Updated: Jul 5, 2020
*Disclaimer: I want to make it clear from the outset of this blog series that I am generally not at all fond of mental health diagnoses. I understand that they can be helpful in so many ways, to be able to identify and label difficulties, to find commonalities with others, to gain access to treatment and the list goes on. However, from a ‘normal-abnormal’ perspective, I have to question the usefulness of these constructs. This is definitely a topic for a future blog but just wanted to get it out there before we begin, particularly as I’m starting with ‘high functioning anxiety’, which isn’t even a clinical diagnosis but rather a social construct to describe various experiences shared by many.
High Functioning Anxiety, the Anxiety Response & Perfectionism
So, high functioning anxiety….. well to start, there is some controversy around the term and on the back of what I‘ve just said, it’s not a formal ‘diagnosis’ and there is limited scientific research using this term at all, in fact zero to my knowledge (“maybe that can be my next project” says my own anxiety!). However, if you read on, you’ll probably see that although it’s not an official category or label in the DSM-V (Diagnostic and Statistical Manual), which is the classification handbook used by psychiatrists and psychologists, it certainly rings a bell with many people and is becoming a part of laypersons' terminology. So, in researching this particular topic for the blog, I wasn’t faced with much and needed to dig a bit deeper. But let me start by saying a little about what high functioning anxiety is said to (anecdotally) consist of and the reasons that it seems to have taken off as a term, and then we’ll talk about the science.
So, some would argue that ‘high functioning anxiety’ is a more ‘acceptable’ term to use than simple anxiety or panic. For some reason, it has more of a positive connotation. It somehow separates ‘bad’ anxiety from ‘good’ anxiety. The narrative around this focuses more towards the positives as it’s said to urge us forward to achieve, rather than the usual unhelpful anxiety experiences, like being frozen with fear. When we think of anxiety, many of us would imagine someone who struggles to go out, someone who may have regular panic attacks, someone who retreats from the world to keep themselves ‘safe’. Well, yes, these are all factors in anxiety for some people but what has come to be known as ‘high functioning anxiety’ looks quite a bit different from this, at least it may do on the surface.
Instead, think of someone who is a high flyer, an extrovert who is the centre of attention, the person who wants to be out and about socialising all the time, someone who is a huge success in whatever their chosen world of expertise. This person could be the ‘go to’ person, the doers amongst us, those who thrive on being busy and helping others out. They are quite possibly very organised and are good at making plans and arranging. Often appearing completely calm, not the bag of nerves that you may expect with an anxiety sufferer. The person experiencing HFA may be immaculate and take great care of their appearance. Anyone heard of the ‘Type A’ personality?? Well there you have it! (There’s one for another blog!) The anxiety experienced can arguably be helpful in so many ways, urging the person on to succeed, they can appear driven, motivated and on the ladder to success (if they haven’t already reached that pinnacle!).
In fact, when we think about the science of anxiety more generally, it’s a great evolutionary strategy for human beings to experience this emotion. I know it doesn’t feel it when we’re in the throngs of anxiety, but actually it's there to keep us safe. Anxiety is stimulated by the stress response, which is an evolutionary inbuilt and innate strategy that alerts us to danger. If we’re about to step into the road and a car comes whizzing by, we’re grateful to the stress response for alerting us to that danger and in a split-second our body reacts by stepping back on to the pavement. There’s a lot going on between the mind and body in that split second and it starts in the brain! But this very safety strategy is also what can lead us to experience anxiety, as we can come to see danger in things that we often don’t need to. (More on this one in another blog too!)
