Does being 'high functioning' mask mental health problems at work?

When Claire* opened up to her colleague about often feeling anxious, they reacted with surprise. “But you always seem so confident,” they said. “You’d literally never know.”

But behind her confident, capable exterior – she works in admin at a prestigious university – she is fighting a constant churn of anxiety. “I’m terrified of failure and my worries tend to spiral out of control. I never stop,” she says.

Although it’s not an official or recognised mental health diagnosis, high-functioning anxiety is something many people struggle with. As many as 60% of adults in the UK have anxiety, according to the Mental Health Foundation, but almost half (45%) keep it a secret.

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And for many people, this means keeping up the appearance of being cool, calm and in control – or perhaps an overachiever – while burying the feelings of anxiety, stress or low mood.

It’s difficult to pinpoint exactly how many people have high-functioning anxiety because of the nature of the condition. If you’re bottling up or compartmentalising your feelings, it’s unlikely you’re going to speak up about feeling anxious.

However, being ‘high-functioning’ on the outside can have a serious impact on your mental and physical wellbeing. Instead of seeking support or treatment for anxiety, you may find yourself taking on too much work to keep up appearances or please others.

It can be isolating to keep difficult feelings to yourself, which can exacerbate feelings of depression. Some may turn to alcohol or substance abuse to cope with the hidden stress.

“Using a label like 'high functioning' – which can often appear to have positive connotations of high performance, high work output or resilience under pressure – can be damaging when it comes to the context of anxiety or depression at work,” says Eloise Skinner, a psychotherapist, career expert and author.

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“Although an external appearance of professional competency might be possible to sustain, it doesn't mean that the conditions themselves are resolved or mitigated,” she adds.

“In fact, presenting oneself as having little difficulty at work, or having no symptoms of anxiety or depression, can lead to a worsening of the situation over time, since the root causes are not dealt with.”

So why do people ‘mask’ or hide their feelings of anxiety at work? Although many employers now recognise how poor mental health can affect people at work, there may still be a degree of stigma surrounding anxiety or depression.

For some people, it can be difficult to separate the symptoms of high-functioning anxiety – like being high-achieving or detail-oriented – from who they feel they actually are. In other words, someone may not realise these attributes are driven by their own internal anxiety or fears.

It can also be difficult to tell others that you’re struggling if you’re used to people seeing your perfect exterior.

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“Individuals may feel it impacts their professional reputation, and may be concerned about performance metrics, consequences on professional growth – or even just an internal fear of not being able to complete work tasks to the usual standard,” says Skinner.

“Work may also provide an environment separate from home or personal life, and so there may be a reluctance to bring more individual or personal issues into the workplace.”

It can be difficult for people with high-functioning anxiety to seek help. However, it’s important to recognise any signs that you’re struggling, such as feeling overwhelmed, overthinking small things, having difficulty sleeping or feeling like your mind is racing.

Anxiety can lead to behavioural changes, like avoiding socialising or engaging in nervous habits like skin-picking. It’s also common for people with anxiety to have physical symptoms like stomach problems, tension headaches or general aches and pains.

If you’re struggling with anxiety, it’s important to speak to someone you trust – whether it’s a friend or a relative. Therapy is a good way to work through problems or worries, both past and present. It’s also important to take time off from work and to take regular breaks during the day – and employers should encourage this too.

Names have been changed to protect identities.

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