What is high-functioning anxiety and why does it so easily go unnoticed?

“It’s just me versus me at this point.”

On the rare occasion Krisha doesn’t meet her KPIs at her sales consultancy job, it’s not just a bad day at work. She leaves the office with a head full of doubts and a stomach of anxious nerves. She goes home “absolutely devastated” thinking ‘I’m not worthy of this job’ or ‘I could’ve done this differently or that better’.

Most days though Krisha doesn’t just meet her targets, she surpasses them. And although her inner critic only offers an ‘Okay cool’ for these wins, it’s keeping her anxiety at bay that’s the real reward. It wasn’t until a few months ago when Krisha saw a few short infographics on Instagram that she found a name for her experiences: high-functioning anxiety (HFA).

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Generalised anxiety disorder (GAD) is what many people think of when they think ‘anxiety’. GAD usually involves persistent nervousness, worrying and a feeling of impending doom, coupled with difficulties sleeping and concentrating. What separates GAD and HFA is a person’s response to these experiences.

Many people with GAD tend to live in a constant state of fight or flight, with flight being the preference (withdrawing from life and anxiety-provoking activities). Those with HFA though are nearly always in fight mode – pushing harder and hustling more when they feel anxious.

Keeping busy to cope – it sounds so 2020. For many of us, filling our time with new hobbies or learning new skills was nothing more than a lockdown survival tactic. But for those with HFA, the schedule-overloading strategy didn’t start and end with the lockdown(s), just as the increased demand on our time didn’t.

A recent Harvard study found that working from home now has many of us labouring longer each day – an average of 8.2 per cent more. Even before the pandemic, hustle culture was defining our world of work, stretching the boundaries of what’s a normal workload. So, you’d be excused for thinking HFA is just the condition of our time, a necessary evil if we want to keep up. But those experiencing HFA will likely tell you it’s a lot more than that, and no, they’re not okay, not really.

What HFA looks and feels like

If you met Krisha, you’d be impressed. She’s 21 years old, works as a sales consultant and has moved all the way to Australia from Malawi to study biomedicine. As with other high-functioning anxious types, Krisha is used to being simply dubbed (read dismissed) a high achiever. But this evaluation is often short-sighted as it misses the internal struggle required to reach that level of success. “Underneath, it’s not that great because day in, day out I’m always worrying ‘Am I doing this right?’, ‘Am I doing enough?’”.

The answer to the latter is usually no. And the solution to these fears and self-doubts? More effort, more hustle – more self-inflicted stress. This is because productivity and busyness are the fuel to a high-functioner’s engine. “The stress, the overworking and the subsequent reward are essentially what drives you,” explains Krisha. 

34-year-old English and Indonesian teacher Mentari tells me how she was thrown into an anxious spiral preparing for some leadership webinars earlier this year. “I couldn’t sleep. I constantly felt so fidgety and antsy, and I couldn’t concentrate,” she says. 

Catastrophic thinking – thinking that overestimates the potential dangers or negative outcomes of a certain event – is often a hallmark of anxiety. For those with HFA, the irrational fears are usually channelled into a productive outlet. “I over-prepared because I was so worried something bad was going to happen,” says Mentari. 

Sometimes the anxiety will get to be too much, or the high standards (usually self-set) will feel impossible to meet. That’s when procrastination and avoidance come in. “The anxiety is so unpleasant and uncomfortable that I procrastinate, hoping it will disappear,” explains Mentari. “But that usually only works for a short period of time.” 

But HFA isn’t technically diagnosable

Mentari tells me she’s going to seek a psychologist’s help now that she’s put a name to her experiences. But if you thumbed your way through the Diagnostic Statistical Manual of Mental Disorders (DSM) you wouldn’t spot HFA. While psychologists are recognising the term and its associated experiences more, the discussion on HFA mostly remains confined to pop psychology and the general public.

