High-functioning anxiety refers to a person who experiences chronic, excessive worry, stress, or obsessive thoughts, despite the outward appearance of having everything under control. Those with high-functioning anxiety often appear successful or are labeled as an overachiever. However, internally they may endure a pervasive fear of failure and doubt while feeling burdened to maintain their seemingly perfect exterior.
Many people have anxiety but manage to function in life and the workplace. According to a recent survey, Around 13 million people had an anxiety disorder in the last year, and 6 million of those people work.1
What Is High Functioning Anxiety?
High functioning anxiety may allow the person to get an education, go to work, and maintain their responsibilities at home, but it will require great effort and distress. The process will be a struggle, but it will not debilitate them. There is no mental health professional who will offer the diagnosis of high functioning anxiety, since the condition does not exist in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
In general, the term ‘high functioning anxiety’ describes one of two things:
- A person with more mild anxiety symptoms who is not currently seeing significant impacts in their life
- Typical levels of stress misinterpreted as signs of anxiety casually refer to it as high functioning anxiety
It’s common for anxiety disorders to differ from typical or expected levels of anxiety because of how excessive and persistent they are.
Can You Have Anxiety and Not Know It?
You can absolutely have anxiety and not know it. You may just be living your life as you always have and feeling the pressure of anxiety without even being able to name what the issue is. You may even be very successful and that could be a result of high functioning anxiety that isn’t allowing you to slow down, sleep enough, or make any mistakes (there’s a connection between perfectionism and anxiety).
High Functioning Anxiety and Depression
It can be common to have both high functioning anxiety and depression at the same time. While symptoms may overlap, it’s possible to actually have both and not realize it because symptoms can be overlooked.
The classic symptoms of depression and anxiety are easier to identify as they often disrupt everyday life, but those with high functioning anxiety and depression don’t appear to be anxious or depressed. They tend to be seen as over-achievers and look like they have it all together. This could be true, but it could be a sign of mental health issues and personal struggles that no one can see or feel except the person experiencing the internal symptoms.
High Functioning Anxiety Symptoms
Anxiety symptoms like worry, restlessness, and trouble sleeping are common in anxiety disorders, but those with high functioning anxiety may not exhibit symptoms with the same frequency or intensity as others. Some people with high functioning anxiety will have an actual mental health diagnosis, while others will not have symptoms that meet the criteria for a disorder.
Some of the most common physical symptoms of high functioning anxiety include:4
- Being overly fatigued and easily tired
- Physical tension with tight muscles
- Problems with falling asleep or staying asleep
- Changes in heart rate with palpitations, pounding heartbeat, and quicker pulse
- Increased sweating
- Feeling shaky
- An inability to sit still or appearing fidgety
In addition to the physical signs and symptoms of high functioning anxiety, there are several potential emotional symptoms that may arise:4
- Excessive worrying
- Feeling restless or edgy
- Increased irritability
- Feeling out of control or that something terrible is about to happen
- Issues concentrating or remembering
- Intense fear connected to certain people, places, or things
The Sneaky Signs of High Functioning Anxiety
Often, outsiders cannot see the physical or emotional symptoms of high functioning anxiety when they are present.
If you’re interested in identifying high functioning anxiety in someone else, here are some signs to look for:
- The tendency to stay inside or away from crowds
- The need for control over the situation or decisions
- A strong drive to work on something until it is completed
- Perfectionist traits
- Going to bed late or getting up early to complete a project
- Appearing dissatisfied or annoyed when others attempt to help a situation
- Blaming others for their stress
- Avoiding vacations or free time
- Always looking busy and engaged in some activity
- Being distracted or inattentive when someone is speaking
It’s important to note that people with high functioning anxiety may display no outward symptoms. To friends or family members, they may like a happy and healthy individual who is capable of great achievements.
Causes of High Functioning Anxiety
The causes and triggers of high functioning anxiety include numerous biological and environmental elements, from family genetics to traumatic events. Some people will have a strong biological predisposition to high functioning anxiety from birth, while others will be significantly influenced by the characteristics of their life experiences.
Some of the most common causes and triggers of high functioning anxiety include:4
- Certain personality traits like being shy and quiet
- Being exposed to trauma during childhood like abuse, trauma, living in dangerous areas, and family chaos
- Relatives who have anxiety disorders or other mental health conditions
- Substance misuse, especially when the substance used is a stimulant like cocaine, caffeine, or medications for attention-deficit/hyperactivity disorder (ADHD) as these can create higher levels of anxiety
- Thyroid or heart problems, since these may create or worsen symptoms of anxiety
In some situations, a person could have just one cause of high functioning anxiety and that will be enough to produce symptoms. Other times, the individual could have multiple causes without fully experiencing the effects of high functioning anxiety.
Negative Characteristics
Having any form of anxiety is an uncomfortable experience that will make each day challenging. Not only will people with high functioning anxiety have to navigate the daily struggles of work, school, or at-home responsibilities, but they will have to do so with anxiety symptoms.
Worry, physical tension, uncertainty, stress, and other signs of anxiety will be present on a regular basis, but people with high functioning anxiety may feel like their condition is a secret that they cannot share with the world. They may also face some level of disbelief and doubt from others who question the presence of symptoms, since they can function so well.
Positive Characteristics
Other people with high functioning anxiety may see their symptoms as a gift that pushes them to be motivated and driven to perform at high levels. Without a small amount of anxiety, they might not be able to accomplish their goals.
Anxiety as a tool has some scientific backing. Called the Yerkes-Dodson Law, this principle states some levels of anxiety are positively correlated to increased performance at work, school, or home.2 When anxiety is too high or too low, performance suffers. Some people with high functioning anxiety may strike the desired balance between their stress and productivity. However, others might be able to function short-term, but something like work anxiety can start small and become a problem if not addressed.
