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Do you have high-functioning anxiety?

Meet Daisy Goodwin. It’s difficult to imagine someone more successful than Daisy. An acclaimed newspaper columnist, bestselling novelist, award-winning screenwriter, and creator of TV shows including Grand Designs and Escape to the Country, she’s a modern-day polymath with a Midas touch.

We can all picture the kind of person we think she is. Uber-confident, no-nonsense, sorted, and probably (and entirely justifiably) rather pleased with herself. So, it comes as something of a shock to read her recent column in The Times where she reveals her struggles with mental health. On the surface, she says, she is serene, optimistic, sociable, and laid back. And yet… “Underneath I am fermenting with anxiety, some of it specific — did I remember to renew the insurance/complete the Ocado order/send the thank you email? But mostly it is more free form and existential.”

Meanwhile, her most high-achieving friend reveals to her “that she hasn’t slept a full night for years, and that her diary is so full because the only way she can keep the anxiety at bay is to “keep busy”. It is much easier to keep climbing the hill than it is to look down.”

Welcome to the distressing world of High-Functioning Anxiety.

High-Functioning Anxiety is not just successful people dealing with a bit of work stress. It is a lot more deep-rooted and fundamental than that. One of the features of a person with HFA is that they are probably professionally successful, their anxiety propelling them forward rather than leaving them frozen in fear. But at what cost? Underneath a seemingly perfect exterior, they are fighting a constant churn of anxiety.

And it’s not just anxiety about work. Here’s Daisy Goodwin again: “Here is a snapshot of the alarms that have been ringing in my head this morning: Is the book/script/play I am writing any good? Are my children happy? Do I have any friends? Do they really like me? Am I a good person? Do I spend enough time talking to my family? Are my thoughts inherently racist? Do the typos I keep making mean I am going to get dementia? In the small hours the thoughts become even more stark: will I ever work again? Have I done anything worthwhile with my life? Have I been a good mother? And so on, and on.”

And, as with all forms of anxiety, the symptoms of HFA are many and varied. They include the regular range of anxiety symptoms (insomnia, overthinking, churning stomach, sweating, tight chest, racing mind, fatigue) and some more specific to HFA: Making to-do lists; consistently arriving early for appointments; overworking or struggling to switch off from work; an inability to say ‘no’ to more work, and a reluctance to delegate; a tendency to compare oneself unfavourably to others; and an inability to take satisfaction in one’s achievements.

Many of the people who have achieved the most career success are driven by an anxiety that constantly gnaws away at their core. But herein lies part of the problem with HFA: People with it believe that their condition has been integral to their success. As such, they might be reluctant to address the issue and take steps to alleviate their anxiety.

According to the mental health website Very Well Mind, there are a number of reasons why people with HFA are reluctant to seek treatment.

  • You consider it a double-edged sword and don't want to lose the positive influence of anxiety on your achievements.

  • You are worried that your work will suffer if you are not constantly driven to work hard out of fear.

  • You might think that because you seem to be achieving (strictly from an objective standpoint) it means you do not "need help" for your anxiety—or perhaps that you don't deserve help.

  • You might think that everyone struggles the way that you do and may think of it as normal.

  • You might believe that you are just "bad" at dealing with life stress.

  • You've never told anyone about your internal struggles and your silence has reinforced the feeling that you can't ask for help.

  • You might believe that no one would support you in asking for or seeking help because they have not seen you struggle.

According to psychotherapist Jean Claude Chalmet, many HFA sufferers simply decide to live with the condition. “Usually people exhibiting this type of anxious behaviour tell themselves it’s just who they are, but the truth is this is learnt behaviour that can be unlearnt. You can face your fear — which is that your world would fall apart if you exerted less control or relaxed your routine. The first step is to speak kindly to yourself and to challenge your thoughts in a compassionate way. Risk tiny shifts in habit: wait till the morning to send that email, for example. Have a relaxing swim instead of going for a pounding run. It will improve your mental and your physical health.”

The problem of HFA is further compounded by the fact that it is not an anxiety disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides diagnostic criteria for mental disorders. As such, there isn’t a lot of information or research on it. And because the people suffering from HFA give the outward appearance of functioning well, it is a form of anxiety that people fail to take seriously – as a brief look at some of the comments under Daisy Goodwin’s article will testify.

But HFA is real, and surprisingly prevalent. Goodwin says she spoke to a journalist who interviews high achievers: “He said that he could always predict the first biographical paragraph before he met them, because it always contained some kind of trauma/bereavement/illness.” In other words, people who have a desperate need to prove themselves are often the most successful. But by no means the happiest.

Fortunately, there are steps that can be taken. First and foremost, anyone suffering with any form of anxiety disorder, including HFA, should see their GP, and consider medication and/or therapy to address the issues that are plaguing them.

But they can make other changes too. They include:

  • Lifestyle changes, such as limiting caffeine, eating a healthy diet, and getting regular exercise.

  • Sleep hygiene – sticking to a regular bedtime, and not staying in bed if your mind is racing. Instead, get up and do something else until you feel tired.

  • Recognising negative thought patterns, and countering them with something more realistic or helpful.

  • Practicing deep breathing or progressive muscle relaxation to help control tension.

  • Taking time to do things that are totally absorbing and keep you in the present moment, like painting or gardening.

And employers have a role to play here, too. It is highly likely that many employers will have a number of extremely capable, successful and seemingly content workers who are, in fact, struggling under the surface. This is not sustainable for the individual or their colleagues. A good employer will take time to nurture the wellbeing of their employees, with effective wellbeing policies and programmes. And the lesson here is: don’t wait to be asked for help, because many people suffering won’t feel capable of asking.

Anxiety and depression are, in many ways, invisible illnesses – and High-Functioning Anxiety is particularly difficult to spot. But it is an issue that needs to be addressed. Employers need to look after their employees, and sufferers themselves need to learn that their anxiety isn’t what drives their success, it is holding them back from enjoying the fruits of their achievements.

Image by Freepik


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