That’s not to say psychologists can’t work with the definition of GAD printed in the current DSM-5. Beaumaris-based psychologist Paige Hill explains how the ‘clinically significant impairment’ criterion can apply even if someone appears to be functioning well in daily life. “Most people end up in my office because it’s impairing something,” says Paige. “Someone could be doing really well in their professional field but they’re not sleeping, or they’re sacrificing their relationships and that’s the impairment they come see me about.”

Despite not being diagnosable, reports on HFA stress its realness and the importance of taking it seriously. One of the main reasons for this is that the high-functioning aspect of HFA can’t be sustained. “People who push themselves to the extreme can’t maintain it,” explains Paige. “Maybe they’re highly functional for a while, but staying on top of your game, all the time, with that level of anxiety – at some point they’ll burnout.” 

So, what’s society’s role in all this?

There’s that word again: burnout. Burnout is the natural outcome of what’s been called ‘internalised capitalism’, where we measure our value by our productivity. But if we think of people who’ve burned out as having fallen victim to capitalism’s productivity spell, those with HFA are completely spellbound. Krisha explains how tight the knot between self-worth and productivity can be tied within those experiencing HFA. “We become the societal pressure ourselves,” she says. “I’m now the one telling my parents that just doing okay at uni isn’t enough.”  

Perfectionism is the self-destructive belief that if you look perfect and do everything perfectly you can avoid the unpleasant feelings of blame, shame and judgement. For psychologist Paige, modern society and the age of social media have a lot to answer for when it comes to our anxieties about looking perfect.

“People are anxious to look like everything’s fine and social media is a big part of this – it’s a photo-worthy moment all the time.” But this isn’t just about our social lives anymore. “I have a lot of clients who’ve changed or lost jobs and they’ve been so freaked out about how it’s going to look on their LinkedIn,” says Paige.

Both online and offline, society simultaneously demands and valorises productivity, busyness and achievement. This explains why it can be hard to spot HFA both in ourselves and others. The societal reward for overworking not only makes it hard for people to recognise HFA but makes the self-inflicted stress worth it. It’s the clasp that closes the vicious loop. “You’re being rewarded for hurting yourself. You know something is wrong with you, but you can’t stop because there are benefits from it,” explains Krisha. 

Changing the narrative on functioning and mental health

Herein lies the dangers of equating high functioning or productivity with an absence of internal struggle. The discussion on disordered eating can help illustrate this. Awareness has finally grown about the dangers of complimenting someone on weight loss. Aside from the inadvertent weight stigma it holds, doing so can mean rewarding damaging self-beliefs and behaviours like disordered or restrictive eating. 

One look at the media, advertising or diet industry will explain why people congratulate weight loss. Society has been drawing profitable lines between physical appearance and self-worth for decades. As a result, thinness – one of the signs of a serious condition like anorexia – has become commendable, even enviable. In much the same way, our society, which endorses productivity and hustle culture, sees us look up to those who ‘overdo it’. They’re applauded as the go-getters and the #careergoals. Our first response is not to ask if they’re doing okay but to commend them.

That’s not to say everyone who loses weight has an eating disorder, or that everyone who is high achieving is experiencing HFA. But there’s always value in checking up on those around us more. At the very least, doing so will unpick the knot between productivity and self-worth, which goes beyond helping those experiencing HFA. Stigma surrounds non-high-functioning mental health disorders for much of the same reasons HFA exists.

That is, society equates productivity, achievement and success with good mental health and strong character. Sure, that’s not always untrue. But such simplistic categorising sees those who withdraw from daily responsibilities easily dismissed as lazy and those who overdo it being considered naturally high achieving.

Breaking the ties between achievement and self-worth, high functioning and great mental health will also help each of us to break capitalism and hustle culture’s productivity spells. Maybe then we can reclaim the work-life balance, gain more headspace for being present and get better at checking in with one another. And that means with everyone, even (and perhaps especially) with those busy do-it-alls.

This article was originally published on June 12, 2021.

If you identify with HFA or have other mental health concerns, visit your GP for a mental health plan. Although a psychologist can’t technically diagnose HFA, they can help you reduce your anxiety while maintaining your optimal level of functioning. For support online, head here.