How to Handle High Functioning Anxiety in Medical School

I came across an interesting term on Instagram, and decided a post on how to handle high functioning anxiety in medical school was a necessary topic. This video resonated with me because I felt like it described me to a tee.

Considering I’m surrounded by type A individuals, I know I’m not the only one struggling with high functioning anxiety. I think, though, that people don’t know what it is, so they don’t really know how to handle it. That’s okay, because working through my thoughts is a daily effort. I have come up with practices and coping skills that keep me level, and I want to share them with you.

What is high functioning anxiety?

High functioning anxiety is an unofficial term. You can’t go and be diagnosed with it, and honestly it may just be a made up term. However, the parameters of high functioning anxiety may accurately describe what some of you are feeling, because it definitely helped me put things in perspective. If you feel like you’re able to function just fine, but at the same time you just feel anxious or uneasy about everything you’re doing, you may be similar to me.

Definition

According to Very Well Mind, someone with high functioning anxiety lives with anxiety, but they are propelled by their anxiety, rather than paralyzed by it. So, for someone with an anxiety disorder as outlined in the DSM, their anxiety may be debilitating. They can’t take exams because their test anxiety is so bad. Or maybe they despise public speaking and get sick if they have to do it.

Signs of high functioning anxiety

High functioning anxious people thrive off their anxiety. On the outside, you are put together, organized, and confident. However, on the inside the wheels won’t stop churning. You overthink everything and your rumination can be disruptive. But, you know that a way to calm your anxiety is by doing something, so therefore you go and achieve something, and that settles your anxiety for a while. Until something else triggers it, then you are on the quest to find something else to calm these feelings.

You may also feel very unsure of yourself, even though you constantly succeed. Others may perceive this as being humble or deceptively self-doubting, but you truly believe those insecurities.

High functioning anxiety can be driven by many things, including a fear of failure, a desire to seem perfect or be a people pleaser. Maybe there is this desire for control, but this fear that that control will disappear in a moment. Some other signs of someone with high functioning anxiety include:

• Nervous chatter/afraid of silence
• Super busy social schedule
• Inability to say no – which causes an overloaded schedule
• Need for reassurance
• Rumination
• Procrastination followed by long periods of cramming
• Insomnia
• Racing mind
• Inability to enjoy the moment

These are just a few of the signs you can find on the Very Well Mind website that outlines what a high functioning anxious person looks like. If any of these sound familiar, then we have something in common.

Having high functioning anxiety in medical school

Having anxiety in medical school is pretty common. The tests are hard and everything is so uncertain, that it is hard to live life comfortably. In fact, if anyone is comfortable in medical school, they probably are cheating…or failing (and don’t care). Very few of my classmates are relaxed, and to those that are…what is the secret???

Having high functioning anxiety in medical school can be both a detriment and an advantage. The positive, is that I am motivated by my anxiety of failing. I know that science is not my strong suit and that I much more enjoy the clinical/social aspect of medicine. I want to be a doctor because I enjoy helping patients, not because I’m crazy over science. Therefore, I hold a lot of internal doubt about my ability to handle the course material, especially when I watch the mastery of some of my classmates.

Getting into medical school was such a difficult road, that I felt like I barely slipped in. And now that I’m thinking about residency and trying to put together a fantastic application as early as possible, I can’t help but be overwhelmed by the uncertainty of my future. It’s hard to stay in the moment, because I’m always thinking about the future implications of everything I’m doing.

I’m so addicted to the future and succeeding, that I skip right over the present. Or I move on to different ideas before I’ve even given certain ones a chance to flourish. I’ve had to develop practices to help tone down the rumination and increase my self confidence that I would like to share with you.

Below are some tips on how to handle high functioning anxiety in medical school.

Protect your free time and me time

The most important way to handle high functioning anxiety is to protect your free time and me time. Doing nothing is doing something. It is taking time to do what you want to do. If that is laying down and doing nothing, then that is your choice. If you decide to take yourself to a movie, that is your choice. Those with high functioning anxiety don’t have a lot of free time. Our schedules are so packed, that our time really is money, because we could be doing so many things with it.

