Spotlight on High Functioning Anxiety (Because The Struggle is Very Real)

Between a global pandemic, the war in Ukraine and the rising cost of living, many of us will have experienced restlessness, burn out, heightened anxiety and overwhelm over the last two years, perhaps even accepting this as part of our everyday lives.

It can be difficult to determine exactly what you’re feeling when it doesn’t meet the standard criteria of what an anxiety disorder looks like, or when so much of what you’re dealing with on a daily basis begins to feel ‘normal’ to you. But there’s a huge difference between thriving and just getting by. 

Although not officially recognised as a distinct anxiety disorder, people with High Functioning Anxiety wrestle with the very same symptoms but hide it well, presenting a calm and confident exterior with no outward signs of anxiety, regardless of how mentally and physically exhausted they may feel. 

The anxiety can oftentimes play a motivating role in their lives, driving them to overachieve in the workplace, rather than holding them back and affecting their day-to-day life in subtle but damaging ways. Needless to say, this quest for perfectionism coupled with the propensity to go the extra mile and the inability to switch off (all whilst enduring these symptoms) is the recipe for overwhelm. 

You won’t find High Functioning Anxiety in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) but just because it doesn’t fall neatly into a mental health category doesn’t make it any less real for those dealing with it. This oversight is precisely one of the reasons so few people seek professional help, believing that their symptoms are ‘not bad enough’ to warrant a conversation with a GP. 

Here’s your reminder that you don’t need to wait for your anxiety to become all-consuming before seeking help.

Here’s your reminder that you don’t need to wait for your anxiety to become all-consuming before seeking help. While society might be quick to glorify your ability to take on more than the average person, you don’t have to keep it together all the time or wait for it to get to a point where it’s dysfunctional enough to be taken seriously. If you identify with any of the signs of High Functioning Anxiety, there are ways to reduce stress and restore emotional balance in your life once you know how to recognise and name it. 

From typical characteristics and how to spot the ways it can show up in your life, to causes and coping strategies, we spoke to Dr Michaela Dunbar to find out more about this often overlooked anxiety condition…

What are the characteristics of High Functioning Anxiety? 

High Functioning Anxiety is when someone experiences high levels of anxiety and the physical symptoms that come with it, but at the same time seemingly functions well in their day-to-day life. Doctors cannot diagnose High Functioning Anxiety because it is not a recognised disorder YET, making it difficult to get the appropriate treatment but the symptoms are VERY real.

Pictured: Dr Michaela Dunbar

How does it manifest and how can you spot it?

Key symptoms of HFA include:

  • Worry, fear, and anxiety
  • Irritability and frustration
  • An inability to relax
  • A need for perfectionism
  • Overachieving
  • Fear of failure or judgement
  • A desire to keep busy all the time
  • Overthinking and overanalysing
  • Anxiety before events
  • Elevated heart rate and faster breathing
  • Sleep problems
  • Changes in appetite
  • Digestive issues

Experts don’t fully understand the causes of anxiety disorders, but they most likely occur due to a combination of factors, such as:

Genetics: People with a family history of anxiety disorders or other mental health conditions are more likely than others to develop anxiety.

Personality: Childhood traits of shyness or nervousness in new situations, for example, increase the risk of having an anxiety disorder.

Long term exposure to stress or trauma at any point can trigger chronic anxiety.

Underlying physical health concerns, such as a thyroid disorder or heart problems can trigger or worsen anxiety symptoms and having another mental health disorder is also a risk factor for an anxiety disorder.

Misuse of drugs or alcohol can trigger anxiety, as can withdrawal from these substances.

How can anxious thoughts hold us back and interfere with our quality of life?

Having anxious thoughts is like having an overprotective parent in your mind telling you all the reasons why you shouldn’t do something and all the things that will go wrong if you do it. It’s likely that these thoughts, although intended to keep you safe (that’s what our brains do all day, try to keep us safe), cause you to overprotect yourself by avoiding or withdrawing from things that you are worried about.

