What is high-functioning anxiety?

Bonnie Evie Gifford
By Bonnie Evie Gifford,
updated on Apr 5, 2024

What is high-functioning anxiety?

We speak to experienced anxiety experts to find out more about high-functioning anxiety, how it affects us, and what we can do to cope...

We’ve all heard of anxiety. Related to our ‘fight or flight’ response, while the emotional and physical sensations are unpleasant, it can be a normal thing to experience from time to time. However, for some of us, these feelings of worry, fear, or unease can have a much greater, lasting effect that can become overwhelming.

According to the Mental Health Foundation, generalised anxiety disorder – one of the most common forms of anxiety – is thought to affect nearly 6% of all adults in England. But what about high-functioning anxiety? And how prevalent is that?

What is high-functioning anxiety?

“High-functioning anxiety (HFA) is one of the most invisible anxiety disorders,” psychotherapist Lesley Shearer explains. “It can go on for months or years without being diagnosed or treated, and to an individual’s friends, family, and colleagues, even themselves, the symptoms can go unnoticed.”

Many who experience HFA may try to ignore symptoms, or ‘power through’ them. It’s not until they are alone that they may ‘crash’. “The intense time they have controlling their emotions can be a drain on their energy, meaning they need prolonged periods of downtime to recuperate, or that they turn to maladaptive strategies such as drinking, drug-taking, or binge-eating as a way of coping,” says Lesley.

Cognitive behavioural psychotherapist Peter Klein explains some of the overt and covert ways HFA can present itself. More obvious, outward signs can include being very quiet or talkative, fast movements and actions such as scanning your surroundings with fast eye movements, or overly submissive or aggressive behaviour when conflict arises.

Easier-to-miss signs can include constantly thinking about what could go wrong and what you should do about it, struggling to be present in the moment, daydreaming, experiencing a fear of failure or being a fraud, constant planning, or cringing over your own behaviour.

Due to the ongoing stress that can be caused, Lesley explains, those who experience HFA may develop physical health problems as well. “There is more potential for people with HFA to develop physical health conditions such as cardiovascular, respiratory, or gastrointestinal disorders due to the enduring effect of stress on the body, or as a result of the unhealthy behaviours they have employed as a way of managing their internal distress.”

Why do we experience HFA?

“People can have high-functioning anxiety due to stressful events, such as a difficult childhood, biological causes such as food insensitivities, or other reasons,” Peter explains. “High-functioning anxiety can be beneficial when growing up in a stressful environment, as it makes it easier to anticipate threats before they occur, and therefore implement measures to avoid or control perceived danger.”

Raising your awareness of your physical feelings of anxiety and accompanying thoughts can help you to stop when the symptoms begin

While those with HFA will typically appear successful, together, and calm, often excelling in different areas of work and life, this can conflict with how they feel on the inside.

What can we do to cope with symptoms?

Just as anxiety can affect us all in different ways, so too can different ways of coping help us to varying degrees. If you’re worried that you may be experiencing high-functioning anxiety, it’s important to seek help and support. Trying different methods of coping with how you are feeling is key; the first method you try may not be quite right for you and your situation, but by exploring your other options, you’re more likely to find the best way for you.

“Often people will try to choose the ‘rather safe than sorry’ approach,” Peter warns. “This means that they will try to avoid things that they perceive as threatening. The problem here is that anxiety can make certain things appear as a threat even though they aren’t. It’s therefore important to recount in a more calm state of mind, where and when this applies.

“The next step is to plan how to adjust behaviour in a way that indicates that there is no threat. For example, an employee who avoids eye contact during meetings with their boss can readjust their gaze. This can initially be scary, but the fear subsides after time, as the mind starts to learn that a ‘rather safe than sorry’ approach is not necessary.

“It’s important to generally embrace symptoms a little more, without trying to lessen them. People avoid anxiety symptoms by checking social media or the news on their phones. Behaviour geared towards avoiding symptoms can make them worse, as the brain recognises this behaviour as an indicator of threat – meaning we run the risk of developing anxiety over anxiety.”

Raising your awareness of your physical feelings of anxiety and accompanying thoughts can help you to stop when the symptoms begin, and learn how to intercept the cycle of anxiety. The STOP technique is just one option that can help you to break the cycle.

Lesley explains: “Your body is the compass with anxiety, so learn to pay attention to it. Notice if the feeling isn’t so good. Shift the focus of that attention to your thoughts. Ask: what am I thinking right now? Does it feel good to think the things I’m thinking?

“If you notice it doesn’t feel good, even if you believe them, say the magic word STOP. Imagine swatting the thoughts away like a pesky little fly. Now, mentally shift your focus to slowing your breath down. Take three long, slow, deep breaths. Focus your attention on all of the sounds in the room or your immediate surroundings. Anchor yourself in sound.”

Over time, anxiety can eventually become worse if your stressors keep building, or if you struggle to reach out and talk to others about what you are struggling with, and how you are feeling. Working with a counsellor can help you to understand the root causes of your anxiety, as well as to learn coping techniques.

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