Therefore, those gaps in your planner, keep them. In fact, when you make your schedule, include them as a permanent marker, cannot be moved appointment. Free time or me time has the same priority as all of your obligations, because free time and me time is an obligation. If someone texts you and asks you to do something during that time, do not feel obligated to give them that time. Before you respond, really evaluate if they are worth those precious minutes; worth sacrificing your me time for. If the answer is no, then respond with you have a prior engagement, and you’ll have to reschedule.

This will feel hard and suck. You may even spend your me time feeling bad or wondering what they think of you. But at the end of the day, other people’s opinions of you is none of your business. Accept that you put yourself first because you needed the time, and that other person will be fine. Even if they ask for help, and you truly just don’t have the bandwidth for them, it’s okay to say no. Be okay with saying no and not regretting it. At the end of the day, what would they do if they didn’t know you? (My parents’ favorite question.)

Practice being mindful in your everyday activities

Another helpful tip on how to handle high functioning anxiety in medical school is to practice being mindful. I write a lot about mindfulness, and in fact, Octate Wellness is all about mindful wellness. How can we connect with the present in order to preserve ourselves for the future?

Mindfulness is a practice of staying in the moment. Mentally, we can train our brains to be better at focusing on the now by practicing mindfulness. One way is to practice mindful meditations. However, if you don’t think you have time, or meditating isn’t for you, then you can be mindful In your other activities. You can be practice mindfulness while eating or driving.

Keep your mind engaged on what you’re doing, how things feel, what you see. If you feel your mind wander, simply bring it back to what you’re doing. It’s natural for your mind to run around and get stuck on a certain thought. However, in order to handle high functioning anxiety, you have to gain control over rogue thoughts that take over your brain for minutes or hours at a time.

Start with just 30 seconds of mindfulness at a time. The more you do it, the longer you’ll be able to stay focused, just like running. Your brain is a muscle, so it takes exercise to build its endurance. Practice mindfulness in different contexts such as being in a meeting or engaging in a conversation with someone. Coach yourself to stay focused on what you’re doing, without the judgement whenever your brain wanders off. Continue this practice and watch how less anxious you feel and how much more you can enjoy when you stay in the moment.

Create reasonable action plans and then follow through

My number one way that I handle high functioning anxiety in medical school is coming up with action plans. However, I struggle the most with following through. It’s like I plant all of these seeds in different gardens, but don’t water them, and then wonder why none of them are sprouting. As a person with high functioning anxiety, it’s easy to confuse productivity and being busy. Just because you have no gaps in your schedule, are you actually getting things done?

This is why action plans are so important. Action plans are a step-by-step layout of everything you need to get done to achieve a goal. This can be something daily that you put in your planner, or something that takes place over a long time, and you create a plan that you keep in a journal or something. I find, that by taking it out of my brain and writing it down somewhere I can see it, the rumination over it stops. Now, I have a clear visual to-do list, and all I have to do is follow each step until I get to the end.

I actually have large poster boards on my wall of several large projects and everything I need to do to accomplish them. Even though it takes a long time for some tasks to receive check marks, they are no longer floating thoughts taking up space in my brain. I also have actionable items to arrive at my end point, subduing my fear or anxiety of not actually accomplishing anything.

Reevaluate your measures of success

Having high functioning anxiety in medical school is hard because everyone around you is great. Therefore, relative success may tell you that you’re a failure because you didn’t do well on a medical school exam compared to your classmates. And not that anyone likes to be at the bottom, but being in the bottom 1/2 of a medical school class still puts you in the top 10% compared to the general population. Having these intense standards of success, though, can really sabotage how well you’re actually doing.

