High Functioning Anxiety

High functioning anxiety is a mental health condition in which the affected persons experience the symptoms of an anxiety disorder but appear to function well in social settings, work related tasks, etc. 

There is no definition for high functioning anxiety, as it is not an officially recognized condition. High functioning anxiety is not a disorder and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), yet it can prove to be very harmful for one’s health. 

People with high functioning anxiety may not seem as though they are struggling externally, but internally, they go through a lot of turmoil and anxiety reactions. Some people may say that they have this condition, however, it can be difficult to diagnose as the characteristics between those with Type A personality and those with high functioning anxiety are quite similar. People with high functioning anxiety, in most cases, tend to have self-esteem issues yet seemingly do well in life. Hence, on the surface, they may appear as though they are growing, flourishing and thriving. But the truth is, they don’t feel as healthy or at peace on the inside. Their anxiety can rise to crippling levels and make them experience intense feelings of impending doom, anxiety, rapid heart-rate, gastrointestinal distress, fear and hopelessness. 

Signs of High Functioning Anxiety

Anyone with high functioning anxiety would seem to be your typical overachiever, a charming go-getter, or in simple terms, an incredibly successful person, or whatever you may like to call them. You may think they have it all together, but in reality, their achievements or performances don’t make them feel better. They do negative self-talk and beat themselves up over not living up to their ideals and not being “good enough.” 

High functioning anxiety, unlike the classified anxiety disorders, doesn’t produce any severe physical symptoms. When anxiety rises to a peak, people suffering from high functioning anxiety do experience some physical symptoms, yet they aren’t intense enough to restrict daily functioning or for outsiders to notice them. This condition can be compared to generalized anxiety disorder (GAD) given its vague nature, and at the same time, some overlaps can be seen in the symptoms produced by other disorders and high functioning anxiety as well. 

The signs and symptoms of high functioning anxiety include: 

  • Worries and feelings of anxiety, inability to relax 
  • Overthinking and overanalyzing events, second-guessing recently made decisions
  • Anticipatory anxiety before a new event or encounter
  • Obsessive fear of failure and negative judgement of others
  • Perfectionism: This involves consistent feelings of dissatisfaction with performance at work and other areas
  • Workaholism: This involves the need to constantly keep producing output and working constantly, even when at home
  • Problems with maintaining a consistent healthy sleep pattern, periodic insomnia
  • False optimistic disposition expressed publicly that conflicts with the actual pessimistic thinking patterns
  • Difficulty saying no regardless of the difficult demands of the task proposed
  • Unconscious nervous habits like hair pulling, biting nails, etc.
  • Low self esteem and self confidence
  • Unrealistic goals and expectations from self and others 

Positive and Negative Characteristics of High Functioning Anxiety

The positive signs of high functioning anxiety, that may make the individual suffering from it appear normal and in fact functioning on an elevated level (hence the term, “high functioning”), are numerous. People with high functioning anxiety are actually able to channel it to achieve success in life, however their anxiety is overwhelmingly crippling and does affect them internally. They appear awkwardly calm in public and are over-achievers in their lives. They have extroverted personalities and are quite helpful and passionate beings. They are often overly organized and keep to-do lists, calendars and schedules and are detail-oriented individuals. 

However, the negative characteristics do outweigh the positive qualities. Despite their armour of perfectionism and idealism, they constantly fight crushing feelings of anxiety and the fear of disappointing others, and themselves. They’re persistently burdened with a sense of all-consuming nervousness. They may try to evaluate themselves with their achievements, but in real life, they are simply not doing as well as they seem.

They tend to be people pleasers with a crippling inability to say no, and have a need for being reassured and validated by others all the time. They have overloaded schedules and are busy all the time. As a result, they are physically fatigued and mentally burnt out, and have racing thoughts all the time. They overthink situations. They feel they fall short of their and others expectations all the time and keep comparing themselves to others. They talk a lot and indulge in nervous chatter. They tend to procrastinate, as well and then do a lot of work in short bursts which leads to stress. 


The exact cause of high functioning anxiety cannot be pinpointed, however some risk factors are involved that can lead to the development of this problem. Type A personalities seem to be prone to developing high functioning anxiety as well. The risk factors are as follows:

  • Demanding and critical parents
  • Shyness during early childhood
  • Witnessing traumatic events, or experiencing them
  • Childhood abuse
  • History of anxiety disorders in the family
  • Personal history of depression
  • Stressful work or jobs
  • Financial and legal problems
  • Burn out

The roots of high functioning anxiety can be found in the childhood experiences and personality traits developed during childhood of the person suffering from this condition. They generally don’t respond to external stressors but instead experience symptoms related to internal stressors. 

Complications of High Functioning Anxiety and Co-Occurring Disorders

Chronic anxiety leaves intensely negative and long term impact on the health (mental and physical) of the person suffering from it. At the same time, there are many overlaps between other mental illnesses and high functioning anxiety. 

