The Characteristics of High Functioning Anxiety

Generalised Anxiety Disorder

Generalised anxiety disorder (GAD) is a mental health condition characterised by constant and (usually) irrational worries. Those with anxiety struggle to control anxious thoughts and habits, which manifest both physically and mentally.

The DSM-5 defined generalised anxiety disorder and symptoms of anxiety: [1]

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
2. The person finds it difficult to control the worry.
3. The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
4. Restlessness or feeling keyed up or on edge
5. Being easily fatigued
6. Difficulty concentrating or mind going blank
7. Irritability
8. Muscle tension
9. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
10. The focus of the anxiety and worry is not confined to features of an Axis I disorder (e.g., the anxiety or worry is not about having a panic attack [as in panic disorder], being embarrassed in public [as in social phobia], being contaminated [as in obsessive-compulsive disorder] being away from home or close relatives [as in separation anxiety disorder], gaining weight [as in anorexia Nervosa], or having a serious illness [as in hypochondriasis]), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder.
11. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
12. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.

This persistent anxiety is characterised by uncontrollable worry for a long period of time. Commonly associated with alcohol abuse, substance use, and other health problems, anxiety presents with a list of treatable complications.

What is ‘High Functioning Anxiety?

‘High functioning anxiety’ occurs in individuals that suffer from anxiety but are still able to meet the demands and responsibilities of daily life. People often keep their fears and worries internal, seeming confident and fearless on the outside.

This is not the same as general anxiety disorder, and it isn’t recognised by the DSM as a diagnosable disorder. The difference between general anxiety and high-functioning anxiety lies in the person’s emotional and physical response to the stimuli causing anxiety.

People who experience general anxiety fear certain situations and often avoid them. People with high-functioning anxiety will often push themselves regardless of the anxiety they are feeling. [2]

Causes and Symptoms

It is difficult to diagnose high functioning anxiety, but certain factors may contribute to its presence:

• Genetics: family members with a history of anxiety disorders
• Traumatic experiences
• Certain medical condition
• Environmental factors
• Substance abuse and alcohol use

It is challenging to know exactly how many people suffer from high-functioning anxiety, as it can often be mistaken for constant feelings of ‘fight or flight’. [3]

Those with high-functioning anxiety use their fears to push them towards uncomfortable feelings, propelling them into situations and experiences rather than holding them back. How people appear on the outside is the opposite of how they feel on the inside. So, what does it look like?

Positive Characteristics of High Functioning Anxiety: [4]

• Outgoing personality and other positive personality traits
• Punctual and proactive
• Organised
• High-achieving and detailed
• Actively driven at work
• Active and helpful
• Busy social life
• Passionate and loyal

Negative Characteristics of High-Functioning Anxiety:

• Fear of failure and overthinking
• Perfectionist
• Fatigue and constant tiredness
• People-pleaser
• Nervous habits
• Overthinking and procrastination
• Inability to decline extra work or events
• Insomnia
• Struggle to enjoy the moment
• Always thinking about the future
• Tendency to self-medicate with alcohol or drugs
• Overloaded schedule or busy schedule

Those with high-functioning anxiety are often seen as hard workers and over-achievers. This perception can add unnecessary stress to individuals already struggling internally, aiming to please and confirm the high expectations set by others.

However, this perception fails to take into account the internal struggle and the constant deep-rooted worrying that is required to uphold such positive external facades.

This form of anxiety hides people’s true feelings, which can impact their quality of life.

There are different levels of anxiety and different types of anxiety. Severe high-functioning anxiety engages a false persona, as people with this form of anxiety will lead productive lives on the outside but battle constant fears and worry on the inside.

Inside, people with high-functioning anxiety may suffer from:

• Elevated heart rate
• Heart palpitations
• High blood pressure
• Functional impairment
• High-stress levels
• Intense fear
• Physical tension

The Stigma Behind Anxiety

Mental health became stigmatised as early as the Middle Ages. Those who were mentally ill were said to be possessed by demons and devils in need of a priest.

These negative attitudes persisted into the next Centuries, which led to the confinement and imprisonment of the mentally ill.

WHO, The World Health Organisation states that stigma is ‘a mark of shame, disgrace or disapproval which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society‘. [5]

The National Survey of Mental Health Literacy and Stigma states that the biggest misconception about anxiety is that it is viewed as a weakness. It is also common for people to believe that anxiety is not a ‘real’ medical illness, and that they should just ‘calm down and relax’.

Stigmatising anxiety leads to reduced self-worth and a lack of confidence.

This can lead people to disconnect from those who aren’t being supportive and others. Fear of being negatively labelled often prevents people from seeking the medical care they need as they feel embarrassed asking for help.