So let’s get back to the high functioning variety and why this may be seen as the more positive younger sibling of anxiety… Perfectionistic traits are one of such characteristics often discussed in association with ‘high functioning anxiety’. Perfectionism can be seen as a helpful trait in so many different ways, particularly in the workplace whereby employers may be grateful for employees who are diligent and strive for perfection, however for the perfectionist, the truth is that such traits tend to breed unhappiness. Or at least, a lack of fulfilment. It’s impossible for someone to be perfect all the time (or arguably ever!) so if this is what we strive for, we are always going to be left short. Great for the employer who has someone working for them who will put in all the hours and overtime, who is also organised, precise and punctual. But for the person who is constantly aiming to live up to these expectations that they hold of themselves, they will generally never feel quite as though they’ve achieved enough. Always striving for more and placing the bar higher for themselves. This could all be down to the anxiety of not doing well enough, not feeling good enough. So, if perfectionism is the goal and anxiety drives this, then anything short of perfect will only cause more anxiety which can actually look more like nervous energy than anxiety. And so this vicious cycle leads to constantly wanting to do more, to be better and to achieve more.
As discussed earlier, high functioning anxiety is not a term used in the scientific literature and hasn’t made it into the DSM-V. So, in delving into the literature, I’ve been looking mostly at the term perfectionism, which I would argue is the cousin of so-called ‘high functioning anxiety’ and here is an outline of 2 relevant studies which support the discussions in this blog around anxiety and perfectionism. A study conducted by Koivula, Hassmen & Fallby (2002) investigated self-esteem and perfectionism in elite athletes, and the effects on anxiety and performance. They found that those who have perfectionistic standards and have thoughts about attaining an ideal show that they are likely to experience greater anxiety due to their existing situation and their ideal. So this is suggestive that if one doesn’t feel good enough in some way (and for a perfectionist, this can often be commonplace), they may compensate by doing more, working harder, and pushing themselves. Furthermore, in a study investigating whether perfectionists raise their standards after success, Kobori, Hayakawa and Tanno (2009) found that students with self-oriented perfectionism were more likely to choose a more difficult goal for the next task rather than the same goal. Therefore, rather than being satisfied with their accomplishments, they are again striving for more, potentially again stimulating an anxiety response.
Although a person experiencing high functioning anxiety may seem in control and engaged in the usual daily routines, behind the exterior of confidence and possible extroversion, they can be experiencing daily challenges which can significantly impact on their quality of life. A usual behavioural hallmark of anxiety is avoidance but with HFA, much of the anxiety is experienced internally and the often visible signs of anxiety can be negligible. They are more likely to push through regardless of the feelings they may be experiencing rather than avoid situations, yet even so they may feel uncomfortable before, during and after stress-inducing situations, whether that be, for example, in a working environment, a sporting situation, or when socialising.
If you’re wondering what type of behaviours or emotions to look out for, these are some of the most commonly reported ‘symptoms’, beginning here with perfectionism…
Regularly aiming towards perfectionism yet often feeling dissatisfied with accomplishments or performance;
Sometimes feeling a failure despite obvious achievement and success;
Becoming preoccupied with judgement and criticism from others;
Feeling overworked and constantly ‘on the go’;
Although constantly feeling overworked, also agreeing to additional tasks/demands/social events rather than saying no;
Outwardly positive and often extrovert but with an inner critical voice;
Nervous habits, such as biting nails, lip biting, spot scratching, hair twiddling; and self-soothing behaviour such as face/chest stroking;
Overanalysing discussions and situations, leading to anticipatory anxiety, during and post-event anxiety;
Sleeping, eating and substance use issues.
Whilst the behaviours above may be indicative of HFA, treat this with caution. These are just examples and I dare say many of us experience these behaviours at one time or another. If whilst reading this however, alarm bells are going off and you recognise some of these behaviours and feelings (as I do!!), I’d love to hear from you in the comments below. And if you’d like to know more about how you can help yourself if you experience HFA, you can sign up to my newsletter for regular updates.
Kobori, O., Hayakawa, M., and Tanno, Y. (2009). Do Perfectionists Raise Their Standards After Success? An Experimental Examination of the Revaluation of Standard Setting in Perfectionism. Journal of Behavior Therapy and Experimental Psychiatry. 40(4):515-21.
Koivula, N., Hassmén, P., & Fallby, J. (2002). Self-esteem and perfectionism in elite athletes: Effects on competitive anxiety and self-confidence. Personality and Individual Differences, 32(5), 865–875. https://doi.org/10.1016/S0191-8869(01)00092-7