High functioning anxiety: signs and what to do about it
Reviewed by Steve Silvestro, MD, Ro,
Written by Ellyn Vohnoutka, BSN, RN
Reviewed by Steve Silvestro, MD, Ro,
Written by Ellyn Vohnoutka, BSN, RN
last updated: Apr 14, 2021
5 min read
Here's what we'll cover
Have you ever felt a wave of terror wash over you when someone asked for your opinion in a meeting?
Or avoided talking to someone because every time you tried your mouth got dry and you couldn’t find the words? Or lost sleep because you couldn’t turn down the racing thoughts in your mind?
If you find yourself in similar situations frequently, but you are still generally functioning at a pretty high level in your day-to-day life, you may be living with a condition commonly called “high functioning anxiety.”
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What is high functioning anxiety?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) is the most commonly used guide to the diagnosis of mental illness in psychiatry.
You might be surprised to learn that the DSM-5 does not include an official mental health diagnosis for “high-functioning anxiety.” Instead, it is an informal term to describe symptoms of anxiety that might not rise to the level of being a diagnosable anxiety disorder. Or, it can describe people with diagnosable anxiety disorders who are otherwise functioning at a high level in their daily lives.
The 2019 National Health Interview Survey found that 15% of adults surveyed reported experiencing anxiety symptoms in the past two weeks (Terlizzi, 2020).
Anxiety disorders are some of the most commonly diagnosed psychiatric disorders. Women are twice as likely as men to experience them. Non-Hispanic white adults were the most likely to report symptoms, but all races are susceptible (Chand, 2020).
What are the symptoms of high functioning anxiety?
The symptoms of anxiety are unique to each person, but science has found that there are many common threads. Symptoms have been categorized as cognitive, physiological, behavioral, and affective (mood). If you have anxiety, you may experience some of these symptoms (Chand, 2020).
Cognitive symptoms
These symptoms can include (Chand, 2020):
Fear of injury or death
Fear of negative opinion of others
Fear of losing control or “going crazy”
Frightening thoughts or memories
Trouble concentrating
Poor memory
Excessive worry about potential threats
Confusion
Physical symptoms
You may experience some physical symptoms, including (Chand, 2020):
Increased heart rate
Rapid breathing
Feeling like you have trouble breathing
Feeling lightheaded
Heart palpitations
Trouble swallowing
Chest pain or pressure
Feeling sweaty
Upset stomach
Nausea or diarrhea
Hot or cold flashes
Shaking
Feeling numb
Behavioral symptoms
These can include (Chand, 2020):
Feeling restless or agitated
Pacing
Hyperventilating
Freezing up
Avoiding situations that may provoke anxiety
Feeling the need to escape or run away
Trouble speaking
Needing repeated reassurance
Affective symptoms
Affective symptoms are mood-related symptoms that can include (Chand, 2020):
Feeling nervous, tense, or “wound up”
Feeling frightened or terrified
Feeling jumpy
Feeling overly impatient or frustrated
Risk factors for developing an anxiety disorder
It's impossible to predict exactly who will or won’t struggle with an anxiety disorder at some point in their lives. The following risk factors have been shown to increase the risk of developing an anxiety disorder (Blanco, 2014):
Female gender
Family history of major depression
Disturbed family environment
Childhood abuse
Low self-esteem
Lower educational attainment
Researchers have attempted for years to determine if there are objective biomarkers such as brain structure or genetic markers to help predict who will be affected by an anxiety disorder. Most studies have produced results that couldn’t be replicated, but research is ongoing (Maron, 2017).
How are anxiety disorders diagnosed?
As previously mentioned, the DSM-5 is the gold standard for criteria to diagnose mental health disorders. There are nine separate anxiety disorders defined in the DSM-5. Your mental health provider will compare your reported anxiety symptoms to the definitions in the DSM-5 to see if you meet the criteria for a particular form of anxiety.
For example, the criteria for diagnosing generalized anxiety disorder are (Reynolds, n.d.):
Excessive anxiety or worry that occurs more days than not for at least 6 months
Difficulty controlling the anxiety
The anxiety is associated with at least three of the following symptoms: restlessness, feeling easily fatigued, trouble concentrating, irritability, muscle tension, sleep disturbances
The symptoms are causing distress or difficulty functioning
The symptoms aren’t caused by substance use or a medical condition
The symptoms aren’t better explained by another mental health disorder
Many people with high functioning anxiety try to manage their symptoms on their own, but it can be especially helpful to seek help. Having a diagnosis can make you eligible for certain treatments and services with your insurance company and can help guide which treatments might be most beneficial.
Related issues
Anxiety disorders have a very high chance of happening alongside other mental and physical disorders. Often, people need to address both their anxiety and these other illnesses to improve their quality of life.
Depression
Individuals with high anxiety traits have been found to be potentially more vulnerable to depression. This is thought to be because increased anxiety contributes to greater vulnerability to stress. Over time, this can contribute to the development of depression (Weger, 2018).
Substance abuse
Decades of psychiatric research have shown that anxiety disorders and substance abuse disorders occur more often together than can be explained by chance. Researchers have concluded that when a person experiences anxiety or substance abuse, they are at risk for the other to develop (Smith, 2008).
Eating disorders
An Australian study of 152 women presenting for either eating disorder treatment or anxiety disorder treatment found a significant overlap between the two conditions. 65% of the women getting treatment for an eating disorder also met the criteria for an anxiety disorder. The majority of these (69%) reported that the anxiety disorder symptoms began before the start of their eating disorder (Swinbourne, 2012).
Physical illness
Physical ailments and anxiety are another area where two conditions influence each other. People who have a diagnosis of depression or an anxiety disorder report more than double the rate of chronic medical illness compared to those without depression or anxiety. Being diagnosed with a chronic medical condition also significantly increases the risk of being diagnosed with anxiety or depression (Hirschfeld, 2001).
Treatment options for high functioning anxiety
Due to their prevalence, anxiety disorders have been fairly well-studied, and effective treatments for anxiety are available.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps participants recognize negative thoughts and behaviors that are causing them stress and replace them with thoughts and behaviors that help them deal with problems in a more positive way (Borza, 2017).
Studies have shown CBT to be very effective for a wide variety of mental health conditions including anxiety. Participants with anxiety have reported improvements in symptoms and quality of life (Kaczkurkin, 2015).
Medication
Many people struggling with anxiety may benefit from trying medication to help manage symptoms. First-line treatments are usually a class of medication called “selective serotonin reuptake inhibitors,” otherwise known as SSRIs or antidepressants. These medications increase the amount of serotonin that is available in the brain, allowing for improved mood regulation (Bandelow, 2017).
Other medications may be considered by your healthcare provider based on your individual health history and experiences with anxiety.
Lifestyle changes
There are many self-care, complementary, and alternative treatments that have been touted to help reduce anxiety. The evidence to support these interventions varies significantly.
Mindfulness techniques have shown similar effectiveness as CBT. Most supplements do not have sufficient evidence to support their use and may have significant side effects. There is some evidence that music therapy, aromatherapy, acupuncture, and massage are helpful for anxiety associated with specific diseases, but they have not been studied specifically with anxiety disorders (Locke, 2015).
Although the exact reason it works is not known, physical activity has shown great promise in reducing the amount of anxiety reported by participants. The exact type and amount of exercise needed to benefit will vary from person to person (Kandola, 2018).
Find the right approach for you
Most people suffering from high functioning anxiety will benefit from a combination of strategies that help them address the unique roots of their anxiety. Your mental health professional can help you find out what treatments work best for you to increase your wellness.
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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