High-Functioning Anxiety: Is This Actually a Mental Health Condition?

Date: Wednesday 05 Jan 2022

Is High-Functioning Anxiety a Thing?

Calling all anxious overachievers.

High-functioning anxiety sounds a bit like a humblebrag, right? It implies that you’re keeping it together (thriving, even!), regardless of how anxious and overwhelmed you may be. But despite the popularity of this term in conversations and Google searches, it’s not actually recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a mental health condition. So what do we mean when we talk about high-functioning anxiety, and what should we be doing about it? This anxious-yet-highly-functioning health journalist consulted a few mental health professionals to find out how they define high-functioning anxiety, and what you should know if this term speaks to you.

What is high-functioning anxiety?

You won’t find high-functioning anxiety in the DSM-5, but that doesn’t mean that experts aren’t aware of the concept. It’s a term that’s often used alongside other traits that describe similar experiences yet also aren’t formal mental health diagnoses—like perfectionism, workaholism, and type A personality.

The “high-functioning” qualifier is more than likely referring to subclinical anxiety, or anxiety that doesn’t quite meet the criteria for a formal anxiety disorder, explains licensed psychologist Josh Spitalnick, Ph.D., CEO of Anxiety Specialists of Atlanta. That’s because some sort of disruption in your functioning (whether it’s messing with your work, school, social life, relationships, etc.) is a key criterion when it comes to being diagnosed with a mental health condition. For instance, the diagnostic criteria for generalized anxiety disorder include this point: “The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Chances are, if you identify with the term high-functioning anxiety, you probably don’t feel like your anxiety is holding you back in those major ways. So, what are you experiencing then?

“When I say subclinical, really what I’m conveying is that someone is experiencing the cognitive, emotional, and physiological aspects of anxiety,” Dr. Spitalnick says. That might include things like restlessness, irritability, trouble sleeping, racing heart, unwanted thoughts, and many other uncomfortable symptoms of anxiety that aren’t always noticeable to those around you. But what’s missing is the behavioral piece—how these symptoms lead to disruptions in your day-to-day life.

“They’re not necessarily crumbling under pressure as you might imagine the extreme of any diagnosis,” licensed psychologist Alicia Hodge, Psy.D., tells SELF. “These people are seeing a lot of productivity or busyness, but ultimately are still very physically activated—they’re having a lot of worry, rumination, and concern.”

So, when is high-functioning anxiety a problem?

It’s no secret that being a perfectionist, a multitasker, and a person who generally gets shit done is rewarded and reinforced in many aspects of our society. You’re certainly not alone if you’ve felt like your fatigue, frustration, and overwhelm are just…part of being a person today, especially if you have a lot going on. So, when does being stressed out about your endless to-do list cross the line into high-functioning anxiety territory?

“The difference between the driven person that does not have high-functioning anxiety and the driven person that does is the symptoms of anxiety,” therapist and coach Aisha Shabazz, L.C.S.W., tells SELF. “Do you have restlessness during the day? Are you able to have an even balance and a natural pattern of sleep? Do you have any GI symptoms as it relates to being nervous, overwhelmed, anxious, stressed?” Essentially, if you’re experiencing mental or physical symptoms of anxiety, that’s something worth paying attention to.

“How I conceptualize high-functioning anxiety is that you can take on more than most people. But just because you can lift a heavy boulder doesn’t mean it’s not heavy,” Shabazz says.

Still, most people—whether they realize it or not—seem to be adhering to the criteria laid out in the DSM: They’re not seeking help until their symptoms lead to real consequences in their daily lives, like missing deadlines or special events. Many high-achieving people may not address their symptoms until they notice a dip in their performance or productivity, even if those symptoms include intense dread, constant worry, and the unavoidable physiological signs of stress.

“If the problem is not showing up behaviorally, then some people would say, ‘I don’t have a problem,’” Dr. Spitalnick, who notes that very few adults come into his practice with high-functioning anxiety, says; instead, he tends to see them once that functioning takes a hit. On the other hand, he does see a lot of kids, teenagers, and college students whose parents are worried that their stressed-out child is headed for burnout—despite their perfect attendance and GPA.

Burnout is another term you often hear associated with high-functioning anxiety—both hinting at our culture’s desire to describe an emotionally and physically fraught experience in a way that’s more relatable and less pathological than what you might find in the DSM.

“I think burnout became much more discussed because it’s essentially a manifestation of emotional and wellness issues, but it’s in relation to work,” Dr. Hodge says. “Since we’re very focused in our society on work and productivity, it kind of became a catch-all term for: This is not sustainable, this pace is ridiculous, and I can’t function like this.”