoms of anxiety while maintaining a high level of functionality in various aspects of their lives. Often, they are successful in their careers or other roles, but internally struggle with persistent feelings of stress, self-doubt, and fear of not being good enough. They feel extremely bad inside and struggle with significant self-criticism.

High-functioning anxiety is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, but rather is a subset of generalized anxiety. Many emotional and physical symptoms are associated with generalized anxiety disorder. The symptoms of high-functioning anxiety reflect many of these, but some may be more significant.

Some symptoms of generalized anxiety disorder include general nervousness and worry. Other symptoms that may lead you to high-functioning anxiety include internal struggles with:

• Fears of criticism or significant self-criticism.
• Fears of appearing inadequate or stupid to others.
• Feeling on the edge or about to lose control.
• Hustle.
• Feeling of impending doom.
• Significant stress.

It is important that you meet with a mental health professional to discuss your symptoms and get an accurate diagnosis. Then, if it is determined that you have high-functioning anxiety, you can develop a care plan to have the best quality of life.

Counseling and therapy play a crucial role in helping people with high-functioning anxiety manage their symptoms effectively. Cognitive behavioral therapy can help you learn to reframe your thoughts about life and transform behaviors that may be fueling your anxiety. Instead of criticizing yourself and looking for what could go wrong, you can learn to manage your thoughts, look for solutions, and guide yourself through your feelings of anxiety.

In addition to therapy, other coping strategies to relieve symptoms include:

• Create a support network. People with high-functioning anxiety may believe they must manage their behaviors alone because they fear criticism or negative consequences. A positive support network of people who care about you, regardless of outcomes, can help relieve anxiety symptoms.
• Establish healthy boundaries. This can help improve relationships with others and establish rules for yourself. The importance of saying no is often discussed in the context of setting boundaries. That’s because many people overextend themselves, but some people with high-functioning anxiety should also be willing to say yes to opportunities that increase their comfort level. Their lives grow in experience and fulfillment as they face their fears.
• Forget comparisons. Anxious people tend to compare themselves to others, feel the need to improve, and want to be more like someone else. Comparison can rob you of joy and contentment.
• Identify core values. Some people with high-functioning anxiety become obsessed with socially defined success, such as having the right job, the right car, the right house, and the right material possessions. Often these things are only important because other people think they are. A therapist can help you discover what is important to you outside of society’s expectations and align your thoughts and actions with your core values.
• Learn to accept criticism. This can be difficult for many people, but especially for people with high-functioning anxiety. You might find yourself defensive. A therapist can help you identify ways to step back in this moment and evaluate the comments in a neutral, unemotional way.
• Practice mindfulness. It is the practice of deliberately being mindful and focusing on the present moment. Focusing on one thing or moment can increase feelings of calm and peace.

Medication may help some people with high-functioning anxiety, but should only be used in conjunction with other coping strategies and under the care of a healthcare professional.

Talk to your healthcare team about how you feel. They can connect you with a qualified mental health counselor or therapist, if necessary, and help you develop coping strategies to manage your anxiety and live a fulfilling life. Linda Hubbard, psychotherapyMayo Clinic Health System, Eau Claire, Wisconsin

(The Mayo Clinic Q&A is an educational resource and is not a substitute for regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visit www.mayoclinic.org.)

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