Depression co-occurs with high functioning anxiety in most people suffering from the latter. People suffering from high functioning anxiety are also prone to alcohol abuse and substance abuse as an unhealthy way to cope. For the people who have already developed such a condition, the treatment takes place at an addiction treatment facility. 

And due to low self esteem and low self confidence, people with high functioning anxiety often show overlaps with eating disorders

Some of the chronic illnesses that can be linked to high functioning anxiety as well, and they are as follows:

  • Cardiovascular diseases
  • Irritable Bowel Syndrome
  • Chronic Obstructive Pulmonary disease
  • Asthma
  • Stroke

Treatment for High Functioning Anxiety at Incontact

The treatment for high functioning anxiety involves mostly eclectic psychotherapy approaches. This could include cognitive behavioural therapy, systemic therapy, eye movement desensitization and reprocessing therapy,  an overall eclectic based approach. The treatment for high functioning anxiety generally tends to pinpoint the roots of this anxiety which typically stems from self deprecating perception of oneself. Through therapy we assist you to develop more awareness of yourself and overall encourage behavioural changes that could be contributing to high functioning anxiety

Medication can also be prescribed for the purpose of reducing anxiety related symptoms. This can include intake of antidepressants i.e selective serotonin reuptake inhibitors, and/or benzodiazepines which is an anti anxiety medication.

At Incontact, we work based on a philosophy that everyone is unique and requires a distinct therapeutic touch to their treatment. This helps us create a plan well suited to your needs. 

Anxiety in Children

Anxiety is a biological phenomena that happens as a response to stress. It is a natural emotion that is guided by a feeling of fear or apprehension about what is to come added with physical signs such as, rapid heart rate, sweating, or feeling tired. Children too, just like adults, feel worried and anxious at times. 

Children can feel anxious about several things at different ages, a lot of these fears of triggers are a normal part of growing up and often go away with time. However, anxiety might get the best of them if it starts to interfere with their daily routine. If you were to go to a school on an exam day, you would likely find all the kids to be anxious, but some might be bothered enough to not even show up for the test. Also depending upon their age, children have varied ability to understand or explain their anxiety. 

Anxiety may be deeply rooted in children due to blend of various reasons including:

  • Biological factors, such as genes or even brain wiring
  • Psychological factors, such as coping mechanisms or temperament issues
  • Environmental factors, such as anxious parenting or sometimes even traumatic early childhood experiences

Types of anxiety in children and how it affects them 

Some children naturally tend to be affected by anxiety and be worried more than others. One of the most common causes of anxiety in kids is when affected by change and they might get anxious following a change of place, or if starting a new school. Childrens get worried, or feel sad about things from time to time about various things. But if they fail to outgrow these fears that occur when they are young, they may be diagnosed with anxiety disorders. 

Certain types of anxieties that are common in children are as follows:

  • Generalized anxiety: Also referred to as GAD, is often diagnosed when kids worry excessively about a broad range of things like, what might happen, or about their own past experiences and behaviour, how good they are academically or how popular they are. Often lacking confidence and needing loads of reassurance.
  • Separation anxiety: Anxiety in kids is usually observed in toddlers or young children. They get upset and extremely anxious when parted from parents or objects of affection they tend to keep at close proximity. Refusing to attend sleepovers, or school, worrying that bad things might happen to loved ones when away.
  • Social anxiety: Intense fear of social situations, being extremely anxious and self-conscious while around others, worrying about being judged or having to face humiliation.
  • Specific phobias: Severe fear set off by a specific situation or a thing, often irrational in nature, such as flying cockroaches, or insects in general, loud thundering, or even other kids in general.

Symptoms for anxiety in Kids

Children come up with their own ways to deal with anxiety and strategies for managing stress which usually is to avoid these situations or letting a parent handle it for them. While these can work in the short term scheme of things, avoiding it often leads to it getting more difficult for them to handle the next time they have to face similar situations which might cause them even greater amount of discomfort. Anxiety can cause several physical symptoms such as, sleeplessness, diarrhea, stomach aches, headaches, irritability, difficulty concentrating or tiredness.

When children feel anxious, they cannot always understand or express what they are feeling. However, the following are a few general signs and symptoms of anxiety in kids:

  • If they are seeking reassurance very often
  • If they tend to avoid social situations and feel worried or scared about it
  • If they try to get others to do things that they are worried about
  • If they tell you they have physical pains without any signs of injury as such
  • If they seem more disinterested than usual and have lots of fears
  • If they tend to get upset easily and cling on to a loved one
  • If they always see the negative side of things instead of taking risks

Causes of anxiety in Kids 

More often than not, children tend to feel anxious and stressed out over various issues and such worries are a normal part and parcel of their lives. But, this kind of anxiety can get out of hand and might affect their development negatively. 