How Someone’s “Level of Anxiety” Is Determined
Anxiety is often diagnosed by a standard set of questions and assessments done over a period of time with a licensed professional like a therapist or your primary care physician. The level of that anxiety can be hard to determine as everyone’s “baseline” of symptoms can be different. The way we determine the level of anxiety is by looking at how symptoms of anxiety are managed day-to-day and how much someone’s symptoms impact their responsibilities and ability to function.
9 Ways to Cope With High Functioning Anxiety
High functioning anxiety is problematic and uncomfortable, but there are ways to survive and thrive with the condition, and learn to calm your anxiety on your own. Those with high functioning anxiety must avoid “quick fixes” and too-good-to-be-true schemes. Lifestyle changes can help alleviate anxiety, but only with consistency.
Here are nine coping strategies to try that can work well for those with high functioning anxiety:6
1. Learn More About Anxiety & Your Specific Triggers
Before you can effectively cope with a situation or sensation, you have to understand your anxiety triggers. Take time to gather information about your anxiety, what triggers it, and how you normally respond when triggered.
2. Work Towards Acceptance
You cannot always control your anxiety or the people, places, and things that trigger it. Accept what you cannot change, or anxiety will continue.
3. Reflect on Any Potential Positives
Anxiety is a huge problem that adds complications to your life, but is there anything good about it? Spend time thinking about that balance between stress and productivity and consider other positives that this tension could bring.
4. Practice Active Relaxation
Too many people think that relaxation means staring at their phone or taking a nap, and though these are helpful, anxiety requires active relaxation. This concept means setting aside time to practice relaxation techniques like havening, breathwork, and progressive muscle relaxation.
5. Avoid Negative Coping Mechanisms
Quick fixes like drugs, alcohol, reckless sex, and spending may seem like a fantastic solution to anxiety, but they only bring about greater harm. Keep the coping skills positive.
6. Share Your Situation With Loved Ones
When people don’t realize what you are going through, it is impossible for them to help. Make sure the loved ones that you trust understand what you’re going through, because they want to support you.
7. Join a Support Group or Community Talking About Anxiety
Anxiety support groups are a way to build a sense of community with other anxious people while gaining helpful strategies. Online or in-person groups are good options.
8. Look at the Big Picture
Someone with anxiety may become so focused on one facet of life that it becomes consuming. Zoom out to look at all that life and the world around have to offer.
9. Practice Unconditional Self-Compassion
Patience, support, and kindness are signs of a true friend, but how much have you been giving yourself? Save some of that love and understanding for when you need it the most.
Alone, these coping skills may not be enough to completely shift your anxiety, but adding them to lifestyle changes and professional treatments from therapists and prescribers can help the cause. Experiment and adjust along the way to find the combination that works for you and your symptoms.
High Functioning Anxiety Treatment
The most effective treatments for anxiety include psychotherapy, medication management, or a combination involving both. No matter the professional treatments, a set of lifestyle changes will further boost the treatment effects. With a concerted effort and dedication, a person with high functioning anxiety can manage their condition and reduce unwanted symptoms.
Therapy
Therapy for anxiety disorders and worry involves a person meeting with a therapist in a one-on-one, group, or family setting to assess the current level of issues and plan helpful strategies to reduce symptoms. The therapist will propose a treatment plan that involves the target symptoms as well as the therapeutic interventions used in therapy and the coping skills the client will gain throughout the process.4
Common types of therapy for anxiety include:
- Cognitive behavior therapy (CBT): The most common, and perhaps most effective, form of therapy for anxiety symptoms and anxiety disorders.4
CBT involves meeting with a therapist to review the client’s thoughts, feelings, and behaviors that contribute to anxiety, and to plan ways to shift these in another direction. - Acceptance and commitment therapy (ACT): Focused on helping people live in the moment and accept the present without judgment as a way to cope with discomfort.5
- Dialectical behavioral therapy (DBT): A blend of CBT skills with Eastern mindfulness techniques that strives for acceptance and change.5
- Eye movement desensitization and reprocessing (EMDR): a way to reduce the disturbing thoughts commonly linked to anxiety disorders like panic disorder and phobias.5
Medication
Psychiatrists, nurse practitioners, primary care physicians, and a number of providers may prescribe medications for anxiety. The medications can increase levels of calm by regulating certain chemicals in the brain. Prescribers may utilize trial and error to find the most helpful medication, so people using medication to alleviate symptoms must be patient. Also, they should always inform their prescriber of any unwanted side effects and issues caused by the medication.4
When to Ask for Help for High Functioning Anxiety
As long as a person is ready and willing to admit the need for treatment, accessing quality care for anxiety is a simple process. A quick phone call, a stop in the doctor’s office, or a few minutes of searching online is all it takes to find a treatment team ready to start the process of anxiety recovery.
If you need help finding a therapist, online therapist directories offer access to many therapists all in one easy to use tool. Be sure to ask what the average waiting time is for any therapist you’re considering, and if medication management options are available as well.
How to Get Help for a Loved One
If your loved one is not convinced of the need for treatment, getting them help for their anxiety can be complicated. You may want to kindly offer some reasons why anxiety therapy and/or medication could be helpful for them. Providing them with local treatment providers, being by their side while making the appointment, and heading to the appointment with them are all great ways to show your concern and support.
Throughout the process, make sure to let them know you are always on their side. Discuss the appointments and treatments with them as much as they are comfortable. Always continue the conversation about mental health and make yourself available.
Final Thoughts
While not debilitating, living with high functioning anxiety can be exhausting. Learning some new coping mechanisms from a therapist, or even just talking with a trusted friend or loved one about how you feel, can make a big difference in your anxiety levels.
High Functioning Anxiety Infographics
