Q&A: Understanding high-functioning anxiety

Dear Mayo Clinic: I've always been a high achiever, both personally and professionally. But I struggle with a whirlwind of worries and thoughts, constantly second-guessing myself and pushing for perfection. I've heard the term "high-functioning anxiety," and I feel like it is 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 ongoing anxiety can be a challenge to control and interferes with daily activities.

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

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

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

• Fears of criticism or significant self-criticism.
• Fears of looking inadequate or foolish to others.
• Feeling on the edge or on the verge of losing control.
• Sense of impending doom.
• Significant stress.

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

Counseling and therapy play crucial roles 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 feed your anxiety. Instead of being self-critical and looking for what could go wrong, you can be taught to manage your thoughts, seek solutions and guide yourself through anxious feelings.

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

• Creating a support network. People with high-functioning anxiety may believe they must deal with their behaviors alone because they fear criticism or negative outcomes. A positive support network of people who care for you, regardless of outcomes, can help ease anxiety symptoms.
• Establishing healthy boundaries. This can help improve relationships with others and establish rules for yourself. The importance of saying "no" is often talked about as part of boundary setting. That's because many people overextend themselves—but some people with high-functioning anxiety also should embrace saying "yes" to opportunities that stretch their comfort levels. Their lives grow in experiences and fulfillment the more they face their fears.
• Forgetting comparisons. People with anxiety 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.
• Identifying core values. Some people with high-functioning anxiety become fixated on society-defined success, like having the "right" job, car, house and material possessions. Often, these items are only important because other people believe they are important. A therapist can help you uncover what is important to you outside society's expectations and align your thoughts and actions with your core values.
• Learning to accept criticism. This can be difficult for many people but especially people with high-functioning anxiety. You may find yourself getting defensive. A therapist can help you identify ways to step back at this moment and evaluate the feedback neutrally without emotion.
• Practicing mindfulness. This is the practice of purposefully being aware of and focusing on the present moment. Concentrating on one thing or moment can increase feelings of calm and peace.

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

Talk with your health care team about how you are feeling. They can connect you to a skilled mental health counselor or therapist, if needed, and assist you with coping strategies to manage your anxiety and lead a fulfilling life.

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