Have you got high-functioning anxiety?

Daisy Goodwin for The Times, October 29 2022,

Your friends think you’re serene. But you rarely sleep well and you can’t stop making lists. Daisy Goodwin knows the feeling. Plus the signs to watch out for

I shuddered when I was asked: “Do you have HFA? High-functioning anxiety — calm and competent on the outside, custard inside?” The only answer was: “Of course, doesn’t everybody?”

I can’t be the only person swimming through life serenely swanlike — or, rather, ducklike — on the surface and furiously paddling through a lagoon of insecurity, anxiety and dread below. I ask my most high-achieving friend, the one who is on every board and who everybody has on speed dial when they need a favour.

She is famous for her positivity and her ability to conjure the sunlit uplands out of thin air. At first glance you would think: here is a woman who is utterly sorted. But she confesses to knowing 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.

HFA is not a recognised psychological disorder, because by definition the people who have it are “functioning”. It is nothing like depression, which I have suffered from in the past, and which makes getting out of bed a superhuman effort. HFA is like having a fire alarm that keeps going off in your head. Sometimes it goes off for a reason, sometimes it’s just the batteries running down — but you can’t be quite sure which it is.

Daisy Goodwin: “Underneath I am fermenting with anxiety”

On the outside, I probably don’t look like I have HFA. I cycle around London, I have no fear of public speaking and I will happily chat to strangers at a party.

My children think that I am such a lax mother they are lucky to be alive. My husband thinks I am ludicrously optimistic. My (younger) siblings are always surprised when I start a sentence with “I am so worried about . . . ”, because they assume that I always have everything under control. But 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.

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.

Weirdly I don’t worry about things I have actually experienced, like will my cancer come back or will my house burn down again?

When I was sick I was quite happy to listen to my doctors and did not spend every waking hour on Google. My big anxiety was whether I should tell people that I had breast cancer — my case was mild and didn’t involve chemotherapy, so it felt attention-seeking when I know so many women who have been through so much worse. My default mode was to keep calm and carry on.

Every time I have a party I fret that no one will want to come, and if they do come that they won’t have fun, and that I haven’t done enough to make sure that everybody meets somebody they might like. Not that it shows — people always say to me: “You seem very relaxed for someone having a big party.” If only they knew.

There are moments when the alarms stop ringing when I get so involved in something I am writing that I forget to judge and I am just immersed in the world that I am creating — I believe it’s called “flow”. I like boxing, and cooking and gardening for the same reason. But sadly there aren’t enough of those moments, and you can’t produce them to order.

Sometimes, though, the alarms are worth listening to. I doubt that Liz Truss has HFA, for example. A key component of HFA-dom is predicting the worst possible outcomes of your actions, and that does involve an uncomfortable amount of self-awareness.

I am not saying for a nanosecond that I am capable of taking on that kind of responsibility, but I know that if I did I would be paralysed by the thought that if I pressed the wrong fiscal button and the economy went pear-shaped, it would all be my fault.

I once talked to a journalist who interviewed high achievers, and 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.

People with happy, carefree childhoods do not spend their lives imagining the worst. I am hoping that there are lots of people out there who take unadulterated pleasure in their lives and who look into the future with insouciance. I wish I was one of them, but sadly no amount of alcohol, infrared saunas, mindfulness apps or hot stone massages will do it for me. Therapy is helpful, as are anxiety-relieving antidepressants, but as I get older I have come to realise that the alarms can only be managed, not switched off. I have tried saying to myself I am enough, but I just don’t believe it.

There is a poem by Fleur Adcock that I have learnt by heart because it is so spot on.

There are worse things than having behaved foolishly in public.
There are worse things than these miniature betrayals,
committed or endured or suspected; there are worse things
than not being able to sleep for thinking about them.
It is 5 am. All the worse things come
stalking in

I am now worried that by writing this article I have overshared big time. But if there are any others with HFA reading this, you have my respect and sympathy. I know just how you feel.

Do you have HFA? What the therapist says

By Jean-Claude Chalmet, As told to Anna Maxted for The Times, October 29, 2022

High-functioning anxiety is not an official diagnosis but it will be familiar to millions. I see it in many of my clients — people who are not necessarily debilitatingly anxious but would lead happier lives without the nagging critical voice in their head. They’re often very successful, and for good reason — they’re organised, efficient and disciplined. Others look to them for wisdom, guidance and leadership. Little do they know that their minds are a constant whir of worry. If you feel this might be you, here are the signs to watch out for — and what you can do about it.

You can’t relax and are obsessed with to-do lists

You’re a high achiever, you’re excellent at your job —some would say you’re a gift to your employer — and quite rightly you get a sense of validation from that. In my experience, though, people like this often present as alphas but beneath lies the feeling of not being quite good enough, often instilled in childhood. It’s why there’s a sense they constantly need to prove themselves. They have a harsh inner critic whispering in their ear that they might fail. It compounds their anxiety and heightens their need to be on top of everything. But mostly they keep on smiling.

Living like this can be tough. It’s difficult to let yourself forget or make mistakes, hence the love of to-do lists, Post-its and flurries of texts. You’re tired but you can’t relax because you are full of nervous energy and compulsively potter around rather than allow yourself to go to bed.

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.

You are prone to sleepless nights

Girl Using Smartphone on Bed Before Sleeping

You suffer from insomnia because your mind is like a hamster running on a wheel. You expend enormous energy unconsciously trying to escape anxiety. For example, you may overexercise — usually in the form of cardio.

You might think you’re being healthy, but this behaviour usually contains an element of self-punishment and denial. In moderation the exercise would be an antidote to stress, but because it’s extreme it actually stresses your system further.

You often suffer from aches and pains

In a constant state of alert, you may feel restless and tense, or suffer from a headache or other aches and pains. Anxiety can be soothed by learning to calm the body and mind. You might try playing an instrument, exercise (but without half-killing yourself), practise deep, slow breathing, singing or meditating. Or you could try a massage or reflexology session, or simply socialise and laugh with friends. Any of these activities redirect your thoughts to the present and make ruminating almost impossible.

If my clients feel overwhelmed I advise that they take two ice packs and press one to their face or forehead and one on the back of their neck. It jolts the system out of the fight-or-flight response, and by forcing them to focus on the sensation it distracts them from their thoughts. The tension we feel when anxious isn’t just psychological.

People with HFA very often have lower-back issues, headaches, jaw tension, digestive problems or sciatica because their nervous system is buzzing. When we distract ourselves from our negative thoughts by replacing them with enjoyable activities (swimming in a lake in winter is a more dramatic, some say thrilling, version of applying ice packs), we learn to stop our anxiety from escalating.

You’re not keen on plans being disrupted

The battle between keeping control and suppressing your worries creates tension. While you may appear to be serenely gliding along, the madly paddling anxiety is just below the surface. Maintaining order is a way of convincing yourself you’re in control. Creating routines to control the various aspects of your life is how you try, subconsciously, to keep negative thoughts at bay. In fact it just fuels anxiety.

You think HFA might be the secret of your success

People with HFA are convinced that they owe their success to their endless worrying and overthinking. I hear it all the time in my practice, the fear that if they loosen up and find a little more balance and lightness in life their success will disintegrate. I always tell them, “I think that you will be better.”

This is a learnt behaviour that sucks up their time and energy and leaves them exhausted. Not only will you feel healthier, brighter and closer to those you love, I tell them, “you’ll have more bandwidth to expand on what you’re already so brilliant at”.