A child of ages 2-3 will stop feeling anxious over brief periods of separation from parents, however, if this kind of anxiety follows up to the ages of 6-7, it may be a condition called separation anxiety. This anxiety is developmentally inappropriate, and thus your child may require treatment and a behavioural plan. Other reasons could be underlying mental or physical health concerns such as ADHD, autism spectrum disorder, learning disabilities, etc. Preschool age children also tend to develop specific fears or phobias, and while these phobias go away as children grow up, in some cases they don’t. Situational and environmental factors are also an important consideration when we talk about the causes of anxiety in kids. Often, drastic changes in environment, or during the time when exams are being conducted, or in social situations, children may develop symptoms of anxiety and may need parental or professional support. 

Ways to manage and ease anxiety

No parent would want to see their wards be in despair and even their well-meant intentions can make them get into a negative-cycle. And just by not wanting their child to suffer they might exacerbate their kid’s anxiety. 

Being healthy is not only an important aspect of having a healthy life physically it is also significant in terms of being able to manage and lead a healthy mental life too. In addition to getting the right kind of support a healthy diet can play an important role in managing symptoms of anxiety.

A few pointers for guardians and parents on supporting children facing anxiety are:

  • Maintain a healthy diet, which is focused on fruits, green vegetables, whole grains, legumes and lean protein sources, nuts and seeds. Exercise for at least an hour and get enough sleep.
  • The goal is to help the child manage their anxiety and not do it for them by eliminating it, this serves as a life lesson for them and also forms the basis of a guide on how to manage it themselves as they grow up. Instead of trying to remove the stressors or the causes of anxiety, the child must be assisted to tolerate or cope with it in healthy ways.
  • By expressing positive but realistic expectations to a child will give them confidence that even if they fail at something or some task, it is still okay and does not mean the end of the world for them. 
  • You must respect their feelings or worries but that should not mean you agree with it. If the child is afraid of participating in an activity, you should listen and be empathetic towards them and encourage them to face their fears instead of cancelling the event.
  • Encourage them to identify the stressors and signs of what causes them anxiety but also allow for them to be able to ask for help from you.

Sleep Anxiety

Anxiety is a debilitating feeling of nervousness and worry that can disrupt our daily functioning and cause a lot of distress. These sensations are experienced by all of us at some point in our lives when we get stressed out. 

To a certain extent, these feelings are very normal and good for us as they motivate us to perform well in all aspects of our life. But when these feelings go beyond a particular level, they can be pathological and render you incapable of performing any task.

What is Sleep Anxiety?

When anxiety lingers on for longer than usual then it starts to interfere with your sleep. Neverending worries and doubts cloud your mind, making it very difficult for you to fall asleep. 

Sleep anxiety can include anticipatory anxiety before going to sleep as well, this includes having negative thoughts and distress associated with sleep. This could have a drastic effect on their routines and sleeping patterns causing insomnia where both the quality and quantity of sleep are hampered. 

Anxiety also causes disturbing dreams reinforcing the negative beliefs around going to sleep. There is also strong evidence that lack of sleep can instigate or worsen your anxiety, and hence sleep deprivation is not only a symptom but also a cause for anxiety. 

Types of Insomnia

Insomnia is a sleeping disorder where you have trouble falling or staying asleep. This condition can be acute or chronic depending on the period a person suffers for; it could be 1 night to a few weeks or 3 nights a week for a few months. 

Acute Insomnia

It is also known as adjustment insomnia as it involves having a brief episode of difficulty in sleeping. This is generally caused by the stressful events of life such as losing loved ones, major life changes, cessation of drugs, etc. Acute insomnia generally lasts for less than three months and the symptoms fade as the individual learns to cope with their situation.

However, if acute insomnia is left untreated, the likelihood of developing chronic insomnia and other complications that are associated with this condition increases manifold. Women are more susceptible to it than men, especially during pregnancy and menopause.

Chronic Insomnia

Insomnia that lasts for 3 nights a week for three months or more is termed as chronic. It also has several reasons such as irregular sleep schedules, poor sleep hygiene, persistent nightmares, mental health disorders, underlying physical or neurological problems, medications, a bed partner with sleep apnea or other problems, and certain other sleep disorders.

Other Types of Insomnia

  1. Sleep Onset Insomnia- This Insomnia means difficulty in falling asleep at the beginning of the night. It is marked by constant tossing and turning in bed without actually getting any sleep. People stay up for 20-30 minutes even after going into bed. A person with this type of insomnia has a reduced sleep time and can feel the effects of lack of sleep the next day.
  1. Sleep Maintenance Insomnia – It is characterized by the inability of staying asleep throughout the night. This often means that the individual wakes up at least once during their sleep and is unable to sleep for the next 20-30 minutes. It decreases the quality and quantity of sleep and leaves them feeling sluggish and tired the next day.
  1. Early Morning awakening Insomnia- It involves waking up way before a person has planned to in the morning. He/she is not able to get the planned amount of sleep which hampers mental and physical activity. Some experts view it as sleep maintenance but most consider it separately.
  1. Comorbid Insomnia- Initially insomnia was considered as comorbid or secondary insomnia. This meant that insomnia was a result of anxiety, depression, sleep apnea, gastroesophageal reflux disease (GERD), or physical pain. 

