According to the National Alliance on Mental Illness (NAMI), over 40 million American adults have an anxiety disorder and most develop symptoms before age 21. For some, their anxiety can be described as high functioning. In these cases, their symptoms of anxiety are hidden or well managed, at least from the outside.
They appear to be in control and highly organized. Others see them as an individual with an outgoing personality or someone who is detail oriented and a high achiever. On the inside, however, this couldn’t be further from the truth.
Key Points
- High functioning anxiety is a form of generalized anxiety disorder that hides behind achievement and productivity.
- It often goes undiagnosed because people appear calm, organized, and successful on the outside.
- Common signs include perfectionism, overworking, people pleasing, and trouble relaxing or enjoying achievements.
- Physical symptoms can include sleep issues, muscle tension, headaches, and difficulty concentrating.
- Left untreated, high functioning anxiety can lead to burnout and strained relationships.
- Cognitive behavioral therapy (CBT) and other talk therapies can help people manage symptoms effectively.
What Is High Functioning Anxiety?
High functioning anxiety is a subset of generalized anxiety disorder in which a person has significant anxiety symptoms while still functioning well in daily life. It’s often masked by achievement, productivity, or perfectionism, which makes it hard to spot from the outside.
Generalized anxiety disorder is the broader condition, but people with the high functioning form often appear calm, organized, and successful on the outside. This form of anxiety can be difficult to recognize because it’s often masked by achievement, productivity, or perfectionism.
Defining “High Functioning” in a Mental Health Context
In a mental health context, high functioning means that outwardly you appear to be doing well despite having a mental health condition. You appear to manage the responsibilities of daily life, including work, school and relationships, all while internally struggling.
Why It Often Goes Undiagnosed
High functioning anxiety often goes undiagnosed for many reasons. People who are suffering from high functioning anxiety appear to be organized, calm or driven. They may seem highly dedicated and focused on their work or family responsibilities, while struggling with tremendous anxiety.
Their symptoms of anxiety may manifest as perfectionism, tension or constant worry. The outside world may perceive it as being high achieving, serious or extremely dedicated. Because high functioning anxiety does not outwardly appear to be causing problems with day to day activities it often goes overlooked or ignored.
Common Emotional Symptoms
People with high functioning anxiety often experience persistent fear, guilt, or self-doubt that drives them to overachieve or seek constant reassurance. Even when they reach their goals, relief is short-lived before new worries take over.
Although a person with high functioning anxiety may appear they have it all together, inside, they are struggling. They often experience persistent feelings of fear, guilt, or self-doubt that drive them to overachieve or seek constant reassurance. Even when they accomplish their goals, the sense of relief is fleeting, quickly replaced by new worries or unrealistic expectations.
Constant Worry Hidden Behind Success
A person with high functioning anxiety may attempt to cope with their anxiety by overachieving or striving for perfection to mask their feelings of stress, self doubt or worry. Their anxiety fuels a constant drive to achieve and a fear of failure, resulting in overfunctioning. This overfunctioning can lead to burnout and significant emotional and physical distress.
Perfectionism and Overthinking
Perfectionism and constant overthinking are coping mechanisms often seen in people with high functioning anxiety. It stems from underlying fears of failure, as well as an attempt to prevent negative outcomes. A person with high functioning anxiety uses these behaviors to give themselves a sense of control over unpredictable situations, to avoid disappointment or judgment from others.
Behavioral Signs You Might Miss
Overworking, people pleasing, and difficulty enjoying achievements are behavioral signs of high functioning anxiety that are easy to mistake for dedication or drive. They often stem from a need for control and a fear of disappointing others.
American culture pushes the narrative that if you aren’t constantly productive, working or achieving something, you aren’t a valuable member of society. We have learned to attach our sense of worthiness to accomplishments. This constant pressure often drives high functioning anxiety.
Overworking and People Pleasing
Overworking is one behavior that is associated with high functioning anxiety. Individuals push themselves to do more, be more and achieve more in an attempt to diminish their feelings of self doubt and worry.
People pleasing is another coping behavior often seen in individuals suffering from high functioning anxiety. People gain a sense of control by making sure everyone is happy. They may also constantly seek approval from others.
They act in an attempt to prevent conflict, avoid disapproval or ease their worry that they aren’t good enough. While these coping mechanisms may provide some relief from their negative feelings, they often lead to burnout, resulting in exhaustion and worsening mental health.
Trouble Relaxing or Enjoying Achievements
Individuals with high functioning anxiety often have trouble relaxing or enjoying their achievements. Having trouble relaxing results from needing to be in control or anticipating a potential problem or danger. Overthinking prevents individuals from relaxing or turning off their brain.
Relaxing makes them feel a lack of control over their environment, current situation or that they may not be prepared to handle what is coming. Over time, they use busyness as a coping mechanism, helping to dull feelings of fear, doubt or unworthiness.
