The hidden struggles of high-functioning anxiety and depression
When we fall into the trap of over-identifying and self-diagnosis based on social media terms, it delays seeking help
Over the last 20 years, I have noticed a significant change in the language that clients use to describe their mental health struggles and inner world, and most importantly, how they carry it. I increasingly hear clients—young and old alike, and especially in the past eight years—use terms such as “high-functioning anxiety" and “high-functioning depression" to describe themselves during our initial conversations.
They talk about being perceived as individuals who are excellent at multi-tasking, managing personal and professional lives, and are seemingly happy with their lives, but their appearance doesn’t sync with how they are feeling. It’s this dissonance that contributes to an invisible suffering.
These clients say that neither their family nor their colleagues have an inkling of the distress they are experiencing. They feel that they are crumbling internally, struggling to sleep and feeling exhausted all the time.
Everything they do requires an effort and fails to evoke joy. I remember a client’s words: “I show up everywhere with a smile, no one can imagine how depleted I feel at the end of every day. It feels like I’m fooling everyone and myself, ignoring my unhappiness and exhaustion."
It’s important to remember that terms like “high-functioning anxiety" and “high-functioning depression" are not clinical diagnoses or part of the Diagnostic Statistical Manual of Mental Health (DSM), which mental health professionals use to understand mental health conditions. These terms are part of a language heavily shaped by digital media, and social and cultural trends that are attempting to name experiences which may not be fully captured or understood by existing clinical diagnoses.
Mental health conditions are now being understood as being on a continuum, influenced by variety of factors, both cultural and structural. Some of these oft-used labels have evolved from the movement away from clinical labels to phrases that are catchy yet misleading. As a therapist, my concern is that these terms inadvertently construct new hierarchies of suffering.
Labels like “high functioning" trivialise internal distress, imposing a false expectation that genuine pain must be visibly apparent to be valid. We are forgetting that often pain, grief and states of mental distress can co-exist with functionality.
We are moving away from a medical model and creating a new dichotomy by embracing these phrases. When people fall into the trap of over-identifying and of self-diagnosis, it takes them longer to seek help, and it minimises the person’s lived experience and personal distress.
Social and cultural trends shape the semantics of a society, and social media has become a linguistic amplifier.
In a world that constantly rewards productivity, the focus has shifted entirely to “doing" rather than “being". Our lives are often viewed through a performative lens, where external perception increasingly dictates our identity and actions. Phrases like “high functioning" reflect and unintentionally reinforce this mindset, promoting false beliefs about productivity, self-worth, and the nature of distress.
I’ve shifted my vocabulary to focus on how clients’ concerns are “masked", and I now attempt to understand their struggles through the lens of irrational beliefs that often lead them to minimise their own feelings.
Learning to remember that we need to understand, and seeing mental health through a lens of what’s life affirming for us rather than, reduce it to high-functioning and performance, is crucial.
Sonali Gupta is a Mumbai-based psychotherapist. She is the author of You Will be Alright: A Guide to Navigating Grief and has a YouTube channel, Mental Health with Sonali.
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