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Do you have high functioning anxiety? You seem in control on the outside, but are plagued by worry inside

High functioning anxiety - a condition where sufferers appear organised, in control and thriving, always perfectly presented, on time and upbeat on the outside while simultaneously struggling on the inside, plagued with anxious thoughts and spiralling worries and feeling utterly unable to cope - can be tricky to spot, for obvious reasons.

Scientifically speaking, high functioning anxiety is not officially recognised as being its own mental health condition, but rather a sub type of anxiety. So what exactly is it and how can you spot the signs? Essentially, it's anxiety but totally not obvious. The sufferer is able to maintain the illusion that they are functioning well and mentally healthy, which might look like excelling at work, being an attentive friend or keeping a Pinterest-perfect household. Indeed, they can hide their anxiety symptoms so well that they appear to be unaffected.

“When a person presents as capable, functioning and even excelling (such as in work, social, family or educational settings), but are actually hiding and internalising the fact they are experiencing all the chronic and debilitating symptoms of anxiety disorders, including fear, impending doom feeling, over worrying, hyper-vigilance and importantly the physical responses such as high heart rate and blood pressure, insomnia, gastro-intestinal issues (including diarrhoea, nausea and changes in appetite)," Dee Johnson, an accredited Priory psychotherapist tells GLAMOUR.

According to mental health charity Mind, in any given week in the UK, 6 in 100 people are diagnosed with generalised anxiety disorder, the most common form of anxiety. So where does high functioning anxiety fit in to that and how can you deduce whether you have it? We break it down…

What does high functioning anxiety look like?

Due to high functioning anxiety being characterised by a degree of pretence and keeping up appearances, signs can look to be unrelated to anxiety on a first glance. A common one, Dee says, is presenting as a "perfectionist" and someone that is "always fearful of not being good enough or getting things wrong". Those suffering can also be workaholics.

At the more troubling end of the spectrum, she warns: "This can manifest as controlling behaviour when actually its fear driven rather than ego based, but when you are at the receiving end of such behaviour, it’s really difficult to see anything other than control and power. People will try to avoid allowing themselves to feel their emotions and find ways to block them out (in case their emotions will inhibit them)."

Other signs can include but are not limited to: restlessness, being irritable, an inability to put assert boundaries, always being busy and full-on, insisting they are happy in difficult times.

"These people may have a history of depression, trauma in their past, low confidence and feelings of unworthiness, fear of rejection, substance use disorders (addiction) or an eating disorder - these are all examples of things that can drive high-functioning anxiety," Dee adds.

What can cause high functioning anxiety?

As with any form of anxiety, there are all sorts of factors that can cause the onset of high functioning anxiety, though experts generally believe that genetic and environmental factors are responsible. Some of the causes may include:

  • Family history of anxiety disorders
  • Exposure to negative or stressful life events
  • Certain physical health conditions like thyroid issues
  • Substance or alcohol abuse
  • Shyness or nervousness traits from childhood

It's important to note that people who fall into any of the above categories are not destined to suffer with high functioning anxiety, nor do they count as a diagnosis on their own.

How can you cope with high functioning anxiety?

If these words ring true, there are some things to consider:

  • Ask for help, including professional help (though Dee says "this is not in their nature and hard to do as they will see this as a failure).
  • Look at your belief systems and challenge them.
  • Learn to say no and that the drive for perfectionism is one of destruction.
  • Put in boundaries, limiting time you spend on trying to achieve everything.
  • Engage in ‘slowing’ down activities, such as walking, yoga, dancing, gardening, holistic therapies, and anything creative "as this shuts down the anxiety response in your brain" Dee adds.

Telling people that you trust you are struggling, and this can include your GP who can refer for further support including psychotherapy, CBT, and mindfulness.

Quit negative self-talk. "Stop insulting and punishing yourself with harsh and unkind words – and if at first you cannot find anything nice to say about yourself, at least stop saying the harsh stuff – nurture takes time," Dee says.

High functioning anxiety doesn't have to be a life sentence, but it requires dropping the act enough to acknowledge the need for change - functioning well on the outside while struggling internally can only be sustained for so long.

"Being human is being flawed - if something is flawless it doesn’t let the light in," Dee says, "go easy on yourself."

This article was originally published on Glamour UK.

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