Are You One Of The Many Women Suffering From 'High-Functioning Anxiety'?

Photo: Eylul Aslan.
Ask a twenty-something whether they've ever suffered from anxiety and you'll probably get an affirmative response. Generation Y has been dubbed the most anxious generation to date, with a quarter of young women in the UK having suffered from anxiety or depression.
We're gradually becoming used to talking more openly about our mental health but stigma, misunderstanding and the pressures of modern society mean many young women still keep their illness hidden. They appear to lead their lives as normal – going to work, meeting friends, going on dates – while suffering in silence. This worrying trend is appearing among millennials in particular – and it has been dubbed “high-functioning anxiety”.
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“High-functioning people with significant levels of anxiety are sometimes called the 'worried well'," says Amy Bach, a clinical psychologist and a professor at Brown University. "Despite problems with anxiety, they are high achievers or function quite well in various aspects of life.”
The problem with the term 'worried well' though, she says, is that it minimises the distress people are actually enduring. "Although they appear well," she says, "they may privately suffer intense panic attacks, follow hours of secret compulsive rituals, or feel paralysed at the thought of air travel, meeting new people, public speaking, or even making mistakes.
“For such people, the anxiety itself may be compounded by a desire to hide it from others.”

Millennials are maligned as the 'snowflake generation' of cereal cafes and deconstructed coffees. But we live in an age of job insecurity, extortionate rents and enormous debt, all of which wreak havoc on our mental health.

Amelia* is 28 and works in finance. She has a great job and a busy social life, but she also has chronic anxiety – which she kept hidden for months, only recently seeking help.
“Anxiety is something I battle on a daily basis. Instead of using my energy to deal with how I was feeling, I've spent the last few months pretending to everyone in my life – including myself – that I'm completely fine,” she says.
“I have still managed to maintain my job, social and love life on the outside – with most people not knowing anything has been wrong.”
As a self-confessed perfectionist who likes to be in control, Amelia says she saw anxiety as a weakness and something she thought she would be judged for having.
“This was particularly felt in relation to my job – we are in the process of recruiting someone new for me to manage and I was worried if I told anyone how I was feeling this would curb my career development, as I would be seen as not capable.”
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Anxiety is a growing epidemic among millennials. Early adulthood is a common age of onset for anxiety disorders – and women are more likely to develop a mental health problem, says psychologist Natalie Dattilo.

Not only are we never able to switch off, we're also constantly bombarded with pressure to be a 'better version' of ourselves.

“The reasons that have been cited for this are differential exposure to stressful life events and trauma, higher likelihood that symptoms will be recognised and/or taken seriously, higher likelihood of seeking treatment for mental health problems and higher likelihood of following through with treatment recommendations,” she says.
"High-functioning anxiety" isn’t a medical term but it is a phrase now recognised by many mental health professionals. It has been more frequently used in recent years, as pressures on young women increase – from building a career with job security to the pressure of perfection on social media.
“I doubt high-functioning anxiety is a new thing, but maybe recognising it as such and labelling it is,” Dattilo says. “And I am nearly certain that our very busy, information-abundant, connected lives contribute to life stress and pressure in a way we have never dealt with before.”
Whether it's via WhatsApp, Facebook or Twitter, rarely a minute ticks by without us scrolling through feeds or messenger groups. And our 24/7 work culture means many of us are guilty of replying to our bosses late at night.
Not only are we never able to switch off, we're also constantly bombarded with pressure to be a "better version” of ourselves – whether it's from clean-eating Instagram gurus or the high-earning friend who runs ultra-marathons.
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A recent study found four of the five most popular forms of social media are damaging to young people's mental health because they exacerbate body image worries, as well as feelings of loneliness and inadequacy.
“I think there is a huge amount of pressure to be a twenty-something who is completely in control of their life and knows where they’re going,” Amelia says. “The extensive use of social media presents 'perfect' people with 'perfect' lives, which naturally make people feel inadequate about their own.”

Someone might be “functioning” on the outside – the life and soul at the pub on a Friday – but it is a defence mechanism to mask their internal suffering.

Millennials have been maligned as the “snowflake generation” of avocado-everything, cereal cafés and deconstructed coffees. All this aside, though, women live in an age of job insecurity, extortionate rents, enormous debt and high living costs, all of which wreak havoc on our mental health.
For Emma*, 29, having a child in this environment only heightened the anxiety she has lived with for most of her life.
“Our generation feels so precarious at times,” she says. “I have no pension and a mortgage and a son. Both my husband and I work but if either of us lost our jobs the wheels would fall off very rapidly. This is a constant worry for both of us.”
“As much as I looked forward to his arrival, I dreaded the return of my anxiety which I knew I would be prone to with my history,” Emma says. “After my son was born, the constant, vivid images of him being hurt or seriously ill in hospital were unbearable.”
On the outside, she appeared to adjust to motherhood without any problems – because she hid her anxiety.
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“I felt that I couldn't speak to anyone about how I was feeling as the terror of him being taken away from me was too real and too frightening for me to risk for one second by seeking help,” she says.
On the surface, high-functioning anxiety appears to be easier to deal with than other mental health problems – but this isn’t the case. Someone might be “functioning” on the outside – the life and soul at the pub on a Friday – but it is a defence mechanism to mask their internal suffering. And it’s just as dangerous as anxiety because, without treatment, it can lead to the same devastating outcomes.
“If the individual tells themselves they are functioning just fine and/or don’t see the point of treatment, or feel they are too busy to fit it into their day – these individuals may be less likely to seek treatment,” says Dattilo.
“The danger with not pursuing treatment, or not participating in treatment with a qualified professional, is that both untreated and under-treated anxiety tend to get worse over time,” she says, adding that it can also lead to other health problems such as irritable bowel syndrome, insomnia and heart problems.

A person’s quality of life is certainly suffering, but you want to know the good news? High-functioning means highly treatable.

Keeping her anxiety hidden had a huge impact on Amelia’s life. “I felt extremely alone, as if I was the only person who could be going through this – it left me feeling as though what I was thinking and feeling was wrong and I should 'sort myself out' and be better quicker.
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“This made everything worse as the more pressure I placed on myself, the worse my anxiety.”
Some women – particularly those who have had anxiety for a long time – may feel their anxiety is normal, so it's not worth getting help. Others may even rely on their anxiety to fuel a busy lifestyle, which can lead to burnout.
“The difficulty is getting people who have come to rely on their anxiety as an 'energy source' to see that it is not really serving that purpose and let it go,” Dattilo says.
No matter how bad it gets, anxiety is treatable – whether it is using self-help resources or talking to your GP, who might recommend cognitive behavioural therapy (CBT) to help deal with unhelpful thinking.
“There are people with anxiety so bad they can no longer function,” Dattilo says. “It can be quite devastating or even deadly – so if you are 'living' with anxiety that’s a good thing, simply because you’re still living.
“A person’s quality of life is certainly suffering, but you want to know the good news? High-functioning means highly treatable.”
*Names have been changed to protect identities.
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