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High-Functioning Anxiety: How It Affects Teens and How To Help 

While anxiety is a serious issue for many teens, some may not get treatment or even a diagnosis for it when they should because they have high-functioning anxiety, which can go unnoticed. Their stress and mental health concerns are masked under so-called “good” behaviors or outcomes, such as strong academic performance. 

Here’s what you need to know about high-functioning anxiety in teenagers, including its tie to depression and how you can help. 

What Is High-Functioning Anxiety?  

While high-functioning anxiety is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, it’s nevertheless a real concern for many teens.  

With high-functioning anxiety, your teenager may earn high grades, excel in sports, and keep a very organized bedroom, which you and your teen’s teachers and peers may interpret as them having their life put together. But internally, they’re struggling with excessive stress, intrusive thoughts, or other symptoms of anxiety that can lead to greater mental health problems down the road. 

Signs of High-Functioning Anxiety  

“Teens with high-functioning anxiety have anxiety that they hide really, really well,” said Dr. Harry Gill, the medical director of the Embark Behavioral Health outpatient therapy clinic in Cabin John, Maryland. “Parents are unaware that the teen is actually in trouble. Unfortunately, if the teen hides the symptoms for too long, any coping mechanisms they’re using could stop working, and they could end up with depression or self-harm issues as well.” 

Gill added that parents tend to be surprised by these developments.  

“They’ll come in and say, ‘Everything was great with my teen, they were getting great grades, and then something happened. We don’t know what happened,’” he said. “In fact, the teen was probably showing telltale signs of high-functioning anxiety for years.” 

Positive signs  

According to Gill, high-functioning anxiety and anxious tendencies can drive teenagers to excel so they feel in control over their thoughts and worries. This can result in “positive” signs that mask the deeper mental health issues the teenager is facing. 

Positive signs include being: 

  • Successful.  
  • Punctual.  
  • Socially outgoing.   
  • Organized.   
  • Active, especially when it comes to extracurricular activities and sports.  

Negative signs  

Regarding negative signs, Gill said, “Parents should look for any sudden changes in social behaviors, such as withdrawal from friends, spending a lot of time in their bedroom, or too much engagement with digital screens.”  

Some of the most common negative signs your teen suffers from high-functioning anxiety include: 

  • Perfectionism.  
  • Procrastination.  
  • Being a people pleaser. 
  • Worrying.  
  • Abusing substances. 
  • Ruminating on thoughts
  • Seeking constant reassurance.  
  • Having anxious habits (e.g., nail-biting, tapping their foot, etc.).  
  • Being indecisive. 
  • Isolating from friends and family.  
  • Being constantly irritable, which Gill said is one of the most common signs he sees. 
  • Having difficulty concentrating. 
  • Being sensitive to criticism. 

Symptoms of High-Functioning Anxiety  

“Negative high-functioning anxiety symptoms in adolescents tend to be different from symptoms of anxiety in adults,” Gill said.  

Whereas an adult might walk into their psychologist’s office and say, “I’m dealing with a lot of anxiety,” Gill warned that many teens can’t even identify what anxiety means.  

“Thus, we look for external symptoms that a parent might see that might point to anxiety, like increasing stomach pain, dizziness, or nausea,” he said.  

Other high-functioning anxiety symptoms include: 

  • Sleep issues (e.g., having trouble getting to or staying asleep).  
  • Fatigue.   
  • Headaches.  
  • Panic attacks.  
  • Racing thoughts.  
  • Hypervigilance (i.e., increased alertness to potential danger). 
  • Multiple mental health issues at the same time.
  • Restless leg syndrome.  

High-functioning anxiety and depression  

As mentioned earlier, an anxious teenager could become a depressed teenager

“The ongoing experience of anxiety and living under a sense of high pressure begins to feel overwhelming to teens, and eventually it begins to feel like the teen cannot be successful,” Gill said. “That can lead to depression.” 

The connection between high-functioning anxiety and depression points to the importance of helping your teen manage their symptoms sooner than later. 

“Oftentimes, suicidal ideation, which is a symptom of depression, begins as a result of very severe anxiety that went unnoticed,” he said. 

Causes of High-Functioning Anxiety 

There are several causes of high-functioning anxiety. Sometimes, it can be due to social or familial pressure.  

