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    High-functioning anxiety: Signs, symptoms and treatments

    High-functioning anxiety is a mysterious condition, mainly because those who experience it usually hide it well from the world. On the outside, people with high-functioning anxiety come across as super successful, organised and are often over-achievers.

    However, on the inside, they are driven by fear and live in turmoil; experiencing debilitating worry, stress and tension that’s usually associated with an anxiety disorder.

    Do you suffer from high-functioning anxiety? You may not even known you do.

    Here are the signs, symptoms and treatments for high-functioning anxiety that can help you understand the condition better and adopt ways to cope with your internal struggles.

    What is high-functioning anxiety?

    A person with high-functioning anxiety is like the proverbial “duck on water”. Above the surface, they appear calm and in control. Beneath the surface, their feet are kicking wildly.

    To the people around you, you outwardly appear confident and successful. However, the truth is; you’re living with constant feelings of worry, stress and feelings of inadequacy.

    High-functioning anxiety is not an official medical diagnosis. It’s something that therapists have coined to help individuals identify with what they’re feeling. It’s most closely associated with Generalised anxiety disorder (GAD) which has symptoms similar to panic disorder and obsessive-compulsive disorder; and involves constant worrying, restlessness and trouble with concentration.

    High-functioning anxiety plays havoc with your emotional state of mind but it rarely is severe enough to disrupt your day-to-day life.

    In fact, the majority of people living with high-functioning anxiety are never formally diagnosed. They continue to do well in life and in fact, are usually overachievers.

    What is the difference between high-functioning anxiety and other anxiety disorders?

    The big difference is people with high-functioning anxiety can continue to function normally. Typically, they’re hugely successful, overachievers who – to the rest of the world – appear to be on top of their game and people admire and respect them.

    Other anxiety disorders can be more debilitating, leading to you not being able to function at your best. Anxiety disorders can have a big impact your life such as not being able to hold down a steady job, loss of income, relationships breaking down, hospitalisation or worse, suicide.

    High-functioning anxiety is actually a double-edged sword. The positive characteristics are what drive people to succeed while the negative characteristics cause worry, stress and internal mental struggles.

    How you cope with anxiety is what separates high-functioning anxiety from general anxiety. People living with an anxiety disorder live in a constant state of “fight or flight”. Those with high-functioning anxiety spend almost all their time in fight mode, meaning they push themselves harder and harder to achieve their goals.

    What does high-functioning anxiety look like?

    The characteristics of high-functioning anxiety are similar to those associated with a Type A personality. This includes operating at a more urgent pace, exhibiting higher levels of impatience, having a more competitive nature, putting unreasonable pressure on themselves and associating their achievement with self-worth.

    Positive characteristics of high-functioning anxiety

    These characteristics have a positive impact on the person’s life and are typically what drives their success and achievements.

    • confident
    • outgoing
    • organised
    • detail-orientated
    • punctual
    • proactive
    • orderly and tidy
    • active
    • involved
    • conscientious
    • helpful
    • well-groomed
    • calm and collected
    • passionate
    • loyal

    Negative characteristics of high-functioning anxiety

    These characteristics are what individuals struggle with on a daily basis and the anxiety symptoms may never be noticed by colleagues, friends and family.

    Often, they’re seen to be part of the person’s quirky or ambitious nature.

    • talks a lot; often dominates conversations
    • nervous habits; nail biting, cracking knuckles, twisting hair
    • overthinks everything
    • people pleaser
    • constant need for reassurance
    • avoids eye contact
    • alternates between procrastination and overworking
    • sees the ‘glass half empty’
    • agonises over past mistakes or failures
    • mind is always racing
    • finds it hard to say no
    • suffers from insomnia or has poor sleep habits
    • overindulges; problem drinking or recreational drugs
    • hard to bond with; stoic, unemotional, cold
    • limited social life; too busy to attend social functions
    • finds it difficult to relax and enjoy simple pleasures
    • experiences mental and physical fatigue
    • suffers from burnout
    • prone to risky behaviour

    Physical symptoms of high-functioning anxiety

    Physical symptoms of high-functioning anxiety

    High-functioning anxiety can manifest as physical symptoms that may become severe over time if you don’t deal with the root cause of your anxiety.

    • sweating
    • shaking
    • shortness of breath
    • nausea
    • frequent urination or diarrhea
    • dizziness
    • exhaustion
    • muscle tension
    • increased heart rate or heart palpitations
    • insomnia
    • heart rate with palpitations, pounding heartbeat, and quicker pulse
    • Increased sweating

    Is high-functioning anxiety a real thing?