When we avoid something we feel relief, but that feeling of relief is bad for you in the long run, because you start to associate that good feeling of relief with avoidance, so you continue to avoid.Dr Michaela Dunbar

Avoidance is fuel to the flame of anxiety because when you avoid something you just don’t get the opportunity to see that a) the scary story you pictured in your mind was just a scary story and b) that whatever happens, you can handle it. Essentially, we massively overestimate the threat and massively underestimate our ability to cope with it. When we avoid something we feel relief, but that feeling of relief is bad for you in the long run, because you start to associate that good feeling of relief with avoidance, so you continue to avoid. This avoidance of things you are worried about can spread to other areas of your life if you don’t manage it. This is a vicious cycle and can feel very lonely, but you can find your way out of it with the right information and the right support. Whether that’s blogs, books, podcasts, or therapy.  

In your debut book You’ve Got This, you provide a practical toolkit to reframe anxious thoughts. How can cognitive reframing help manage High Functioning Anxiety and challenge the anxious brain?

We have thousands of thoughts every day, some negative, some positive, some fiction, some fact. However, depending on our experiences our thoughts can end up a little biased towards negativity.  For example, if you were bullied when you were 14 that might have left you thinking that you were unlikable, and those thoughts can stick with you well into your older years. However, just because you were bullied at 14 doesn’t mean that you are unlikeable by any means.

So, we have to take that ‘I’m unlikeable’ thought to trial, especially if it’s affecting our behaviour today.  When you take a thought to trial you look for tangible, objective, evidence for and against your negative thoughts, and then use that evidence to decide if it’s true. It’s usually not. You might still ‘feel’ as though your negative thoughts are true, but that doesn’t matter too much, as long as your behaviour is in line with the new belief you want to have, ‘I am a likeable person’. By changing your behaviour in this way you will start to see a shift in how you feel about yourself, and how others see you. 

What causes overthinking tendencies?

A number of things, but overthinking is really common in people who have experienced trauma at any point in their lives. This could be getting bullied at school as I mentioned before, or a car accident, or even having an emotionally unavailable parent. Essentially, if we have had difficult experiences that were hard for us to process at the time, our brains and our bodies hold onto the memories in an effort to make sure it doesn’t happen again.

If your past experiences were interpreted by you as negative, and you haven’t had the opportunity to process them, that could be informing how you think, feel, and behave today. Dr Michaela Dunbar

So we think and think and think about all the things that could go wrong so we can prepare for it. Our brains act like a time machine in these cases, where we will think back to past experiences, propel ourselves into potential outcomes in the future, and pair it with the current situation, all in an effort to assess risk and what we should do about it. However, if your past experiences were interpreted by you as negative, and you haven’t had the opportunity to process them, that could be informing how you think, feel, and behave today. 

How are High Functioning Anxiety and imposter syndrome connected?

Self-doubt is a huge theme for people with HFA and imposter syndrome. 

Imposter syndrome is the overwhelming feeling that you just don’t deserve your success. By anyone’s standards you are successful, conscientious, and ambitious but you have become convinced that you’re not as intelligent, creative or talented as you may seem. If anyone comments on your achievements you just tell them that it’s all down to luck, good timing, or just being “in the right place at the right time”.

Like High Functioning Anxiety, imposter syndrome isn’t an official diagnosis, but psychologists and other experts acknowledge that it is a very real and specific form of intellectual self-doubt characterised by:

Feeling Inadequate

Having Perfectionist Tendencies

Fearing Judgement and ‘Discovery’

Denying Your Own Success

And Like HFA this impairs professional performance and contributes to burnout.

What is the first step to overcoming or diminishing anxious thoughts and feelings? How can you break the pattern of spiralling ‘what ifs’ and ‘shoulds’?

Mindfulness is amazing for overthinking tendencies. It helps to stop the time machine and focus only on the present moment. Allowing you to fully engage with what’s important and valued to you right now, rather than rehashing the past or worrying about the future. It takes practice, as it is essentially training your attention, but it’s free and you can start with just 1 or 2 minutes a day, then build the time up. You need to remember that you can’t stop thoughts coming into your mind, our brains are literally designed to think, but you can choose which thoughts you give your attention to. Mindfulness also helps you to notice your triggers sooner, giving you more time to respond in a helpful way.  