My mom and I had a conversation about all my business ventures, and I told her I’m so addicted to success, I feel like a crackhead chasing around anything that I think will get me there. And she had to put it in perspective that I’m in medical school. It’s okay if I don’t start a million dollar business right this second. That doesn’t make me unsuccessful. I’m doing what I need to be doing right now and that is being a medical student. If I don’t accomplish that, then I won’t be able to have the long-term impact on patients and other future Black doctors like I want to.

If you find yourself doubting and fishing for reassurance because you’re insecure in your ability to succeed, it may be time to reevaluate what you consider success. Your measure of success should be determined by your goals and what will help you move forward. It cannot be based on how others are doing compared to you. That is ever changing and focuses on things that have nothing to do with you. Once you’ve determined your own standard for success, it shouldn’t change until you’ve reached that level and are ready to move on to the next.

Accept people and their words for face value

Another issue I have, and I’m sure many of you reading this have as well, is a problem with taking people at face value. We always have this thought of “I hear what you’re saying, but I don’t believe that you mean that.” Then we begin this cycle of “What did they really mean? Oh no have I done something? Are they mad at me? What’s happening next?”

We work ourselves up, mean while the other person probably has no clue that we are obsessed over what they think about us. Then begins the people pleasing because we want to be liked, and the overscheduling because we want to be seen as dependable.

At the end of the day, we have to accept people and their words for face value. If someone tells us something or does something, the easiest thing is to take it for what it is. If someone says they are fine, then we should believe that they are fine. When someone tells us they like or didn’t like something we did, then that is how we should take it. If someone tells you something is okay, then there is no need to worry ourselves to death if they really felt like it was okay.

At the end of the day, we are all adults, and it is the responsibility of those who you are talking to to be honest with you. Now of course, you shouldn’t take anything without a healthy level of skepticism, however, going back and forth about whether or not something is true isn’t healthy for you either. I believe that everything done in the dark will soon come to light. Therefore, I watch and wait for something that someone said to show itself to be untrue. If it never does, then I go on about my day. If it does, then I deal with it in that moment and move on.

Either way, I don’t have time to go in circles about whether or not someone meant something one way or how they are truly feeling. If they wanted me to know, they would tell me. And by having this mindset, I have improved at letting things go and moving on.

Give yourself rumination time

Ruminating is inevitable, especially for someone with any time of anxiety. However, ruminating also takes so much time. In medical school, no one has time for all of that overthinking and back and forth. It’s futile, and hardly ever productive. But it’s so addicting to sit there and think about something until you’ve worked out every little detail.

Set aside rumination or worry time. Dedicated this time in your schedule to thinking about the things that both you. When you set aside this time, you can be mindful about overthinking. And then, when your time is up, you can go back to being mindful about working, studying or whatever else you were doing before you started overthinking.

If it is helpful, put ruminating time in your schedule and set a timer. When the time goes off, then the ruminating time is over, and it is time to go back to what you were doing. It is going to be so difficult to stop ruminating when that timer goes off, but this is when self-discipline comes into play. You have to increase the control you have over your mind, because then you can stop letting the outside world control you.

Talk to someone

Anxiety is a mental health disorder. Even if you are not someone who meets a diagnostic criteria because your high functioning anxiety is not debilitating or harmful to you or anyone else in your life, you still exhibit some form of anxiety. An effective way to handle high functioning anxiety in medical school is to talk to someone. This person can be a mentor or a licensed therapist/counselor. Talking to someone, however, is a way to get it out of your brain and out to someone else. Not only can you unload the mental weight that has been holding you back, you may even get some perspective on the things you’ve been worrying about.

Having high functioning anxiety may sound like a not-so-bad-thing because we get things done. However, we are at high risk for burnout and a manifestation of a debilitating depression or anxiety. If our entire purpose is rooted in succeeding, then what happens to us if we fail? Without those proper coping skills, then failure may feel lik e smacking into the concrete instead of dropping down to a trampoline. Regardless of how high functioning you are, it’s important to find ways to decompress and reign in the brain. I hope these tips helped and I would love to hear about how you are dealing with your high functioning anxiety in the comments below!

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