Anxiety, or ‘claiming anxiety’, is commonly seen as an excuse. The difference between generalised anxiety and high-functioning anxiety is that internal worries do not prevent people from functioning, instead the anxiety is used to keep going.

To many people, this does not ‘appear’ like anxiety, as it manifests differently on the outside. Despite these negative attitudes, high-functioning anxiety can be as damaging as a generalised anxiety disorder.

Effective Treatments for High-Functioning Anxiety

Mental health professionals can help with high-functioning anxiety through behavioural therapy. Anxiety is a mental health disorder that can affect our daily lives.

An anxiety disorder diagnosis may seem scary and overwhelming, but it is treatable. Feelings of anxiety are often irrational, but these deep-rooted fears can be managed by changing our mindset and outlook.

Cognitive behavioural therapy (CBT) can be used to treat anxiety disorders, PTSD, OCD, and other anxiety disorders such as social anxiety disorder. [6]

CBT is a short-term treatment that focuses on skills to aid emotional responses to irrational thoughts. This changes the way patients think, modifying behaviour. By addressing underlying negative thoughts, CBT alters maladaptive emotional responses. [7]

Exposure therapy is commonly used in CBT methods for treating anxiety. [8] Exposure treatment comes from the theory of emotional processing; fear is represented by cognitive networks that retain information about the feared stimulus and response.

For example, your brain will remember that the last time you got in an elevator you felt an increase in heart rate and started sweating. When the environmental stimulus that activates fear is encountered, brain networks activate the fear structure.

The relationship with the stimuli and responses are often irrational and maintained by avoiding the feared stimuli.

Exposure therapy aims to modify the fear structure. By activating it in a safe environment, the brain then provides new information to the structure to disconfirm the associations we usually make.

Medication for Anxiety

Amongst other forms of therapy, medication is also available from your GP to help your anxiety.[9] Medication for anxiety has been developed for both long-term and short-term use depending on the nature of your anxiety.

The first type of medication you may be prescribed is selective serotonin reuptake inhibitors, also called SSRIs. This is likely to be the first medication you are offered, working to increase the levels of serotonin in your brain.

Sertraline is a common type of SSRI, used to treat depression, OCD, panic attacks and PTSD. This starts to work after four weeks of the first tablet, although positive effects can be felt after the first week.

Common side effects of sertraline:

• Nausea
• Headaches
• Trouble sleeping
• Changes in appetite
• Lower sex drive

Escitalopram and paroxetine are used to treat similar conditions, such as depression, anxiety, OCD and panic attacks. They also have parallel side effects as sertraline.

Serotonin and noradrenaline reuptake inhibitors called SNRIs may be prescribed to help ease feelings of anxiety if SSRIs don’t seem to help.

This medication increases the levels of serotonin and noradrenaline in the brain. Venlafaxine and duloxetine are two forms of medication under the SNRI bracket, with these side effects:

• Nausea
• Headaches
• Drowsiness and dizziness
• Dry mouth
• Constipation
• Insomnia
• Sweating
• High blood pressure

If SSRIs and SNRIs aren’t applicable to you, the GP may suggest pregabalin. This anticonvulsant is used to treat epilepsy, but research has shown that pregabalin helps levels of anxiety.

This medication is less likely to cause low sex drive and sickness than the others (SSRI and SNRI).

How Do I Naturally Help Anxiety?

Before you go to the GP and seek medical help, make sure you are doing all you can to help your anxiety using natural coping mechanisms.

Constantly living with anxiety can prove to be challenging, so try to implement the following into your daily routine:

• Avoid alcohol and smoking: alcohol is known to induce anxiety following a heavy drinking session, and so is smoking
• Drink water and eat a balanced diet: dehydration and lack of nutrition can influence mood and energy levels
• Exercise regularly: exercise releases endorphins and natural aids serotonin levels
• Practice mindfulness (e.g., yoga or reading): studies have shown that mindfulness eases symptoms of depression and anxiety
• Talk to someone
• Learn about high-functioning anxiety
• Join a support group

References

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.

[2] The South African College of Applied Psychology. What is high functioning anxiety and is it real?

[3] National Institutes of Mental Health (NIMH), The National Institute of Mental Health Information Resource Center. Any Anxiety Disorder.

[4] AH Clark, Clark Psychology Group. 9 Surprising Symptoms of High Functioning Anxiety.

[5] https://www.beyondblue.org.au/the-facts/anxiety/stigma-relating-to-anxiety

[6] HansE.HillerW.A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders.Clin Psychol Rev.20133395496423988455

[7] https://www.tandfonline.com/doi/full/10.31887/DCNS.2015.17.3/akaczkurkin

[8] FoaEB.KozakM.Emotional processing of fear: Exposure to corrective information.Psychol Bull.19869920352871574

[9]https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/treatment/

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