By Carissa Weber, MA, LPC, CSAC
This post was originally published April 28th, 2021. I’m excited to present you a revised version with new science-based information included.
We see it all the time in commercials. That one ambitious person working late, always in the office building with every light off except for the ones in their own cubicle. We see it in our favorite bingable series; that one character who is always pushing to get everything done. Many people applaud that crazy go-getter, sometimes even wishing they could be more like them.
We have also seen in our favorite shows that one person whose always avoiding responsibility. In our kids’ favorite movies when there is a crisis, we see one character usually hiding in the corner, while the rest are running around like chickens with their heads cut off. That person (or animal if you think about some kids movies) tends to invoke a sympathy response for them. What if I told you that both of these cases demonstrate the sheer flexibility of anxiety?
As outlined in the first post I wrote about anxiety, What Anxiety Really is: A map of Distress to Nowhere, we talked about why our anxious brains do what they do. This post is looking at the many masks and features that anxiety has, as well as some ways to address amped-up anxiety and shutdown anxiety.
Let’s start off with talking about amped-up anxiety. Some of you may have already heard the term high-functioning anxiety, a term that is fairly new in the therapy world. Why have you heard it? Believe it or not, it is because the stigma of mental health is changing in a positive way (Yippee!!!). High-functioning anxiety shares similarities with ” regular” anxiety (like feeling worried all the time, overthinking situations, feeling overwhelmed, and having some of the physical symptoms that come with anxiety). The difference is that people who have high-functioning anxiety have adapted to it and function well, almost flawlessly, to the untrained eye.
People with amped-up, or high-functioning, anxiety often appear outgoing, driven, and ambitious. These crazy cats are always punctual and putting in long hours to achieve their goals. They demonstrate that (on the outside) they are on top of things and use several organizational tools to help them remember what is going on. People with amped-up anxiety come across as passionate, educated, and natural born leaders. In essence, people with amped-up anxiety come across as type A personalities.
There is a dark side to high-functioning anxiety:
- the mask of passion and leadership are hiding the obsession to be perfect
- Working hard is a way to gain acceptance and validation from their peers (better known as people pleasing behavior)
- They struggle to say “no” due to their fear of rejection and disappointing those around them
- Increases in anxiety and nervousness bring sleepless nights, hyperfocus on tasks, and ruminating thoughts (and a decreased ability to relax as demonstrated by the “on the go” behavior)
- Nail biting, playing with their hair along with an increase in irritability when they get confused by tasks
- An unhealthy self-esteem level that stems from setting unrealistic goals and not meeting them (I think I just called myself out).
- All of this is done in an attempt to avoid the feelings that come with anxiety
Is high-functioning anxiety a diagnosis?
High-functioning anxiety is a type of anxiety that isn’t actually a diagnosis yet. Some of you may be scratching your head at that, let me explain why. In the diagnostic Bible for therapists, the DSM-5, it covers a category called anxiety disorders, which include generalized anxiety disorder, panic disorder, agoraphobia (and other phobias), social anxiety, separation anxiety, and obsessive compulsive disorder (OCD).
From OCD to social anxiety, amped-up anxiety takes a little bit from each diagnostic category to make it’s own little cocktail. I love the quote from psychologist Elizabeth Cohen “[High-functioning anxiety] has the people-pleasing that usually comes with social anxiety, the physical responses and ‘waiting for the other shoe to drop’ component of GAD, and the rumination of obsessive-compulsive disorder (OCD).” With that said, people with high functioning anxiety often don’t meet all the criteria needed for one specific anxiety diagnosis. Hopefully, that will change in the future.
Does high-functioning anxiety work differently in the brain than “normal” anxiety? I wish there was a clear answer there for you. As science researches it more, many of us therapists recognize high-functioning anxiety as a coping mechanism for anxiety symptoms as it follows the same pathway as “regular” anxiety (check out the post, What Anxiety Really is: A map of Distress to Nowhere to revisit the anxiety pathway). Essentially, your darn amygdala has adapted to be the fighters from the triple F response (Wahoo!).
“People who have high-functioning anxiety have adapted to it and function well, almost flawlessly, to the untrained eye.”– Carissa Weber
The definition of generalized anxiety disorder
What about “regular” anxiety? Is that called low-functioning anxiety because we are unable to cope with the emotions? It is not. “Regular” anxiety is broadly known as generalized anxiety disorder (GAD for short). The DSM-5 looks at the following symptoms to diagnose GAD:
- The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is clearly excessive.
- The worry as experienced is very challenging to control. The worry in both adults and children may easily shift from one topic to another.
- The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children, only one of these symptoms is necessary for a diagnosis of GAD):
- Edginess or restlessness
- Tiring easily; more fatigued than usual
- Impaired concentration or feeling as though the mind goes blank
- Irritability (which may or may not be observable to others)
- Increased muscle aches or soreness
- Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)
Some other things you may experience with anxiety, but are not listed by the DSM-5: avoiding things that make us feel anxious, procrastination of tasks, and forgetfulness ( a lot of forgetfulness).
Now that we have gone over the amped-up side of anxiety, let’s go over the shut down.
What is shut-down anxiety
No different than it’s amped-up version, shut-down anxiety happens when we seemed paralized by the stress anxiety brings us. For people who shut down, they commonly:
- Remove themselves from stressful situations
- Suddenly become quiet or stop talking
- Stop fidgeting in an attempt to stop drawing attention (or they may start fidgeting a lot or their body starts shaking)
- Avoid everyone and everything
These symptoms occur as a coping mechanism to the stress. Rather that fight it (like those with high-functioning anxiety), people with shut-down anxiety run away or freeze up (wait! The rest of the triple F response? how cool is that?!). What it is interesting about shut-down anxiety, is we are able to see why this happens.
When someone has shut-down anxiety and are experiencing extreme amounts of stress, that darn amgydala is on fire. Literally. It is firing away so loud, that it convinces the prefrontal cortex that that darn amygdala is right. To save yourself from the impact of this stress (you know, the stress that darn amygdala is catastrophizing), your prefrontal cortex says the only way to save you is to shut down or run away from the stressor. When that darn amygdala throws the all clear signal, the prefrontal cortex comes back to life and tries to piece together why we were in danger in the first place.
Whether you have amped-up anxiety or shut-down anxiety, it is still anxiety. Remember, your experience to anxiety is unique to you and your coping style. Just because someone experiences anxiety differently doesn’t mean your anxiety is better or worse than the next person’s.
I want to thank you for taking time to read about amped-up (high-functioning) anxiety and shut down anxiety. I know it is a lot of information, but there is relief when we know why it is happening!
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Astorino, D.M. (2020). What is High Functioning Anxiety? Retrieved from What Is High-Functioning Anxiety? Symptoms and Treatment | Shape
- Author Unknown (2020). High Functioning Anxiety. Retrieved from High-Functioning Anxiety – Bridges to Recovery
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY, US: Guilford Press. Retrieved from Cognitive Distortions (Worksheet) | Therapist Aid
- Clark, G. I., & Egan, S. J. (2015). The Socratic method in cognitive behavioural therapy: A narrative review. Cognitive Therapy and Research, 39(6), 863-879. Retrieved from Cognitive Restructuring: Socratic Questions (Worksheet) | Therapist Aid
- Cuncic, Arlin (2020). The Characteristics of High Functioning Anxiety. Retrieved from The Characteristics of High Functioning Anxiety (verywellmind.com)
- Home – SAMHSA Behavioral Health Treatment Services Locator