Further research showed that sleeping problems shared a bidirectional relationship with other health issues. Furthermore, insomnia triggered by other health conditions doesn’t always go away once the issue is resolved. Because of a cascade of factors that cause insomnia, it is very difficult for the patients to narrow down one specific case. 

Healthy Sleep Habits

Now, let’s talk about the ways to battle your insomnia. Following are some tips and lifestyle habits that you can inculcate into your routine to help you have restful sleep and feel energised every single morning, ready to take on the day: 

  • Wake up at the same time each day: It is tempting to sleep in on the weekends, especially if you haven’t had enough sleep during the week. But if you suffer from insomnia then you need to wake up at a specific time every single day so that you fall in line with your circadian rhythms and develop a better sleep cycle. 
  • Eliminate Alcohol and other stimulants like caffeine: Caffeine is a pretty strong stimulant as its effect can last up to 24 hours and has a very strong chance of affecting your sleep and frequent awakening. Alcohol initially has a sedative effect but after a few hours causes frequent arousals and a night of restless sleep. 
  • Limit Naps: Even though napping is a good way to catch up on sleep, if you have insomnia then setting a sleeping schedule is very crucial. Training ourselves with cues such as darkness and sleep time will help in increasing the quality of our sleep.
  • Exercise Regularly: Regular exercise helps in increasing the quality and duration of sleep. However, if we exercise before sleeping then it has a stimulating effect which will be detrimental to our sleep. This is why there should be at least a three gap between exercise and sleeping. 
  • Limit activities in bed: The purpose of the bed should only be sleeping. So, avoid studying, making phone calls, or watching tv in bed or bedroom as this increases alertness and makes it difficult to fall asleep.
  • Do not drink or eat before your bedtime: Eating before bed activates the digestive system which will keep you from falling asleep. Drinking a lot of fluids before sleeping will cause excessive pressure on the bladder resulting in frequent toilet visits disturbing your sleep. 
  • Get over your worries before bedtime. Make a list of all your worries and tasks you would want to accomplish the next day. So that you can plan your day and these thoughts won’t keep you active at night. 
  • Reduce Stress: There many techniques you can use to relax your mind and reduce stress to increase the quality of your sleep. Some of the techniques are progressive muscle relaxation (perhaps with audio tapes), deep breathing techniques, imagery, meditation, and biofeedback.

Ways to Encounter Insomnia and Treatment

If you are suffering from the symptoms of insomnia and sleep anxiety for the past few months, then you may have to see your doctor. Treating insomnia involves two main goals; increasing the quality and duration of sleep and reducing the symptoms experienced during the daytime. Once diagnosed with Chronic Insomnia, you may opt for cognitive behavioural therapy for the purpose of treatment. It may involve processes like stimulus-control, sleep restriction and compression, and relaxation techniques to help you manage sleep anxiety. Moreover, education for sleep and hygiene may also help. Learning about healthy sleep patterns and understanding why you experience insomnia symptoms may reduce the chances of any relapse. Medications may also be prescribed such as benzodiazepines, melatonin agonists, orexin receptor agonists, and other over the counter drugs. 

Insomnia is a grave health condition mostly overlooked by physicians as they do not go to the root of the matter and cover it up by sleeping pills. Thousands of people suffer from insomnia daily with the number increasing every day but people are becoming aware that it is hampering their daily life. It has a negative effect of their relationships, creativity, and workplace productivity causing the quality of their life to decline. If you think you’re suffering from this condition, you must contact a health professional immediately as early intervention and treatment make a lasting difference.

Separation Anxiety Disorder

Separation anxiety involves feelings of fear associated with separation from specific persons or an individual, or at times, a pet. This term is most commonly associated with children, however, adults can also experience this. It can be a sign of a condition called separation anxiety disorder which can be more serious. 

If this separation anxiety is persistent and seems to interfere with your child’s, or your own overall wellbeing, then it’s an indication towards the development of separation anxiety disorder. 

Separation anxiety disorder can result in panic attacks and physical symptoms like nausea, headache, sore throat, ulcers, etc. In children, this condition begins at an early age starting from preschool and may continue on in adulthood if left untreated. 

Separation Anxiety Symptoms 

The Diagnostic and Statistical Manual for Mental Health Conditions (DSM-5) specifies certain symptoms of separation anxiety, and if you feel any or all of these symptoms, you must visit a doctor or a mental health professional.

