Looks can be deceiving, and “high functioning” students with a mental illness are more common than one might think.

The term "anxiety" is thrown around in varying levels of severity and seriousness, from a group of friends talking about how texting their crush gives them “anxiety” to a student having a very real diagnosed panic disorder. The same response is received from professionals when this example is given: a deep breath, a smile and a shaking of the head. Clearly, there are a lot of misconceptions out there, and this question has been asked of them frequently.

“Anxiety is a useful physiological experience, but does your anxiety serve you? Is it helpful?” said Anita Smith, a psychologist at Elon University's Counseling Services, where students can receive free counseling services.

“To experience anxiety is not to have an anxiety disorder — we all experience varying levels of anxiety based on the situation. If someone comes in and says, ‘I have anxiety,’ I say, ‘What does that mean, and what does that look like?’ And the goal is not to eliminate it but how to figure out how to get it to be healthy,” Smith said.

A listen inside

Some anxiety is needed to live a functioning life, Smith said, but it can take a dangerous turn in competitive college environments. “Maybe the person is doing a billion things and appears to be successful, but I challenge that to say, ‘Is it healthy?’” Smith said. “'Is it good for this person, or is it a compulsion or obsession, and at a different level of something that is clinical?'”

However, “high functioning anxiety” is not a clinical diagnosis, Smith said.

CJ Fleming, clinical psychologist and assistant professor of psychology at Elon, agreed. “If it’s not in here,” Fleming said, in reference to The Diagnostic and Statistical Manual of Mental Disorders, “I can’t give it as a diagnosis.”

That does not mean that someone with generalized anxiety disorder, panic disorder or dysthymia (a chronic, low level form of depression that lasts for two or more years) cannot be a high functioning person, Fleming said. The danger that comes with normalizing symptoms and feelings of anxiety or depression is rationalizing them to avoid treating the actual problem.

These disorders all cause some sort of clinically significant impairment to day to day life, and “If you’re totally fine but happen to have some anxious thoughts, that is not what this is describing,” Fleming said.

The Elon experience

Nicole Ackman '17 said she  identifies greatly with the pressures of college and the toll they can take on mental health. For her, it was her Elon experience that helped her understand anxiety and how to live with it. 

"One of the biggest changes for me was that I realized what it truly was while I was at Elon," Ackman said. "I’ve never been formally diagnosed, though my sister, who has very similar symptoms of anxiety to mine, has been. I suspected I had anxiety for about a year before her diagnosis. I think I’ve always had it, but it truly became an issue in my high school years. At the time, I had no idea what they were. I assumed that my ‘problems’ were just personal — signs of a weak personality."

A lover of Disney and Broadway, double major and Honors Fellow who studied abroad in Scotland, Orlando, Anaheim and New York City while at Elon, active blogger and now graduate school student in London, England, Ackman tries to channel her anxiety into productivity.

“I think the biggest pressure from Elon was to hide how I’m struggling," Ackman said. "While people often joke about how little sleep they’re getting or how they’re struggling with a class, I felt a pressure to hide that I was having problems or feeling mentally drained. I never skipped a class even on days when I probably should have taken a ‘mental health day’ and simply tried to make myself feel better. I’ve had bad bouts of anxiety or panic attacks and then gone to class fifteen minutes later."

Physical symptoms differ for everyone, but Ackman said it feels like all her senses are failing at once in the midst of a panic attack. A general anxious period could involve feeling off and on edge for hours or even entire weeks, she said.

Even though the Elon climate contributed to some of Ackman's anxiety, she stressed the importance of having a supportive community and finding time to take care of yourself.

"Some of my friends have been really lovely about it, and I also have some friends who similarly suffer from anxiety — and some who have it much worse," Ackman said. "It’s really helped to find these people who understand what it’s like and that I can trade coping mechanisms with and ask about different treatments."

While Ackman never used counseling services at Elon, if a student feels their anxiety is problematic, Elon provides a free mental health screening tool to use before one decides if they want to pursue further action.

Beyond the bubble

The age group 18-24 is most common to have mental illness development, according to 2015 data from the National Institute for Mental Health. In 2015, there were an estimated 43.4 million adults in the United States with a mental illness within the past year, and 21.7 percent of them were college-aged individuals.

Even without a professional diagnosis, experiencing symptoms like excessive worry surrounding basic tasks for extended periods of time can be a major warning sign. Although she has never seen a psychologist, Emmanuel College senior Julia Cadena has experienced symptoms of an anxiety disorder since she was a junior in high school. Cadena describes her anxiety as constant negative physical and emotional feelings.

“It’s an internalized feeling like something is squeezing at my chest,” Cadena said. “It sounds a bit dramatic, but essentially it comes off as some kind of negative physical experience like I can never feel content existing. At the start of each semester, I feel like I am behind, already failing or haven’t gotten anything done. Imagine those emotions 24/7.”

These feelings can often manifest themselves in a false feeling of inadequacy, and having a support system is one of the biggest positive influences on someone with anxiety — clinically diagnosed or not.

“Stress of course is normal, but having it feel debilitating or impacting your quality of life is another situation,” Cadena said. “A lot of my friends suffer from various mental illnesses and disorders. We are basically rooted in being there for each other at all times so everyone is always ready to offer advice or just let each other vent. No one is judged for having those things, but we show empathy and understanding. I feel not many friend groups are like mine, so hearing that might come off a little strong, but that just goes to show how common these things are.”

Cadena is studying clinical psychology in hopes of helping other people with mental illnesses after her graduation in May.

In the end, the most important takeaway is to understand there are varying levels of severity in mental illness. Learning about them can open the door for acceptance and candid conversations so in the future, fewer of our friends feel pressured to hide what they are experiencing.

“Maybe it is in some way people embracing their ability to feel successful in having a diagnosis,” Smith said. “That's a goal, right? To be able to function with mental illness. There's mental health in mental illness. To be able to function with anxiety — that's ideal.”

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