What is high-functioning anxiety? How to spot it and what you can do about it

You might have seen the term 'high-functioning anxiety' being bandied around on social media and in lifestyle magazines. It's generally used to refer to high-achieving people, some in especially high-profile or successful positions, who are able to succeed in spite of their private struggles with anxiety. Yet if you looked for a description of high-functioning anxiety in psychiatry's diagnostic bible - Diagnostic And Statistical Manual Of Mental Disorders, or DSM - you won't find it there.

The term is not a formal diagnosis, rather it's a fairly recent colloquial expression that people are finding useful to describe an apparently common experience - comparable in some ways to terms and phrases like 'brain fog' or 'having a nervous breakdown', which aren't formally recognised but capture many people's feelings of what they're experiencing.

For some public examples, think of the Hollywood star Ryan Reynolds who has written on social media about his life-long anxiety. "To all those like me who overschedule, overthink, overwork, overworry and over-everything, please know you're not alone,” he said. Also, the BBC presenter Amol Rajan, has shared his experience of panic attacks. And the comedian Jordan Raskopolous' TED talk on her own experiences of high-functioning anxiety and how she's coped has attracted nearly two million views to date.

Out of the media limelight, you might have friends who ace their grades at university in spite of chronic self-critical thoughts, worry or insomnia, or colleagues at work who excel and win promotion, despite their fear of public speaking or panic attacks. Perhaps you experience intense anxiety yourself, but have managed to conceal it and perform well in spite of it.

People who are highly ambitious and also perfectionist might be especially vulnerable to high-functioning anxiety – they're driven to succeed, put a lot of pressure on themselves, but also find it difficult to admit to vulnerabilities or seek help.

The underlying anxiety itself can come in many different varieties, including specific phobias, such as enclosed spaces or bridges, panic disorder, social anxiety, health anxiety, unhealthy perfectionism, or extreme and constant worry. Very often there are accompanying physical symptoms to anxiety, such as sweating, nausea, trembling, palpitations, light-headedness and difficulty sleeping.

To make a formal diagnosis of an anxiety disorder, a mental health professional will rule out other possible factors, such as thyroid problems or underlying drink and drug issues, and they'll also take into account how long the mental and physical symptoms have been going on.

For instance, a diagnosis of ‘generalised anxiety disorder’, which is anxiety that isn’t connected to any specific situation or circumstance, will only be made if the problems have persisted for six months or longer, and if the symptoms have been causing significant distress and/or they are causing an impairment to daily functioning.

That last point is where high-functioning anxiety comes in – you might think that if someone is excelling at work and appears to be coping in life, then they can't have a serious problem. But that's not the case. Many people are able to mask their anxiety problems and excel in spite of them. In fact, they might deliberately avoid seeking out professional help, perhaps because of the pressures they place on themselves to be independent or they might even be anxious about the prospect of seeking support.

If your anxiety problems are causing you significant distress or you feel they’re out of proportion to your circumstances – not the easiest judgment call after a two-year long pandemic and the eruption of war in Europe – or if they’ve been going on for a prolonged period of time, and yet you’re doing very well in your studies or at work, or whatever else matters to you, then the chances are that you have high-functioning anxiety.

It's important to know that anxiety is highly treatable. The first step of course is to realise that you have a problem, and to be open to the idea of seeking help.

Read more about mental health:

• Dr Michael Mosley: What to eat to beat stress and improve your mood
• The stress test: What heart rate variability can tell you about your mental health
• Meditation leaves me feeling more stressed. What am I doing wrong?

One specific sign that your condition is worsening and that you should definitely consider getting support, is if you are becoming increasingly avoidant of whatever it is that triggers your anxiety. For instance, avoiding going out and mixing with friends - if you have social anxiety; avoiding giving presentations at school, university or work - if you have a fear of public speaking; or avoiding catching public transport - if you have a fear of public or enclosed spaces.

It's tempting to avoid the sources of our anxiety, and it might feel like it helps in the short term, but doing so usually only exacerbates the problem, intensifying the fear and robbing us of the chance to learn how to cope.

If you realise you have a problem and you're ready to seek help, there are various options out there. At first you could try self-help approaches, such as making basic lifestyle changes, avoiding too much caffeine and doing more exercise, and scheduling specific ‘worry windows’ in the day that you set aside for thinking about problems on your mind. Doing this will make it easier to avoid worry at other times.

If that's not sufficient you could seek a referral to see a professional for a talking therapy, such as cognitive behavioural therapy, which will help you see the links between your negative thoughts, feelings of fear and nausea, and other behaviour. And then to develop more positive ways of thinking to break these unhelpful cycles – for example, recognising that lots of people look tired and bored when watching presentations could help one cope with a fear of public speaking.

If your problems worsen and don't respond to self-help or therapy, you could consider taking a medication – that's something to discuss with your doctor. The important thing to remember is there is help out there, and you don't have to suffer alone or in silence.

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