What role does fear play in High Functioning Anxiety?

Everything. Fear equals threat response in all humans.  An activated threat response triggers physical symptoms, and often a change in our behaviour. Ultimately, we all just want to stay alive, we naturally try to protect ourselves, and some of us end up over protecting ourselves by procrastinating for example, because we fear failure. If you procrastinate it’s likely that you will have to rush the work so you get it in by the deadline, increasing the chances that you won’t do as well with the project. That age-old self-fulfilling prophecy occurs. Keeping the fear cycle alive in the same way I mentioned earlier. 

How can we use the fear of failure to our advantage rather than our detriment?

Feel the fear and do it anyway, use it to hone in on what’s important to you.

How does HFA differ from GAD and other forms of anxiety?

HFA is much more likely to be ignored because, on the outside, the person is functioning seemingly well in their life – usually better than the average person. The same mechanisms of anxiety occur across all anxiety disorders (HFA is not yet a recognised disorder). We all have a threat response, and a nervous system that can get dysregulated. Essentially it all works the same way, but the internal and external symptoms or experiences of the anxiety may vary. 

When does HFA become problematic? At what point should someone consider seeking help?

As soon as it starts interfering with your everyday life. For example, you wake up many mornings feeling anxious, you start avoiding plans, or the physical symptoms interrupt you. Or as soon as you want to!

Those living with HFA tend to live in their heads in a perpetual cycle of overthinking. How can they reconnect with their body and channel that anxious energy in a positive way?

A little anxiety isn’t a bad thing, we need it to stay alive and we can use it to keep us motivated. For example if you’re in an exam. However, this is better in small doses and becomes a problem when it is disrupting our quality of life. If you’re anxious about something it just means you care about it, it doesn’t mean there is a reason to be anxious. Remember thoughts aren’t facts, so, lean into that. 

when your threat response is activated, it often feels really uncomfortable in our bodies, you might get butterflies or shallow breathing, get a stomach ache or become really sweaty.Dr Michaela Dunbar

If you’re anxious, your threat response has been activated, when your threat response is activated, it often feels really uncomfortable in our bodies, you might get butterflies or shallow breathing, get a stomach ache or become really sweaty. The list goes on, and it’s important to know that everything that happens in your body when your threat response is activated is designed to keep you safe. However, because it feels bad we start thinking up strategies to distract ourselves, or try to escape how it feels in our bodies. This just keeps us scared of our own physical symptoms, and more fear equals more anxiety. The key is to reconnect with your body with things like body scans, mindfulness, or yoga so you can get reacquainted with it and take anxiety off the pedestal. 

One of the most powerful places to be is knowing that you can have any thought and any feeling and still do what you need to do. 

What wellbeing techniques / hacks can be employed to manage HFA on a day-to-day basis?

  • Two minutes of mindfulness
  • Deep breathing, this helps to deactivate your threat response and activates your rest and digest response.
  • Set strong boundaries with your managers and co-workers. Sometimes the stress and overthinking is magnified when your to-do list is too long. Take some things off your plate. 
  • Check-ins, conduct a body scan from head to toe and notice where in your body you feel discomfort and breathe through it. Do this every hour. 
  • Journalling – get your thoughts down onto paper and problem solve them if they need to be, instead of keeping them in your mind taking up space.
  • Move your body to get a quick happy hormone hit such as endorphins and dopamine
  • Get in the sun, vitamin D has huge positive benefits for our mood

What are the treatments and therapy available for HFA? 

As HFA is not an official diagnosis, the interventions (and clinicians that are aware of HFA) are slim but with my clients, I use a mix of cognitive behavioural therapy, acceptance and commitment therapy, and Eye Movement Desensitisation and Reprocessing Therapy (EMDR). These therapeutic models cover a good mix of mindset, actions, and body work. Somatic therapy is also really good for managing trauma held within the body. 

For more advice and tips, follow Dr Michaela Dunbar @myeasytherapy on Instagram and order her new book You’ve Got This: Seven Steps to a Life You Love

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