Sunday Scaries

What is high-functioning mental illness? Experts explain the difficult answer

“There is a gap between scientific knowledge and public understanding of this topic.”

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As Grimes coos, “girl, you know you’ve got to watch your health” a woman looks you dead in the eye and explains you might be displaying the “four hidden signs” of high-functioning anxiety.

This massively popular TikTok is one of many: Videos related to high-functioning anxiety have more than 113.3 million views on TikTok, while videos related to high-functioning depression have more than 47.1 million views.

Meanwhile, the mindfulness app Headspace offers to describe what it’s like to live with high-functioning anxiety, and the online mental health company Talkspace offers the same for high-functioning depression. Google search for both terms peaked this past year in February but has remained relatively steady. Most queries are looking for symptoms or a definition of the condition.

The issue is there’s not really an answer for those questions.

A number of TikTok users claim they can explain the “hidden signs” of high-functioning mental illness.

“There is a gap between scientific knowledge and public understanding of this topic,” Melanie Badali tells me. “As a clinical psychologist, I practice and promote science-based assessment and treatment of anxiety. ‘High-functioning anxiety’ is not a term that I use.”

For example, PubMed, which is comprised of more than 33 million citations for biomedical studies, doesn’t have any results for high-functioning anxiety or high-functioning depression (though there is one paper on the need for more research on how to support “high-functioning” people who have recovered from depression).

“Could professionals be missing a part of lived experience?”

However, “the fact that there is no research does not mean it does not exist or that it is not a topic worth studying,” Badali says.

“Could professionals be missing a part of lived experience?” she asks. “It is possible, but I think it is more likely that mental health professionals use different terms to describe the lived experiences people are labeling as ‘high-functioning anxiety.’”

While it could be that these terms are capturing something professionals are missing, Badali thinks it’s possible they are capturing the result of stigma. Conversations about mental health may be more accepted than ever, but that doesn’t mean identifying your own mental health needs is not a difficult process with its own hurdles.

Videos like “4 hidden signs you have high-functioning anxiety” describe high-achievers and people-pleasers — palatable phrases that side-step the difficult parts of anxiety.

“I think it might be easier for people to come to terms with the fact that they are experiencing an anxiety problem if it is also associated with being intelligent or highly accomplished,” Badali says.

What does “high-functioning” look like?

Despite the lack of study around high-functioning anxiety and depression, the phrasing “high-functioning” obviously still resonates with people who are coming to understand their mental health.

Dana Gionta, a psychologist and consultant, tells me that the term signals to her that a person is still able to do and maintain their everyday responsibilities and chores.

“Basically their to-do’s get done regularly and no one perceives any challenges in their everyday abilities and relationships,” Gionta says. “Oftentimes, the individual also may not realize they are experiencing some depression or anxiety, because it’s not impairing their daily functioning nor having a noticeable impact on their life or relationships.”

A key difference between perceptions around “high-functioning” and not, she explains, is consistency. If depression and anxiety are consistent, this can compromise a person’s “ability to be as consistent in their everyday performance, motivation, and energy levels, despite their intentions.”

The way we use words related to mental health is not necessarily harmonious to their many meanings. You can feel anxious or depressed without being clinically anxious or depressed. What often signals to a mental health professional that you’re experiencing something diagnosable is if symptoms are severe enough to interfere with everyday activities and relationships.

“Labels can be helpful, especially for research purposes. But labels can be harmful, too.”

For example, the American Psychiatric Association describes grief as something that comes in waves and major depressive disorder as experiencing symptoms like loss of energy and feeling worthless for at least two weeks.

But it’s possible that what you’re experiencing doesn’t match these categories. Research shows that mental health exists on a spectrum. And while official terms can help people identify an experience — dysthymia, for example, is technically a mild but long-lasting form of depression — this also helps explain why some people would be drawn to non-technical phrases like “high-functioning depression.”

What gives Badali some pause is the language used in this situation. If you look up high-functioning anxiety via Google Scholar, for example, what you will find are a number of studies on high-functioning autism. Badali explains that “there are numerous people in the autism community who are trying to stop the use of ‘functioning’ labels.” Arguments against functioning labels are many but include that they’re ableist and don’t tell the whole story.

“While I’m generally in favor of people using their own words to describe personal experiences, I am concerned that there are people who talk about high-functioning anxiety as though it is something that has been scientifically studied,” Badali says. “Labels can be helpful, especially for research purposes. But labels can be harmful, too.”

You may be a high-achieving people-pleaser, but you may also be experiencing anxiety — not high-functioning anxiety, but anxiety. If anxiety or depression are causing you distress, then it may be time to talk to a professional about your experiences rather than coping because you can.

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