“A lot of teens, particularly in families that are high pressure and performance driven, internalize that pressure to perform and begin to develop stress-related anxiety symptoms,” Gill explained.  

But, he said, there are often other factors at stake, such as trauma, extremely stressful life events, and medical issues.  

Family history of mental health conditions  

One risk factor is a history of anxiety or other mental health conditions in biological family members. In fact, UNC Health’s psychiatric epidemiologist Anna Bauer has noted that anxiety is thought to be about 30% inherited. 

Trauma  

“In what we see in our practice, there’s an awful lot of trauma — 80% of children and teens who we see have had trauma,” Gill said. “Very frequently, middle school bullying is a common source of the trauma, which leads to anxiety issues.”  

Extremely stressful life events  

According to Gill, stressful life events that could cause high-functioning anxiety include parental conflict and divorces. 

Medical issues  

“Sometimes, complex medical issues in a teen’s early development can create states of anxiety and insecurity,” Gill said. “In some cases, there are teens who needed a lot of surgeries or who were born with various genetic syndromes. For example, teenagers on the autism spectrum can feel very, very anxious.” 

How To Help Your Teen Deal With High-Functioning Anxiety  

When it comes to how to cope with high-functioning anxiety, Gill said teens need to learn how to reduce stress and deal with the stressors of everyday life instead of focusing on external performance and seeking “positive” actions or outcomes. 

“One of the really important things, and it’s clearly effective, is reducing stimulation,” Gill said. “Mere overstimulation of a teen, and social media in particular, can trigger anxiety. One of the most common interventions that we do in our program is a drastic reduction in social media. Reduce social media exposure to two to three hours per day and in the context of family time rather than just in their bedroom alone.” 

Beyond that, Gill suggested six specific ways for how to cope with high-functioning anxiety. The most important application for all of them, he said, is to make them joint activities between you and your child. 

“Teens still need adult modeling and the experience of how to interact with the world,” he said. “For example, if you want them to prioritize healthy eating as an anxiety-coping mechanism, engage with them and cook a meal together.” 

  1. Practice mindfulness: Based on an analysis of 18 studies, a report in the Behaviour Research and Therapy journal found that mindfulness can benefit people who have anxiety. Teens with high-functioning anxiety often rush to perform, rather than tune in to their thoughts and stress levels. Mindfulness, even if it’s taking a deep-breathing break during a high-stress period, can help them check in with their inner psyche. 
  1. Eat a healthy diet: Gill noted that teens are notoriously bad at maintaining a healthy diet. According to research published in the journal Nutrients, there’s a correlation between higher levels of anxiety and diets that are high in sugar, refined carbohydrates, and fat. If you want to help your teen, encourage them to adopt healthy nutrition habits that could help address their high-functioning anxiety.  
  1. Prioritize sleep: Because the amount of sleep people get can affect how they feel not only physically but also emotionally, your teen’s sleep habits are important. According to the Centers for Disease Control and Prevention, teenagers ages 13-18 should get eight to 10 hours of sleep per night. If your teen is falling short of that, help them improve their nightly rest by encouraging them to maintain a regular sleep schedule, reduce screen use before bed, and eliminate afternoon and evening caffeine. 
  1. Exercise daily: Exercise can help significantly reduce anxiety symptoms and protect against anxiety disorders, according to a study in the Advances in Experimental Medicine and Biology. Yet statistics published in the International Journal of Behavioral Nutrition and Physical Activity found that most adolescents don’t get enough physical activity. Encourage your teen to get up and move between homework sessions or before meals. 
  1. Lean on their support networks: Teens may feel like they have to figure out life alone. “One of the major sources of anxiety in teens is the developmental step of separation, of individualization,” Gill explained. “From age 16 through 17 or 18, they have to figure out how to be adults. It’s terrifying, and it creates a lot of anxiety.” Check in with your teen often, and encourage them to talk to peers and other adult role models (e.g., coaches, teachers, and religious leaders) about questions and concerns they have during this coming-of-age season. 
  1. Engage in positive self-talk: Anxious teens often beat themselves up, Gill said. For example, a high-functioning teen may engage in catastrophizing (e.g., a freshman might think, “If I fail this test, I’ll never be able to apply to college”). Encourage your teen to notice the thoughts they have and then ground them in facts and positive self-talk (e.g., “I’ll do my best with this test, and college is still few years away”). 