    Is high-functioning anxiety a real thing?

    As mentioned, high-functioning anxiety is not a recognised mental disorder. However, it’s a serious condition that should not be ignored. If you’re living with high-functioning anxiety, you most likely are excelling at work, have a good social life and are achieving the goals you’ve set yourself.

    However, if you’re hiding intense feelings of impending doom, constantly experience the negative symptoms mentioned above or have a sense you’re spiraling out of control and live in fear of being “found out” as not “good enough”; it’s likely that you have high-functioning anxiety.

    You are not alone.

    It’s estimated that at least 1 in 5 people in developed countries live with high-functioning anxiety. The problem is, it’s not easy to detect for various reasons.

    1. There is a stigma associated with symptoms of high-functioning anxiety
    2. It’s seen as normal for your type of career
    3. It’s what is needed to be successful in your industry
    4. You fear failure or don’t want to be seen as weak
    5. Symptoms are similar to depression or generalised anxiety

    Getting help for high-functioning anxiety

    If you identify with the positive and negative symptoms of high-functioning anxiety listed above, it’s important that you speak to a loved one, your doctor or a therapist.

    If left untreated, long-term anxiety can have a serious negative impact on your mental and physical health.

    It can lead to common co-occurring disorders like chronic depression and anxiety as well as executive burnout, heart disease, hypertension, stroke, asthma and irritable bowel syndrome.

    High-functioning anxiety can also lead to substance abuse; where you might use alcohol or drugs to calm your nerves and help you cope. High-functioning anxiety can definitely lower your quality of life and possibly, shorten it.

    Is there treatment for high-functioning anxiety?

    Yes, there is treatment for high-functioning anxiety even though it’s not a recognised mental disorder. Getting help usually involves a combination of lifestyle changes, psychotherapy and medication; much the same as you would treat other anxiety disorders.

    • Lifestyle changes

    Simple adjustments to your lifestyle can drastically improve the quality of your life. By adopting a balanced approach to your home-work schedule, you can reduce or eliminate symptoms of anxiety. Involve your family and friends to help support you as you strive to live a healthier, more balanced lifestyle.

    Start by seeing a doctor for a full medical as well as a dietician and personal trainer to help you adopt a better diet and exercise regime. Cutting out sugar, caffeine, alcohol and recreational drugs is an excellent start. Join a gym, yoga or a walking/hiking group to get more exercise.

    • Psychotherapy

    You can do it yourself but we recommend investing time spent with a therapist who is trained to help you identify triggers that create anxiety and teach you coping methods. You can opt to attend one-on-one sessions or join a group at an inpatient facility such as White River Manor in South Africa.

    A therapist who specialises in treating depression and anxiety will propose an individualised treatment plan for you and will monitor you throughout the process.

    Cognitive behaviour therapy (CBT) is the most common and often most successful form of therapy for anxiety symptoms and disorders. Other therapies that are helpful include:

    • Acceptance and commitment therapy (ACT)
    • Dialectical behavioural therapy (DBT)
    • Eye movement desensitisation and reprocessing (EMDR)
    • Medication

    There are three types of medication used for the treatment of anxiety. Your doctor or psychotherapist will ensure that you are prescribed the correct medication for your symptoms.

    • Anti-anxiety medication; associated with the risk of physical dependence and addiction
    • Anti-depressants; carry fewer risks than anti-anxiety medication
    • Beta-blockers; reduce blood pressure and often prescribed with an anti-depressant

    Daily tips to help you cope with high-functioning anxiety

    Walking a dog in South Africa
    • Cut out substances that aggravate your anxiety such as coffee, cigarettes and alcohol
    • Increase the amount of exercise you do every week
    • Stick to a regular bedtime routine; go to bed at the same time each night and get at least 8 hours quality sleep
    • Reduce the amount of time you spend on social media or your computer before bedtime
    • Commit to spending 10 to 15 minutes a day meditating, doing yoga or writing in your journal
    • Practice what you learn in therapy sessions; for example, cognitive behaviour therapy (CBT) helps you reframe negative thoughts that cause anxiety and turn them into positive, affirming thoughts
    • Find a way to stop nervous habits such as biting your lip or chewing your nails
    • Avoid using substances to calm your anxiety; limit or stop drinking alcohol or taking drugs as developing an addiction will make your life so much worse
    • Talk honestly and openly with your loved ones and let them help you on your journey to recovery from high-functioning anxiety

    We’re here to help.

    Contact us today if you’d like a confidential and free chat with one of our highly-trained professionals.