 Separation anxiety involves symptoms that are experienced in other anxiety disorders, as well as symptoms associated with this specific condition. The signs and symptoms of separation anxiety are as follows: 

  • Abnormal or intense stress and anxiety attached with separation from a pet or a person or a group of people
  • Feelings of worry, listlessness and hopelessness over being alone
  • Fear that someone may be harmed if they leave them
  • Fear of being left alone and feeling lonely
  • Physical symptoms felt when they know that they are going to be separated from their spouse or someone they are attached to, or on separation from this person
  • The need to know where their loved ones or friends are no matter what time it is
  • Recurrent nightmares involving separation from a loved one 
  • Stomachaches, headaches, etc. felt on separation from the person that they are attached to

The symptoms of separation anxiety can last upto 6 months in adults. They may also experience panic attacks in chronic cases, which involves feelings of intense anxiety rising to a peak when thoughts of triggering stimuli are present. 

Additionally, children may refuse to go to bed without their parent or caregiver, or the person that they are attached to. They may experience nightmares in which they experience separation from this individual. They feel excessive distress when they leave for school, and find it difficult to be away from their caregiver or parent. 

Separation Anxiety in Adults

Separation anxiety tends to have its roots in early childhood and may be due to factors like early separation from a caregiver or a parent. It can also stem from being separated from a partner. It can also be a sign of other underlying mental health problems like psychotic disorders or autism spectrum disorder. 

Adults with separation anxiety disorder have a tough time dealing with any or every situation in which they are away from their loved ones. This can include being away at work, or being at home while the children are at school and the spouse is at work, or going out for shopping or daily tasks without a family member, etc. Even thinking about being away or planning trips to the market or out-of-station trips for business-related purposes, people with separation anxiety struggle with overwhelming feelings of listlessness, constant worry and stress. 

Separation anxiety is a debilitating condition. By the time we grow out of adolescence and step into adulthood, we develop emotional skills that help us understand and deal with brief periods of being away from family and spouses easily. However, adults with separation anxiety feel extreme distress and anxiety on separation, to the extent that it is developmentally inappropriate.

Adults with separation anxiety may be described as being overly protective or controlling of their family members and children, however, this can be seen as their way of expressing their fears associated with separation. 

Separation Anxiety in Children and Infants

Among children, it may be considered normal to have feelings of anxiety and display clinginess every time they have to leave for preschool or go for a hobby class. Throwing tantrums, crying, or hiding behind the parent’s back and not leaving their side might be, in most cases, nothing more than healthy reactions to being separated from a parent. This is normal for certain stages of development and you may have no reason to worry about your child. However, some children may struggle with separation anxiety that may be intense and come with more troubling symptoms than regular separation anxiety that is developmentally appropriate.

 Up till the age of four, children are expected to feel these sentiments and display signs of separation anxiety. However, if they are experiencing more intense and chronic symptoms that are troubling them day and night and interfere with their normal activities, it is time to consider seeing a child’s specialist or a child psychologist. Such children experience the symptoms of separation anxiety which might be more chronic or intense than others, and stay with them even during elementary or middle school. 

Ideally, such fears must fade away once the child gets older. If such problems persist, then it may be an indication that your child has developed separation anxiety disorder. Early diagnosis and treatment help reduce the symptoms and provide significant relief. 

Separation Anxiety Treatment

The treatment for separation anxiety involves psychotherapy, and anti-anxiety medication. 

Psychotherapy often involves the use of cognitive behavioral approach, which aims to help the person identify their behaviours and thought patterns which are deteriorating their condition or might be the reason they have the condition. Moreover, both adults and children benefit from group and family therapy. 

In addition to this, parents are also encouraged to learn parenting skills which enable their children to learn social and emotional skills and achieve developmental milestones in a consistent manner. Clients are also encouraged to join support groups as they help in learning skills which counter separation anxiety. 

Anti-anxiety medication is temporarily prescribed in cases where people feel chronic and intense symptoms. However, drugs are not to be taken in the long term and do not help in eliminating the condition or the symptoms. Some types of anti anxiety drugs are also known to be addictive. 

How To Deal With Normal Separation Anxiety in Children?

For children who experience normal separation anxiety, there are some steps that their parents can take to help them cope and deal effectively with their emotions. 

Practice saying goodbye and brief periods of separation. You could start with 15 minutes of leaving the child alone in a room, and then for an hour at a caregiver’s place. In this way, gradually, the child would become accustomed to handling separation for a while. 

Moreover, the caregiver should be consistent, you must not switch between one person to another as it may be discomforting for your child. Try to let the child be in familiar surroundings whenever you leave, or try to make new surroundings familiar by giving them a stuffed toy or any other familiar object that they may be attached to.  

Also, when you’re going away from the child, do not make the goodbye ritual too long or dramatic. Simply say that you will be coming back after a while. 

Moreover, try to minimize media including television that may arouse fear or worry. A strict no to anything that is frightening. 