How To Treat High-Functioning Anxiety 

Teens may not be self-aware enough to recognize they’re anxious, so Gill recommended contacting a mental health professional if you notice any significant behavioral changes and external symptoms of high-functioning anxiety in your child. This person can assess your teenager, make a diagnosis, and develop a treatment plan.  

A mental health professional who knows how to treat high-functioning anxiety can help your teen work through their feelings and become more intuitive about their stress, fears, and traumas. Therapy approaches they may use with your child include relational/attachment therapy, experiential therapy, family therapy, cognitive behavioral therapy, and dialectical behavior therapy.  

Relational/attachment therapy  

Relational therapy helps teens improve their relationships with key people in their lives, while attachment therapy focuses on creating healthy, nurturing, secure relationships between a teen and parent.  

Experiential therapy   

Experiential therapy uses tools like role-playing and making crafts to help teens re-experience situations that trigger their anxiety. This gives them a deeper understanding of how they react to stressful events and how they can better approach them in the future.  

“We do a lot of experiential therapy as part of the Embark programming because it’s a great way of engaging teens,” Gill said. “It’s also a great way to help them engage with each other. That’s important because one of the consequences of anxiety is social isolation and eventual challenges with interacting socially.” 

Family therapy 

Family counseling helps teens and their family members improve communication with each other. It also provides support for each person involved in the family treatment group. 

Cognitive behavioral therapy (CBT)  

CBT helps teens identify harmful thought patterns and teaches them how to replace those patterns with more positive ones to boost their self-esteem. 

“CBT is very, very useful for teenagers,” Gill said. He explained that it’s helpful for youths with high-functioning anxiety for three reasons: 

  • It will help your teen with their emotional regulation and coping mechanisms, specifically as it relates to negative or inaccurate thinking.  
  • It will help them understand their anxiety and how they may be experiencing it. 
  • It empowers them with specific problem-solving skills to face stressful situations or difficult, intrusive thoughts. 

If your teen has experienced trauma, trauma-focused CBT (TF-CBT) may be helpful, as it will guide them through the healing process in the aftermath of a traumatic experience. 

Dialectical behavior therapy (DBT)  

DBT is a type of CBT, and both are grouped under the umbrella of didactic therapy. Similar to CBT, it equips your teen with problem-solving skills so they can better navigate the stresses and situations of being a teen.  

However, while CBT emphasizes changing negative thoughts, DBT emphasizes learning to accept your thoughts and also puts a greater focus on interpersonal skills, which can be helpful for teens with high-functioning anxiety who struggle with social situations.  

“When it comes to the more didactic therapies like DBT and CBT, teens respond to them better than interpersonal therapy and other open-ended therapies,” Gill said. “Teens really seem to take to it.”  

High-Functioning Anxiety: Wrapup  

While high-functioning anxiety in teens is not a clinical diagnosis, it’s nevertheless a real and difficult mental health issue for many teenagers.   

“Very bright, high-performing teens who are highly anxious can do well for a long time, but at some point, they can break down, which can result in deeper issues like depression,” Gill said.  

By watching for the signs and symptoms associated with high-functioning anxiety and taking steps to address it, you can help your teenager navigate life’s challenges in a healthy way so they can be successful without anxiety being the driving force behind their success. 

Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!  

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Embark Behavioral Health

Embark Behavioral Health is a leading network of outpatient centers and residential programs offering premier mental health treatment for preteens, teens, and young adults. Dedicated to its mission of reversing the trends of teen and young adult anxiety, depression, and suicide by 2028, Embark offers a robust continuum of care with different levels of service and programming; has a deep legacy of over 25 years serving youths; works with families to adjust treatment in real time to improve results; treats the entire family using an evidence-based approach; and offers the highest levels of quality care and safety standards. For more information about Embark or its treatment programs, including virtual counseling, intensive outpatient programs (IOPs), therapeutic day treatment programs, also known as partial hospitalization programs (PHPs), short-term residential treatment, wilderness therapy, and long-term residential treatment, visit www.embarkbh.com.