In the world of therapy (and beyond) there is a saying that “you don’t pick your niche…you you’re niche picks you”. After qualifying as a therapist I noticed a large percentage of my enquiries were from young women experiencing anxiety and low mood due to the same cluster of issues: people pleasing, comparing themselves to others, self criticism, worrying about rejection, perfectionism. Later I learnt that this cluster had a name in social media circles i.e “High Functioning Anxiety”. What was even more interesting was that I really related to the inner worlds of these women but by then had found ways of managing it. I just didn’t have a name for it at the time. Since I loved working with this client group and sharing the tools that had worked for me, I had become a specialist in how to deal with High Functioning Anxiety.
What is High functioning anxiety?
High functioning anxiety is not a medical term and you are unlikely to get diagnosed with this at the doctors. But there is definitely a certain type of person who seem to struggle with certain types of issues enough that a new “umbrella term” has been created.
In my experience it tends of affect youngish women (to middle-aged me anything under 40 seems young!) who seem like they are coping on the outside. They tend to be well educated, have good jobs (often are very driven!), are pretty sociable (sometimes the life and soul of the party…because they think they have to be) and might be in a relationship. But on the inside are often in turmoil. Feeling so insecure in themselves and their relationships that their mental health is actually pretty poor.
High functioning anxiety differs from other forms of anxiety as the focus seems to be on inter personal relationships and achievements as opposed to outside events like general anxiety disorder. It therefore seems to be easy to mask and drives people towards certain behaviours (i.e. working hard) rather than away from them (i.e not leaving the house).
What are the signs of high functioning anxiety
Below are examples of the most common signs of high functioning anxiety. You may recognise all of them or some of them.
- Overthinking social interactions after they have happened wondering how you came across and whether people like you
- Always saying yes either to nights out or requests to help due to fear of letting people down (people pleasing)
- Taking things personally so feeling very anxious if people seem “off” or don’t reply to texts etc
- Feeling the need to change themselves to fit in with others around them
- Being very self critical about actual or percieved mistakes at work (i.e. perfectionism)
- Pushing self to achieve at the expense of wellbeing due to fear of failure
- Strong fear of rejection which impacts on friendships and relationships.
- Negatively comparing self to others, particularly after scrolling social media
- Periods of low mood, insomnia and anxiety.
What causes high functioning anxiety?
As high functioning anxietyis not a recognised medical condition there is no official cause. However, it is widely considered that low self esteem has a large part of play in making a person prone to high functioning anxiety. If a person experiences low esteem the part of their brains concerned with being accepted by others or doing well are more activated. When activated it triggers anxiety symptoms such as heart beating, racing thoughts etc. It can also be harder to self sooth and get a healthier perspective when stressful situations arise.
You can read more about low self esteem here.
How to deal with high functioning anxiety
Thankfully there are lots of things a person can do to deal with high functioning anxiety although most of the tools take a bit of practice. Below are the most effective tools I share with my clients that worked for me and include mindfulness, challenging thoughts and self compassion.
Learn mindfulness
You may have already heard about mindfulness and perhaps have assumed you can’t do it or by now are regularly using an app. But many people don’t realise how much mindfulness can help with high functioning anxiety or just think they are doing it wrong so give up.
Mindfulness really helps reduce the overthinking that people with high functioning anxiety experience. It involves observing unhelpful thoughts, not trying to push them away and can eventually stop thoughts from spiralling.
But not only that. Mindfulness is fantastic at helping you tune into and respond differently to uncomfortable feelings such as dread in chest or tightness in muscles.
Practice Self Compassion
People with high functioning anxiety find it hard to be kind to themselves. They judge themselves for feeling bad, are easily self critical and are unlikely to prioritise their needs. Therefore they tend to lack self compassion, however, it is a skill that can be learnt. An easy way of developing self compassion is asking how you would treat a friend. E.g Notice when you are struggling and remind yourself that you cannot help it. Pause and bring attention to the ways you are being unkind and ask what you would say to a friend.
Reduce anxiety with breath and body based exercises
If a situation triggers anxiety people experience a lot of symptoms in their body. For example your breath will quicken, the heart will beat faster and muscles will tense. These phsyical feelings trigger more unhelpful overthinking which then becomes a vicious cycle. When you notice this do deep breathing and make a conscious effort to relax your muscles. This will make you feel calmer and help you to develop different perspectives. Practice body and breath based meditations each day will also help you do this.
Challenge thoughts
A lot of what causes people with high functioning anxiety to feel anxious are assumptions being made about other people. For example, you might assume someone is judging you or that your boss thinks you are doing a bad job. These are automatic thoughts and we normally have little evidence that they are real. Ask yourself what thoughts are causing the anxiety, whether you have evidence (i.e. Is it a thought or a fact?) and try to generate more realistic alternatives. Learning Cognitive Behavioral Therapy techniques yourself or from a therapist can help.
Increase self esteem
Since the most common symptoms of high functioning anxiety relate to fear of rejection in some shape or form, ultimately the best protection against this is to increase self esteem. However, this is obviously easier said that done as low self esteem is usually deeply ingrained from childhood. But recognising this is the cause and that you can work on how you feel about yourself is the first step. It can take a long time to increase self esteem but it is possible with hard work, the right resources and potentially therapy. You can read more about how to increase self esteem here.
In summary then, High Functioning Anxiety refers to a cluster of symptoms describing people who worry so much what people think or fear making mistakes that work and interpersonal relationships trigger anxiety. There are many effective tools a person can use to help such as mindfulness, self compassion and CBT. It can also be useful to seek the help of a therapist.
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About me
My name is Rebecca Stambridge and am a qualified therapist and mindfulness teacher. I am passionate about helping women who struggle with stress and anxiety due to not feeling good enough because I used to feel that way too. I offer 1-1 therapy and run online courses. If you want information about working with me click here.