Lastly, do provide your child with enough care, affection and attention and do not forget to do so while you’re trying to condition them to be comfortable with separation. Your child will be fine. However, if you suspect that there are indications or symptoms of social anxiety disorder, you must consider proper treatment as it is a serious condition that negatively affects your child’s mental and physical well being.

Frequently Asked Questions about Separation Anxiety

Q. How long does “normal” separation anxiety last?

Separation anxiety tends to peak between ten to eighteen months and then gradually, it fades away as the child grows up to be about two and a half years old. This phase of the emotional development is critical and sensitive both for the child and for you. For others, it might even be difficult and painful to deal with.

Q. How does separation anxiety affect sleep?

When the child is one and a half years old, separation anxiety can cause disruptions in the sleep pattern and many sleepless nights for the child. This phase lasts for several months. In this, the child may wake up several times during the night and cry as well as show signs of anxiety for a parent or both the parents (often they express a strong preference for one parent).

Testing Anxiety

Most people experience some stress or anxiety prior to or during taking any examination. This stress can be considered a prerequisite for performing well in any given test. However, when this kind of anxiety becomes excessive and severe enough to interfere with your performance on a test, at the same time it hinders your ability to function well during the time you prepare for any test, then it is a condition called test anxiety. 

If you pay attention during every class, take good notes and revisit them periodically, spend a good amount of time studying and do everything a good student does and yet you blank out due to nervousness during an examination, you may have this condition. 

This problem affects students of all ages, ranging from kindergarten children to  PhD students and competitive examination candidates.

Test Anxiety Definition

Test anxiety is a psychological condition in which a student experiences a set of physiological, somatic, and cognitive symptoms including over-arousal, worry, tension, dread, fear of failure, catastrophizing etc. during or before taking a test. Test anxiety is a type of performance anxiety, and thus it affects the performance of a student in the test(s). 

Test Anxiety Symptoms

Symptoms of test anxiety vary from mild to severe. Those who experience mild symptoms do fairly good on exams and the ones suffering from severe symptoms experience paralyzing anxiety reactions in a test setting, thus they perform poorly in exams. According to the Anxiety and Depression Association of America, the symptoms of testing anxiety can be categorized into four broad categories i.e physical symptoms, emotional symptoms, cognitive symptoms and behavioural symptoms. 

Physical symptoms include sweating, visibly shaking or trembling, rapid heartbeat, fainting, dry mouth and nausea which can also lead to vomiting. In severe cases, the person may even fall ill. The persons who experience mild symptoms may experience a sensation of “butterflies in the stomach.”

Emotional symptoms include depressive mood, low self-esteem and lack of self confidence, a feeling of hopelessness, anger, and a feeling of helplessness that makes students feel as though they are not in control of their situation and can’t do too much about it. Feelings of inadequacy, stress, fear and self doubt are also some of the emotional symptoms of testing anxiety. Often, students overly criticize themselves and berate themselves for not performing well in exams. 

Cognitive and behavioral symptoms include avoidance based approach to the situation. So some students may try to avoid exams altogether and may even drop out of school to avoid their fear, others may develop behavioural problems like fidgeting, nail-biting, hair pulling around the time when exams are conducted. Often, students resort to unhealthy coping mechanisms such as abusing or taking excessive amounts of prescription medicines and alcoholism. Negative self-talk, catastrophizing, black and white thinking, having trouble concentrating, racing thoughts and blanking out on answers are some of the major cognitive symptoms of testing anxiety. 

Causes of Test Anxiety

Test anxiety can be caused by a number of factors, at the same time some factors contribute to the likelihood of someone developing this condition. The causes and risk factors, overall, can be a combination of or a single one of the following pointers: 

  • Poor Testing History: Doing poorly on tests before due to several reasons such as unpreparedness, anxiety, etc., can make you form negative associations with tests and results. This can be a cause of test anxiety. 
  • Fear of Failure: Connecting one’s self image and self worth to test results and how we perform in tests can be a harmful thing to do, and it contributes to test anxiety. 
  • Unpreparedness can add to your feelings of anxiety
  • Overly high expectations from the self can also lead to test anxiety
  • Having Generalized Anxiety Disorder can make you prone to developing test anxiety

Test Anxiety Diagnosis

The Diagnostic and Statistical Manual (DSM-5) lays out the criteria for the diagnosis of test anxiety under the classification of social phobia. In order to be diagnosed as suffering from social phobia, the following factors should be presented by the concerned individual: 

  • Immediate anxiety response when exposed to the feared situation (in this case, the exam)
  • Multiple attempts to avoid the feared situation or enduring it with extreme difficulty and distress
  • Disruption to normal functioning due to the avoidance or fear associated with the situation
  • Experience of symptoms for at least 6 months

Test Anxiety Treatment

The treatment for test anxiety involves reducing the severe and persistent symptoms which can also include having panic attacks. Panic attacks and anxiety related symptoms can be reduced using the medications prescribed to you or your child by a pediatrician or a doctor. If your symptoms persist, and depending upon your existing condition, your doctor may refer you to a counsellor or a therapist. Counsellors and therapists may use several approaches to reduce the symptoms of test anxiety and form positive associations with examinations. 

