Mayo Clinic Q&A: High-functioning anxiety

Dear Mayo Clinic: I have always been a high achiever, both personally and professionally. But I struggled with a whirlwind of worries and thoughts, constantly doubting myself and striving for perfection. I’ve heard the term high-functioning anxiety and I feel like that’s what I’m experiencing. How can I navigate and deal with this?

REPLY: It’s normal to feel anxious sometimes, especially in stressful situations. However, for some people, excessive and constant worrying can be challenging to control and interfere with daily activities.

There are several types of anxiety disorders. The term high-functioning anxiety represents people who have symptoms of anxiety while maintaining a high level of functioning in various aspects of life. Often, they are successful in their careers or other roles, but internally struggle with persistent feelings of stress, self-doubt, and fear of underachievement. They feel extremely uncomfortable inside and struggle with considerable self-criticism.

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

Some symptoms of generalized anxiety disorder include general anxiety and worry. Other symptoms that can put you in a state of high-functioning anxiety include internal struggles with:

• Fear of criticism or significant self-criticism.
• Fear of looking unworthy or stupid in the eyes of others.
• Feeling on the edge or on the verge of losing control.
• Restlessness.
• The feeling of impending doom.
• Significant stress.

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

Counseling and therapy play an important role in helping people with high-functioning anxiety manage their symptoms effectively. Cognitive behavioral therapy can help you learn to reframe your thinking about life and change behaviors that may be causing you anxiety. Instead of being self-critical and looking for what could be, you can be taught how to manage your thoughts, find solutions, and guide yourself through anxious feelings.

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

• Create a support network. People with high-functioning anxiety may believe they have to deal with their behavior alone because they fear criticism or negative outcomes. A positive support network of your caregivers, regardless of the outcome, can help reduce anxiety symptoms.
• Set healthy boundaries. This can help improve relationships with others and establish rules for yourself. The importance of saying no is often mentioned as part of setting boundaries. That’s because many people try too hard, but some people with high-functioning anxiety should also accept opportunities that help increase their comfort level. Their lives grow in experiences and fulfillment as they face their fears more.
• Forgot to compare. People with anxiety tend to compare themselves to others, feel the need to improve, and want to be more like others. Comparison can rob you of joy and satisfaction.
• Identify core values ​​Some people with high-functioning anxiety become focused on socially defined success, such as having the right job, car, house, and material possessions. Often, these things are only important because other people believe they are important. A therapist can help you discover what is important to you beyond societal expectations and align your thoughts and actions with your core values.
• Learn to accept criticism. This can be difficult for many people, especially those with high-functioning anxiety. You may find yourself getting defensive. A therapist can help you determine how to step back from this moment and evaluate the response in a neutral, unemotional way.
• Practice mindfulness. This is a practice aimed at awareness and focus on the present moment. Focusing on one thing or one moment can increase feelings of calm and peace.

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

Talk to your healthcare team about how you are feeling. They can connect you with a skilled mental health counselor or therapist, if needed, and support you with coping strategies to manage your anxiety and live a fulfilling life. Linda Hubbard, PsychotherapyMayo Clinic Health System, Eau Claire, Wisconsin

(Mayo Clinic Q&A is an educational resource and does not replace regular medical care. Email questions to MayoClinicQ&A@mayo.edu. For more information, visit www.mayoclinic.org.)

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