Some thoughts.

First of off, if you are experiencing anxiety at the level that it affects your job performance, you need to check with your doctor. Help is out there. If you’ve been crushed under anxiety’s heel for a long time, you might not even remember what it feels like to be otherwise.

So the first question is whether you should talk to your boss at all.

You might have several things on your mind. Brain Fog or just general forgetfulness or lack of focus can manifest themselves as missed deadlines, or “dropping the ball” whey failing to deliver on expectations. Unfortunately, mental health issues aren’t widely appreciated. Taking a day off if you’re physically ill is standard practice–even encouraged in more forward-thinking offices. Mental health, not as much.

It may be worthwhile to obliquely bring up mental health in a casual conversation to get a sense of where your boss stands. But don’t pin all your hopes on your current boss being understanding. We live in fast-moving times, and someone who’s your boss today might not be tomorrow. So you need to also pay attention to corporate culture. Taken as a whole, is the company you work for able to compassionately help people without stigma or condescension. If the company isn’t (as is the sad case in many Silicon Valley companies) your might be better off seeking different employment.

But don’t do anything hastily. Things can look much different under the cloud of anxiety compared to how they look after the clouds part. Another reason why it’s important to work closely with your doctor.

If you do decide to have a conversation, spend some time ahead of the discussion putting yourself in your boss’s shoes. How are they measured in their job? What do they expect from those under them?

In many cases, there might be a precipitating event that leads to a discussion. Perhaps your level of overwhelm reached a tipping point, and an important deadline got missed, or something you were expected to do went undone.

Unfortunately, your boss might not be able to tell the difference between someone performing heroic work under the strain of anxiety vs. someone who just isn’t very good. In a frank conversation, your boss will likely what to know specifics, including timelines for improvement. These can be difficult to estimate.

If you’re going to have the discussion, it’s far better to have it on your terms–before some precipitating event happens, than to feel backed into a corner (and even more anxious) wondering whether your job is on the line.

It may be helpful to draw comparisons to physical illness. Last year, I was suddenly hospitalized with a lung infection. It couldn’t be helped that my boss and workmates had to make sudden alternate plans to fill the gap. And yet this wasn’t seen as a major shortcoming on my end. It wasn’t like I had asked to get sick. It’s not off-base to draw a comparison between anxiety and physical illness. Not only do the two often go hand-in-hand, but also in many cases the anxiety stems from physical causes, such as imbalances of neurotransmitters.

Your boss also might ask, “what can I do to help?” Be ready for this question. Have a written list in hand. Some possible items for the list:

• If I take a day off once in a while for health reasons, trust that I’m doing the right thing [Note: for this to work, you need to have been laser focused on building your reputation as one who always does the right thing. Under-promise and over-deliver.]
• Ask for extra specificity. Ask for over-communication, in both directions.
• Ask for extra context around decisions and requests.
• Ask for more frequent reminders of any requests.
• Ask for extra discussions about prioritization.
• If office accommodations are bothering you, for example if you are in a noisy area, ask if different accommodations can be made.

Note that none of these are specific to anxiety! Any of these might be a good thing to discuss with your boss in any case.

In the discussion, stay focused on your boss’s point of view. Think about accommodations to be made on your side that can help the overall team and company continue to thrive while you work through medical issues. Emphasize the positive–things you’ve accomplished, the level of effort you’re committing, and your dedication to the company. Help your boss visualize a better future, where you’re not only firing on all cylinders, but also with that experience under your belt, your unique qualification of being able to see this situation in others and help.

[Bonus: if you are able to visualize this outcome–particularly if you are able to do so vividly enough to convince someone else–that itself will be a powerful component in conquering your anxiety.]

Be sure to talk about time frames. Anxiety at this level usually doesn’t pop into existence out of nowhere. You may have been suffering for some time before saying anything. Your boss might have in mind a particularly-recent incident involving your job performance. To get your message across, it’s important that you’re not seen as making an excuse for a recent incident.

Lastly, a legal note. I’m not a lawyer. Far from it. But in severe cases, you might want to look into taking a short term leave of absence. You’d want to discreetly check your national, local, and company rules and regulations around this.

In the USA this may fall under the Americans With Disabilities Act (ADA), which defines disability in a way that includes mental conditions, possibly including episodic ones.

There may be legal issues, pro or con, about disclosing a disability. It may affect your likelihood to get fired, hired, or transferred. That could easily be a separate posting.

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