At Incontact, we use an eclectic approach to deal with all sorts of mental health issues. For the purpose of treating test anxiety, we may use cognitive behavioural therapy or other related therapeutic approaches. We’ll help you cope with low self esteem and self doubt, if any, that could be causing such a reaction in you during and before examinations. Contact us to know more about our services and book an appointment.

Test Anxiety Tips to Cope

Before the test: To cope with anxiety before a test, you must ensure that you get at least 8 hours of sleep, spend enough time studying so you feel as prepared as possible, learn the right studying methods and take practice tests beforehand. During such practice tests, try to simulate the environmental settings that are present in your examination hall or room so that you expose yourself to such factors and overcome your anxiety. Get plenty of sleep the night before and eat a good breakfast which has an ample amount of protein in it, and avoid caffeine as it acts as a stimulant and may increase your stress levels. 
During the test: Take a few deep breaths and relax your muscles. Bring your focus to the present and attempt each question after reading it more than once, at least. Take one question at a time and focus only on this question for the time being.

Frequently Asked Questions about Test Anxiety

Q. How many students experience test anxiety? Who is at risk?

Studies suggest that 25 to 40 percent of students worldwide experience test anxiety. Students with disabilities, including learning disabilities and those in gifted education classes are at the highest risk of experiencing test anxiety.

Q. What are the measurement scales designed to assess the levels of test anxiety?

Some of the measurement scales designed for this purpose are: The Children’s Test Anxiety Questionnaire which measures the test anxiety levels in children 8-12 years of age, and the Test Anxiety Inventory for Children and Adolescent (TAICA) which is a way to measure and assess test anxiety in children and adolescents in grades 4 to 12.

Dealing With Anxiety

Mental tensions and worries are certainly a part and parcel of our lives. Little things that happen in our day-to-day events can trouble us and be a cause of our stress, and such stress is oftentimes manageable. Some much more important events that happen parallelly to such small events, such as financial problems, work-related issues, and familial troubles, can also be a cause of worry. Such stress can allow us to function optimally in certain problematic situations, drive us to make the right decisions and ultimately energize us to make the effort required to be successful in life.

However there is a thin line between manageable, good worries and unmanageable, bad worries. The unmanageable kind can prove to be detrimental to anyone’s mental and physical wellbeing.

What is Anxiety?

When the feeling of worries, fears, and apprehension rises to a peak and makes us have disturbing and intrusive thoughts, it is called anxiety. It causes us to feel out-of-control, disrupts some of our physical mechanisms and negatively affects all dimensions of our lives. 

Dealing with anxiety and learning how to overcome anxiety in our day to day lives can help a great deal to keep the negative effects at bay. There are some lifestyle changes that one can take up, and little habits that one can incorporate into one’s routine to help provide some anxiety relief. Once these habits become deeply ingrained in the ways we react and respond to anxiety-provoking situations, we become much more grounded, and stable in our minds and as a result the distress caused by anxiety is reduced to a considerable extent.

However, if you constantly experience distress, anxiety, listlessness and helplessness, you might be suffering from an anxiety disorder. While there is no “anxiety cure”, anxiety disorders, just like any other mental health disorder, can be managed with the help of counselling and therapy.

Signs of Anxiety

Anxiety disorders are some of the most common psychological disorders. There are some symptoms that overlap across all anxiety disorders, such as:

  • Constant restlessness and worries
  • Inability to relax
  • Difficulty in sleeping
  • Trembling and shakiness
  • Intense fears (either vague or associated with objects, animals, people, etc.)
  • Diarrhea, nausea, and motor tension
  • Sleeplessness; not being able to get sleep at night due to an overly active mind 
  • Intrusive thoughts
  • Avoidance behaviour
  • Losing focus while doing basic daily activities
  • Motor tension (muscle tightness, stiffness)
  • Feeling drained, weak, or tired.

Causes of Anxiety

Anxiety can be caused by an inter-mix of several factors or a relatively significant presence of one specific factor. They are but not limited to:

  • Biological Factors:

The affected person might have a higher concentration of cortisol in their system (which is also known as the stress hormone). General Anxiety Disorder (GAD) is also known to be associated with low activity of a particular neurotransmitter known as gamma-aminobutyric acid (GABA). There is definitely some sound evidence that indicates such biochemical and other genetic factors’ involvement in anxiety disorders.

  • Having a Predisposition/Diathesis:

Anxiety disorders can develop if your predisposition or diathesis to the disorder is set off by extreme stressors in your environment, or difficulties in life. Many of us carry such vulnerabilities to develop certain disorders. This is based on the diathesis-stress model which is applied to many other mental disorders. 

