High-functioning anxiety and depression aren’t labels that are recognised or accepted in the psychiatric community, with little to no research being done on their existence, despite many people saying they reflect their lived experience. Should its existence be taken more seriously? And do we need updated language to reflect this very real experience?
In the year between the third of December 2020 and the third of December 2021, the Google search trend for ‘high-functioning anxiety’ has been hitting consistent peaks with the highest peak being on November 14th 2021. Searches for high-functioning depression had somewhat fallen off as of the 24th of October 2021 but seems to be on the rise again.
What does this tell us?
Despite the fact that any psychiatrist office in the world would most likely tell you they do not recognise this as a diagnosis, many thousands of people are searching terms like: ‘how to deal with high functioning anxiety’, ‘high functioning depression test’ and ‘what does high functioning anxiety look like’.
This points to a lived experience that feels very real to those querying these terms on Google, so what does ‘high-functioning’ anxiety and depression look like and why do some people feel that it’s different enough to warrant that label?
From The Times and Forbes to Very Well Mind, there are a plethora of articles by various publications about high-functioning anxiety and depression. In an interview with Inverse, Melanie Badali, a clinical psychologist said, “There is a gap between scientific knowledge and public understanding of this topic…As a clinical psychologist, I practice and promote science-based assessment and treatment of anxiety. ‘High-functioning anxiety’ is not a term that I use.”
So wide is this gap that even a cursory search of ‘high-functioning anxiety’ on Google scholar only brings up papers in relation to high-functioning autism spectrum disorders, a label that within that community is quickly falling out of favour.
Badali pointed out that despite the lack of scientific research into the phenomenon of high-functioning mental illness, that “does not mean it does not exist or that it is not a topic worth studying”, finally she pondered, “Could professionals be missing a part of lived experience? It is possible”.
Generally, symptoms of what would be called high-functioning anxiety align the most with generalised anxiety disorder (GAD). The key difference, however, is how these symptoms manifest in a person and how they do or don’t impact their daily functioning.
Some symptoms of GAD:
- feeling dizzy or light-headed
- sleeping problems
- feeling consistently tense and nervous
- fearing the worst or always preparing yourself for the worst
- seeking lots of reassurance from people and worrying that you’ve done something wrong, or that people are angry with you
- ruminating: where think about bad experiences over and over again
- experiencing types of dissociation
- irritable bowel syndrome (IBS)
- muscle tension
For those who are experiencing something that might be understood as high-functioning anxiety, the outward appearance of them may be of one that ‘has it together’, who is achieving in work or school, maintains relationships and a social life but who internally is struggling with many of the symptoms listed above.
Successful mindfulness app Headspace have said people with high-functioning anxiety live in a perpetual state of ‘what if?’ and that:
‘…this isolated turmoil is often hidden by smiles and laughs, success and achievements, and a decent dose of extroversion. Ironically, this nervous energy is what keeps them moving forward. It’s always there pushing them to do more, achieve more, succeed more, and be better.’
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Through this lens, we could see those with high-functioning anxiety as the over-achievers in life, who never want to stay still and who frequently do not seek help because of the fact they maintain the aspects of their life (work, social life etc.) that, to them signal that they ‘don’t need help’, or alternatively, that they don’t deserve it, because they’re not ‘unwell enough’.
High-functioning depression, as with high-functioning anxiety and GAD, shares many of its symptoms with recognised disordered and diagnoses such as chronic depression, sometimes called dysthymia. This is when the symptoms of depression are consistent for two years or more but are milder than in disorders such as postnatal depression or major depression.
Some symptoms of chronic depression:
- low in mood
- empty or numb
- intensely feeling negative emotions and feeling tearful
- you might display avoidant behaviour, e.g not attending social events
- feeling low in energy
- disturbance to sleep patterns, e.g sleeping too much or not sleeping enough
- feeling guilty and being negative towards yourself
- losing interest in activities that normally make you happy
- displaying self-harming behaviours
- suicidal thoughts
For someone experiencing high-functioning depression instead of chronic depression, they might be able to manage how noticeable these symptoms are and how much they interfere with their daily life. In fact, someone who might have high-functioning depression might have developed ways to hide their symptoms, because they are ashamed of them.
Online therapy hub, Talkspace cite one of their therapists, Samantha White as saying those with high-functioning depression ‘worry about others discovering their illness.
However, Talkspace also quotes Annie Wright, who wrote for The Mighty, “In my opinion as a psychotherapist, high-functioning depression is a pop-psychology term for what’s clinically known as dysthymia.”
What do our readers think?
For this article we ran a series of polls on our social media platforms, to gauge what our readers think about this contentious issue.
The question was: Do you think ‘high-functioning’ anxiety and depression is a helpful alternative way to understand some people’s lived experience?
On Twitter the results were close, with 37 votes in total, 51.4% voted yes, while 48.6% voted no.
On LinkedIn, the votes were far more conclusive. Out of 631 votes in total, 75% voted yes and only 25% no.
On our Instagram, 97% of respondents voted yes to high-functioning anxiety and 94% of respondents voted yes for high-functioning depression.
On our Instagram we encouraged those with any insights into the phenomenon of high-functioning anxiety and depression to message us with their thoughts. One respondent, named Alice, had some very interesting thoughts in response to our question:
“Yes, but no…I think it’s actually referring to people that have gone undiagnosed and have consequently developed their own coping mechanisms which are more like a temporary fix.”
She continued, “To elaborate, I mean people who have lived with anxiety/any condition for an extended period of time, i.e childhood and haven’t been diagnosed or self-identified until adulthood – by which time they’ve developed ways of coping. Also, very relevant in the case of ADHD. I think it makes it harder to seek help and to create more appropriate ways of dealing with said condition.”
What about the language?
Many psychiatrists, psychologists and therapists now understand mental health and mental-ill health as existing on a spectrum. Even the diagnostic criteria in manuals such as the DSM or the ICD can be seen as experienced on a sliding scale within a person, and the same person may experience some of those symptoms severely one week, and mildly the next.
Could it be that what we are labelling ‘high-functioning’ is just one experience along this spectrum? When people are first becoming conscious of their mental health, and when it maybe slides along that spectrum to the more severe end, it can be scary to accept labels such as GAD or chronic depression. So often labels are associated with there being something ‘wrong’ with you, and though anxiety and depression are among the most accepted and discussed in society, there is still stigma there.
To destigmatise the experience of being depressed or anxious to the point where it affects your life, we must strive to make these labels feel as normal and acceptable as discussing a spate of bad migraines with a doctor.
As we briefly mentioned above, the label of ‘high-functioning’ has strong connotations to people with autism spectrum disorders (ASD). The classification of high or low functioning people with an ASD, negates and ignores the various and unique ways people who live on that spectrum can communicate and exist, especially when so often those considered as ‘low-functioning’ are non-verbal and communicate in different ways.
As Andy Burns wrote for our sister publication, Learning Disability Today, “I am not “high-functioning” or “low-functioning”: I am simply being.”
As such, it is pertinent to recognise that although understanding your anxiety or depression as high-functioning may be an important step along your journey to familiarise yourself with your own mental health, the label could be perpetuating negative stereotypes or restrictive ideas.
In conclusion, it seems what we are seeing evidence of here, is that anxiety and depression are experienced and felt in a broad and diverse range of ways, and people who live with those disorders are searching for language to describe that experience. We must, together work to perceive all experiences of mental-ill health as existing fluidly.