Calling My Anxiety “High Functioning” is Invalidating
Appearing to be okay on the outside will never tell you if someone is okay on the inside.
The National Institute of Mental Health (NIMH) states that approximately 19% of adults in the United States suffer from an anxiety disorder. However, there are vastly different levels of severity from individual to individual, as with any mental health disorder. What anxiety is for me in my diagnosis will be different from what anxiety is for you in your diagnosis.
I used to always consider the term “high functioning” to be a positive thing.
And in a perfect world where my anxiety would still be taken seriously regardless of my level of functioning, it would be a perfectly positive thing. The problem is that society, and sometimes even health care professionals for that matter, take high functioning cases of an anxiety disorder less seriously. It is a means of brushing off the impact of an anxiety disorder. When you are being evaluated in a psychotherapy session, assessing the patient’s level of functioning is important for formulating the proper treatment plan.
However, sometimes a high level of functioning can be taken at face value to mean something along the lines of “your case isn’t as serious as all the rest.” This can impact treatment all the way down to insurance coverage, where insurance companies base their coverage off of the level of a mental health patient’s functioning. The higher the functioning, the less likely an insurance company is to fund the treatment in some instances.
But what is misunderstood here is that, depending on the severity of your anxiety disorder, you can appear successful, together, and calm — even going so far as having a Type A personality where you excel at work, school, and other endeavors. However, this can have absolutely zero reflection on how you are feeling and thriving on the inside.
And if you are experiencing utter turmoil, restlessness, and a failure to thrive internally with the way you feel on a daily basis, this should never be overlooked — regardless of how well you can manage to pull yourself together and “function” on the outside.
Consider this: someone with high-functioning anxiety may appear as the ideal image of a successful person.
They may record every little “to-do” and upcoming event in their planner, arrive to work meetings before anyone else, and maintain a 4.0 GPA. But what peers don’t see is the constant twinge of anxiety that is nagging at you throughout every move you make. An observation of a social interaction in the workplace can only show so much.
An outsider may see someone speak very articulately to a boss, shake hands, show eye contact, and hold themselves in a seemingly confident manner. The outsider may think to themselves that that person has it all together. But what isn’t observable in such an exchange are internal feelings the anxious person has, such as “am I being awkward?” “am I saying the right words?” “could my colleague tell that my hand was sweaty during that handshake?”
Someone with high-functioning anxiety may struggle extremely, on the inside, with these persistent anxious thoughts, even to the point of wishing they could call out sick more often just to escape from these feelings of believing they must always be “on guard” throughout every social interaction. Internally, these people feel very emotionally and mentally taxed and simple obligations throughout the day can quickly feel like an overwhelming mountain of stress.
Instead, an important factor that should be taken more into account is perceived quality of life. Not outside functioning.
A study on this topic showed that individuals with generalized anxiety disorders reported less satisfaction with their quality of life than non-anxious adults. Furthermore, diagnostic symptom severity was not found to make a difference in influencing perceived quality of life.
This may provide insight into the idea that regardless of symptom severity or “level of functioning,” an anxiety disorder still has the ability to make a significant impact on one’s life. This is exactly why individuals who are perceived to be high functioning deserve just as much attention and to be taken seriously as those who may not appear to be high functioning.
Additionally, it should be up to the individual to identify and decide just how much their anxiety is affecting their internal emotions and cognitions. A healthcare professional can only listen to what their patient tells them and make physical observations on the patient’s demeanor.
And while of course this should be taken into consideration, it is not conducive to assume that because someone is responsible and excelling in certain areas of their life that their anxiety is mild, or under control, or even manageable. Perhaps they have gained the skills to appropriately mask their anxiety when it is crucial to do so, but that does not take away the fact that every day may be an ongoing battle with an invisible illness.