  • Medical Complications:

Anxiety can often be linked to an underlying physical health issue. It can be one of the first indications of a medical illness. A few examples of these diseases are heart disease, diabetes, hypothyroidism or hyperthyroidism, respiratory ailments, and drug abuse.

  • Life Events:

A lot of stress may have accumulated due to daily hassles. This can be linked to lifestyle problems. At other times, people are going through many serious life events that trigger anxiety, such as death of a close relative or friend, break up or divorce, unemployment, financial problems, etc. Anxiety is also significantly contributed by early family of origin experiences.

How to Overcome Anxiety: 5 Methods that Help in Dealing with Anxiety

If you are thinking of something to supplement your treatment plan for anxiety or of something to incorporate into your life to reduce anxiety related symptoms, the following tips are definitely going to help you build a better understanding of yourself and lead a calmer, healthier life. They are as follows:

1. The 5-4-3-2-1 Coping Technique

This coping technique for anxiety enables people to find focus in the present moment and it helps reduce the fixation on thoughts that cause anxiety by using the 5 main senses. These senses are; sight, touch, hearing, smell and taste. One begins to use this technique by breathing deeply and slowly. 

Step 5: Scan your surroundings to look for any 5 things that you can see. For example, a chair, a sweatshirt, a mirror, a windchime and a carpet. 

Step 4: Notice four things around you that you can touch. For example, your hair, your nose, the floor under your feet. 

Step 3: Notice and pay attention to the three things that you can hear. For example, music, people talking in the distance, and the sound of your breath. 

Step 2: Try to find two things that you can smell. For instance, the scent of something baking in the kitchen, and the deo that you used in the morning. 

Step 1: Notice one thing that you can taste. For example, coffee.

2. Limit Caffeine And Alcohol Intake

Caffeine, alcohol, and other liquids like energy drinks or sugary beverages tend to stimulate the nervous system in ways that can increase the levels of anxiety and lead to more frequent instances of panic attacks. A person suffering from an anxiety disorder, or higher levels of stress and anxiety in general should limit the usage of caffeine and alcohol. Instead, you can replace such substances with healthy alternatives which supplement the 4. diet. A balanced diet is an important contributor to both mental and physical fitness. Consuming supplements or foods rich in omega-3 fatty acids, vitamin D, magnesium, among other nutrients can help considerably reduce anxiety levels and help you in dealing with anxiety.

3. Do Regular Exercise and Yoga

Time and again, studies have proven the positive effects of doing regular exercise and yoga on mental and physical ailments. Moreover, this practice strengthens us in our mind and body to lead a happier and healthier life. Needless to say, many researches have confirmed that yoga and exercise provide both immediate and long term anxiety relief. They help in dealing with anxiety by stimulating chemicals in the brain called endorphins. Endorphins induce the feeling of calmness and a positive mood according to several studies.

4. Deep Breathing and Meditation

Breathing and meditation exercises help successfully and efficiently manage stress and anxiety when practiced regularly. Deep breathing is known to increase the supply of oxygen to the brain and stimulates the parasympathetic nervous system which promotes a state of relaxation and calmness. Breathing exercises and meditation often go hand in hand as many meditation techniques require one to focus on one’s breath.

5. Find Your Trigger and Question Your Thought Pattern

Find out what kind of situations that you find yourself feeling anxious in. Why do you feel anxious about these situations? What kind of thoughts do you have with regard to such situations? Such self reflection can be done when you sit with yourself in silence and possibly write into a journal all your thoughts and feelings. Then, try to change the way you think about things from a negative to a positive and/or a neutral, rational way. Try to change your perspective. It is proven that people with an optimistic mindset tend to be more successful in life.

How Incontact’s Counselling And Therapy Can Help

Our therapists and counsellors help you tackle and manage your anxiety much effectively as we believe in designing your intervention programme perfectly suited to you and your unique individuality. Using a heterogenous approach, we involve several kinds of concepts and theories to help you achieve your mental health goals and make each session count. 

We are a team of reputable, licensed counsellors and therapists who attune to your specific needs and learning styles and help bring in permanent, long-term results that make an ever-changing impact on your life. Trained in forming sound relationships, we act as enablers in your journey of self-development and empower you to become your best self.

Frequently Asked Questions on Anxiety

Q. What are the five most common anxiety disorders?

Generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, and social phobia (social anxiety disorder).

Q. What are the statistics for anxiety disorders in Singapore?

In Singapore, 10% of the population suffers from anxiety and depressive disorders. Out of this, 0.9% have generalized anxiety disorder, and 3% have OCD.

Q. What percentage of the world suffers from anxiety?

In  2017, an estimate was made that the largest number of people in the world have anxiety disorder. Approximately around 4% of the global population suffers from anxiety disorders.

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