Nate is pretty sure he has anxiety, but the 28-year-old has never really slowed down long enough to ask a mental-health professional to confirm his suspicions. While he attends grad school for engineering during the day, he bartends for extra money at night and spends most of his late nights trying to come down from the double shift he just worked. But more than a lack of time, he doesn’t really want to fix his perceived anxiety because he believes it’s what keeps him going. “Anxiety is like coffee, it gives me fuel,” he tells me. “I doubt I could last during the really long days without it.”
This is precisely the problem many people with high-functioning anxiety face. “Often, people are feeling ‘good enough’ to get by, which can lead to them not recognizing the symptoms and not getting the adequate help and support they deserve,” says marriage and family therapist Christian Bumpous. “People can still be high-performers and be white-knuckling it in the process.”
Sure, guys like Nate might prefer their energy-boosted experience of anxiety to the debilitating panic attacks and fear of social interaction that people with other forms of anxiety often deal with. But as Bumpous points out, those with high-functioning anxiety similarly “have a limbic system that’s too active given what’s happening in their environment.” The limbic system is the area of the brain where the fight-or-flight response occurs, which means this overactivity releases extra stress hormones such as cortisol, which leads to inflammation and other potential mental and physical health problems.
It’s worth noting that, similar to high-functioning depression, high-functioning anxiety is not a technical diagnosis, but more of an informal way to describe the experiences of anxious individuals who don’t meet the criteria for generalized anxiety disorder under the Diagnostic and Statistical Manual of Mental Disorders, the text clinicians use to make diagnoses. Still, there are plenty of high-functioning anxiety tells. Namely…
You’re An Ambitious Perfectionist
Similar to Nate, people with high-functioning anxiety are typically “labeled as hardworking, loyal, helpful, determined and ambitious,” explains psychotherapist Samantha Newtown. And though these are often seen as positive attributes, the distinct catch for a highly-functional anxious individual is that “underneath the surface, they’re really struggling to keep themselves together,” she says.
A lot of this is fueled by having personal expectations that are too high and become less sustainable over time. But instead of pulling back and recharging, those with high-functioning anxiety keep trying to power through. “People with this type of anxiety often set a standard for themselves, or have a standard others set for them, that they feel the need to live up to and they do so at their own expense,” Newton adds.
You Live in the Future
Being able to stay grounded in the present is important to our mental health because it prevents us from going through unnecessary stress by focusing on things from the past — or future — that we can’t control. Some anxious people get stuck in the past, Bumpous explains, but high-functioning anxiety is “forward-focused and all about planning for the future.”
Of course, some planning for the future is necessary, but people who struggle with high-functioning anxiety tend to take it too far, Bumpous says, and waste a lot of time worrying “about the future, anticipating and preparing for worst-case scenarios — be it at work, with their friends or with their partner.”
You Might Drink Too Much, or Behave in Excess
One of the defining aspects of anxiety is the inability to feel calm, and alcohol is a socially acceptable way to get that feeling. Experts believe this is mostly because alcohol imitates the effects of gamma aminobutyric acid, or GABA, a chemical released in the brain that has anti-anxiety effects, and simultaneously inhibits GABA production later on.
High-functioning anxiety can lead to other numbing behaviors like “food, sex, shopping, the internet, gossip and Netflix binges,” Bumpous says. But because of the chemical relationship between alcohol, GABA and anxiety, drinking is especially important to keep an eye on. “This cycle of dealing with anxiety using substances can become vicious fast,” Bumpous warns, because “the immediate impact is a reward in the form of anxiety relief, while the long-term consequences — not immediately experienced — leave a person feeling more anxious.”
You Never Feel Good
It’s not just the booze hangover — high-functioning anxiety can make people feel physically terrible in numerous other ways, too. “Aside from feeling miserable from being constantly ‘on edge’ and ‘high strung,’ undetected and untreated high-functioning anxiety can lead to significant health problems, such as GI issues, elevated heart rate, and blood pressure, as well as trouble sleeping,” Bumpous explains.
In terms of those GI issues, the stress hormone cortisol causes our bodies to produce more stomach acid than necessary to increase digestive efficiency, which can lead to pain, nausea, vomiting, and in some severe cases, ulcers.
You’re in Denial About Your Anxiety Being a Problem
Nate may not have been in denial about being anxious, but he definitely didn’t frame it as an issue in his life. Per Newtown, this is common among highly-functional anxious individuals, as “they label it as stress, usually because they don’t want to seem weak or incapable of managing their lives.”
The key difference between stress and anxiety is that while stress is a normal response to external circumstances, anxiety engages the stress response in a way that isn’t always rational. And though the notion that anxiety is good and keeps you going is irrational, it can be hard to convince a highly-functional anxious person to try something different. After all, what they’ve been doing has worked to some extent in the past. That’s really the core issue for people who struggle with high-functioning anxiety — their chronic tendency to qualify something harmful as helpful.
So the next time you notice any of the above signs, instead of doubling down on anxiety’s alleged virtues, be honest with yourself about what’s really happening. It’s not fuel or coffee, but stress and anxiety, and you’re not doing yourself any favors chugging along with it every day.
Lauren Vinopal
Lauren Vinopal is a writer and stand-up comedian based out of New York City, who writes mostly about health, science and men. She is the host of the Mid Riff Comedy Show in Brooklyn, a frequent podcast guest all over, and lives the life of a teen who looks like they haven’t slept in years.