For individuals with high functioning anxiety, enjoying their achievements can be very difficult since they are waiting for something to go wrong. Instead of feeling proud and savoring the moment, their thoughts may return to worrying about the future. And, although others see the value in their achievement, they still feel like it wasn’t good enough.
Physical and Cognitive Indicators
Chronic stress from high functioning anxiety often shows up physically as muscle tension, headaches, and fatigue, along with racing thoughts and trouble concentrating. These signs are easy to miss because the person otherwise appears to be doing fine.
Although people with high functioning anxiety look like they are doing well on the outside, there are often physical and cognitive indicators that there are issues. They may experience muscle tension, headaches, or fatigue due to chronic stress. Mentally, they can struggle with racing thoughts, difficulty concentrating, or an inability to relax even in calm situations.
Sleep Issues and Restlessness
Sleep issues and restlessness are common indicators of high functioning anxiety. People who suffer from this condition have trouble “turning off their brains”. They often stay in a pattern of overthinking and trying to anticipate the future.
Sleep is disrupted because the sympathetic nervous system remains on high alert, leading to increased heart rate, muscle tension and restlessness. This begins a pattern of hyperarousal that prevents sleep, leading to fatigue and exhaustion.
Difficulty Concentrating
Difficulty concentrating is another indicator of high functioning anxiety. Individuals may have difficulty concentrating. Their brains are overloaded by constant worry, thoughts of what if and self doubt. Because their brains are focused on negative thoughts, it is more difficult to sustain focus on the task at hand.
How High Functioning Anxiety Impacts Daily Life
High functioning anxiety can make everyday tasks exhausting and strain relationships, even when a person appears successful and in control on the outside. Overcommitting, perfectionism, and fear of failure often lead to burnout over time.
High functioning anxiety can make everyday tasks feel exhausting, even when they appear effortless to others. People may overcommit, strive for perfection, or constantly fear failure, leading to burnout or emotional fatigue. Despite outward success, they often find it hard to enjoy their achievements or maintain a healthy work-life balance.
Career and Relationships
High functioning anxiety impacts many aspects of daily life, including careers and relationships.
Careers come at a cost, although it may seem like a career would benefit from overachieving and people pleasing. Through working long hours, taking on additional tasks or responsibilities and seeking perfection in all you do, your body becomes fatigued, leading to exhaustion, which ultimately results in burnout.
Relationships can become strained by high functioning anxiety. Because a person suffering from this condition uses a lot of their energy in overthinking, worry and overachieving, they lack the focus and energy needed to maintain a good connection with their partners, friends or family.
Internal vs. External Presentation
High functioning anxiety can present in many ways, both internal and external. Symptoms of high functioning anxiety include:
Internal signs of high functioning anxiety:
- Fear of criticism, disappointment or severe self criticism
- Significant stress
- Feelings of impending doom
- Fear of loss of control
- Feeling of inadequacies or excessive worry about what others think of you
External signs of high functioning anxiety:
- Sleep disturbances
- Headaches or migraines
- GI disturbances such as diarrhea or the development of ulcers
- Sweating
- Numbness or tingling of the toes or fingers
- Increased heart rate
- Muscle tension
- Feeling lightheaded, shaky legs or off balance
When to Seek Help
It’s time to seek professional help when high functioning anxiety starts disrupting sleep, relationships, or overall wellbeing, even if daily responsibilities still seem to be getting done. Left untreated, it can lead to burnout and a decline in mental health.
Although you may feel like your high functioning anxiety is well managed or that you have it under control, chances are that you would benefit from professional help and therapy.
Recognizing When Anxiety Becomes Unmanageable
It is time to get help for your high functioning anxiety when it negatively impacts your daily life. This can be due to physical symptoms such as disrupted sleep, restlessness or discomfort. Certainly, problems with your relationships due to lack of focus or dissatisfaction with your achievements are other good indicators that you would benefit from professional help.
Although you may feel like you can manage high functioning anxiety on your own, when left untreated, it can lead to burnout and worsening of your overall mental wellbeing.
Therapy Options and First Steps
People with high functioning anxiety find improvement in their symptoms through therapy that includes the use of cognitive behavioral therapy (CBT) and other talk therapies. CBT is successful in treating high functioning anxiety because it helps individuals to change their way of thinking and positively transform their behaviors. Instead of always worrying about what could go wrong, thoughts are reframed to identifying helpful solutions and setting realistic goals.
As well, therapy can help you develop healthy coping skills. This may include learning mindfulness practices, relaxation techniques, meditation practices or journaling.
Recognizing that your high functioning anxiety is disrupting your life is the first step towards getting better. Once you have decided to seek help, finding a trusted therapist who understands your condition and how to treat it is next.
You can find the help you need through referrals from your primary care provider, support organizations such as the National Alliance on Mental Illness (NAMI) or websites like Therapy.com. Therapy.com provides an easily accessible database where you can search for a provider by location, services provided, gender and in person or online therapy options.
You don’t have to suffer with high functioning anxiety anymore. Reach out today, you won’t regret it!
