Living with High Functioning Anxiety (HFA)

Last year, as part of our companies drive to destigmatise mental health issues, I decided to lead from the front and write up 'my story' regarding mental health and how it affects me, focusing on my ongoing battle with HFA. This story is part of a group of stories now that we have on our mental health and wellbeing site to encourage others to come forward and discuss their own stories and not be afraid to do so. I hope you find it useful.

The best way I can explain my mental health challenge (and often a severe battle) that I have lived with as far back as I remember is ‘pained by inaction’. It sounds somewhat dramatic, I know, but I have tried to understand and manage this from a very early age and can remember past times with crystal clear clarity where it has ground me down and drove me to very low points.

I often visualise the issue as a separate part of me, a different person almost, that tries to take control and has regrettably sometimes succeeded.

A few years ago, I needed some time off work to finally try to get a handle on the situation. I reached out to work with a few different specialists (including the head councillor through Mental Health First Aid Wales, Jan Channing – this is part of our ERP programme, and I recommend it!) to help me come to terms with the situation and identify the condition for what it is. I had always just thought I was highly strung and uptight, but it has a name, High Functioning Anxiety (HFA), and once I had named it, it immediately became far more manageable.

HFA is not a recognised mental health diagnosis for those who don't know. Instead, it's evolved as a catch-all term that refers to people who live with (sometimes very severe) anxiety but identify themselves as functioning reasonably well in different aspects of their lives. Others also identify the individual as seeming functional and don’t notice anything amiss. And therein really lies the problem as many of the behaviours of HFA are positive behaviours, lauded in the workplace and beyond. However, the critical problem with HFA is the moderation of those behaviours. Without proper controls and awareness, the behaviours can often reach extremes that become crippling, something I know very well.

Like any other mental health challenge, those who suffer from HFA can find it debilitating and it’s important to discern the difference between HFA and regular situational anxiety which is perfectly normal, and we all feel that from time to time when something is challenging or scary.

The way I think of HFA (and this is very much just my own layman’s opinion) is not anxiety that prevents you from doing something; in fact, it’s the complete opposite; it forces you to do something and then not know when to stop.

Very Well Mind explains HFA as:

The Characteristics of High-Functioning Anxiety (verywellmind.com)

‘Someone with high functioning anxiety may be the picture of success to others. You might arrive to work earlier than everyone else, impeccably dressed, with your hair neatly styled. Co-workers may say you are driven in your work - you've never missed a deadline or fallen short in each task. Not only that, but you're also always willing to help others when asked. What others might not know (and what you would never share) is that beneath the surface of a seemingly perfect exterior, you're fighting a constant churn of anxiety. It may have been nervous energy, fear of failure, and being afraid of disappointing others that have driven you to success.’

Characteristics of people with high functioning anxiety that are often thought of as positive include:

• Outgoing personality (happy, tells jokes, smiles, laughs)
• Punctual (arrive early for appointments)
• Proactive (plan ahead for all possibilities)
• Organised (make lists or keep calendars)
• High achieving
• Detail-oriented
• Orderly and tidy
• Active
• Helpful
• Appears outwardly calm and collected
• Passionate
• Loyal in relationships

I suppose it’s pretty sad to admit that I do not remember the last time that I was able to switch off and do nothing or think of nothing. I mentioned above that it feels like I am ‘pained by inaction’, and I genuinely meant it. It is both mentally and physically painful for me to have nothing to do, and the outcome can be anything from benign nervous energy outbursts to crippling migraines and chest pains which can take me out of the game for long periods of time.

I have therefore become proficient in finding something to do and keeping active, much to the amusement and recurring irritation of my family and friends.

HFA does have its side effects when taken to the extreme, many of which I have run afoul of, such as:

Burnout – The obvious and inevitable outcome of being constantly switched on. I am aware of three periods of my life so far that I can point to retrospectively and know that the complete crash I found myself in was, in fact, total burnout. Each time it’s taken a month or more to get over the crash, it results in severe flu-like symptoms with continuous migraines and lethargy.

Weight loss is also guaranteed due to eating incorrectly. Bad depression often lasts for weeks/months afterwards and can send me into a downward spiral.

Orderliness - I am incredibly fussy about tidiness and orderliness, and people have often joked that I seem to really enjoy cleaning. They are right; I really do enjoy it, but not because cleaning itself makes me happy; it’s the act of cleaning that is therapeutic to me. It’s hard to explain, but I feel mentally relieved when something is ordered or cleaned, as if a massive weight has been lifted off my mind, allowing me to take back some thinking space. It doesn’t make a difference what form this takes and could be something as simple as a stack of towels that need folding, taking a few moments of my time, to complex data management problems that take weeks/months to solve.

*Please note that these behaviours are not obsessive-compulsive disorder (OCD), which is a diagnosed and often life changing/debilitating mental health condition. People have said to my face that ‘I am a bit OCD’, and I have said this myself in the past about others and myself, but OCD is a severe condition that can ruin lives if not treated correctly. Let’s all stop using this term as a blanket for everyone that is tidy or orderly!

Planning and control - The need to plan and control things is overwhelming for me at times and is a compulsion that I am constantly fighting against. If given a chance, I will create a plan, then create another strategy on how to implement that plan, and round this all off with a few backup plans just in case I can’t implement plan A-C. When I have been forced to take a step back and review this compulsion by others, I can see where it can become dysfunctional, so I try to surround myself with people who are aware of this urge and will step in and give me honest feedback if needed.

Much to the amusement of a few professionals that I have spoken with in the past, despite this need for control, I weirdly don’t have an issue with change and, by and large, run towards it. This has always confused me and seems to fly in the face of my need for planning and control!

The best way I have found of tackling HFA is to surround myself with people who are truthful and will tackle my thought process/actions. Oh, and I married someone who is the opposite of me in most ways, which is a challenge and a blessing. Those of you who have done the same will probably relate to this!

I hope this helps shed some light on HFA and my own personal battle. Sometimes I win, sometimes I lose, but one thing I have found that helps more than anything is, to be honest, and open about it. There is nothing more complicated than the human brain and we are all different so letting your friends, colleagues and family know about your own mental health issues provide massive support and helps destigmatise mental health.