High-functioning anxiety describes someone who experiences chronic worry, stress, or obsessive thoughts but appears to have everything under control. These individuals often seem successful and might even be seen as overachievers. However, beneath this exterior, they might grapple with a deep fear of failure and self-doubt, feeling a constant pressure to maintain their perfect facade.
In fact, many people live with anxiety while continuing to perform well in their personal and professional lives. A recent survey found that around 13 million people had an anxiety disorder in the past year, with 6 million of them actively working. This highlights how common it is to struggle internally with anxiety while outwardly managing to keep things together.1
What Is High-Functioning Anxiety?
High-functioning anxiety is a term used to describe people who experience anxiety symptoms but are still able to function well in their daily lives. They may appear composed and capable, but internally they are often struggling with worry, fear of failure, and self-doubt. People with high-functioning anxiety are often high achievers, and their anxiety goes unnoticed because they seem to be functioning well. Internally, high-functioning anxiety can leave a person constantly stressed and exhausted, making it difficult for them to enjoy themselves.
Would You Like to Have Less Anxiety?
Anxiety is treatable with therapy. BetterHelp has over 30,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week and is FSA/HSA eligible by most providers. Take a free online assessment and get matched with the right therapist for you.
High Functioning Anxiety Symptoms
People with high-functioning anxiety often display no outward signs, appearing to friends, family, and acquaintances as happy, healthy, and highly capable individuals. Despite this outward appearance, they may still struggle internally. Symptoms can manifest in various ways, impacting the body physically, mentally, and emotionally.
Mental and emotional symptoms of high-functioning anxiety include:2
- Excessive worry and rumination: Individuals with high-functioning anxiety often have constant and intrusive worries about various aspects of life, even minor things, that can be difficult to control. One will likely ruminate on past events or experiences, often focusing on perceived mistakes or regrets.
- Perfectionism: Perfectionism and anxiety go hand-in-hand. Those with high-functioning anxiety set unrealistically high standards for themselves, which often leads to disappointment, frustration, and self-criticism.
- Feeling restless or edgy: Individuals with high-functioning anxiety can have a general sense of unease, nervousness, or feeling on edge, even when there’s no apparent reason.
- Fear of criticism or judgment: High-functioning anxiety leads to an overwhelming fear of being judged negatively, resulting in avoidance of social situations or excessive efforts to gain approval.
- Increased irritability: People with high-functioning anxiety often experience heightened irritability, feeling easily annoyed or frustrated.
- Procrastination: Individuals with high-functioning anxiety may chronically procrastinate due to fear of not performing them perfectly or to avoid anxiety-provoking situations.
- Difficulty concentrating: Struggling to focus on tasks due to intrusive anxious thoughts is a symptom of high-functioning anxiety.
- Negative self-talk: Frequently engaging in negative self-talk and doubting one’s abilities or worth is often seen in high-functioning anxiety.
- Imposter syndrome: Those with high-functioning anxiety may have imposter syndrome and feel like a fraud despite evidence of competence and success, fearing being “found out.”
- Avoidance behavior: People with high-functioning anxiety may struggle with avoidance behaviors, avoiding certain activities, places, or people that trigger their anxiety, even if these activities are beneficial or necessary.
Physical symptoms of high-functioning anxiety include:2
- Mental exhaustion: Feeling mentally exhausted due to constant worry and overthinking is a hallmark of high-functioning anxiety. One may also struggle with anxiety-induced brain fog.
- Physical fatigue and tiredness: People with high-functioning anxiety often have difficulty starting the day feeling refreshed and experience exhaustion throughout the day, even after a good night’s sleep.
- Headaches, muscle tension, or gastrointestinal issues: Tightness, soreness, or aches in different muscle groups, particularly in the neck, shoulders, and back, are common in high-functioning anxiety. Headaches and stomachaches can also occur frequently.
- Sleep problems: Anxiety-induced insomnia due to racing thoughts, waking up frequently during the night, or waking up early and not being able to fall back asleep are typical sleep issues associated with high-functioning anxiety.
- Changes in heart rate: Heart palpitations, feeling like your heart is pounding or racing, or a noticeably quicker pulse, especially during periods of stress or worry, are physical symptoms of high-functioning anxiety.
- Nail biting or skin picking: Engaging in body-focused repetitive behaviors like nail-biting, skin picking, or other similar habits can be a way to cope with anxiety.
- Increased sweating: Sweating more than usual, such as hands becoming clammy or experiencing episodes of sweating for no apparent reason, can be a sign of high-functioning anxiety.
- Feeling shaky: Tremors or shakiness in the hands, voice, or legs, particularly in social situations or during anxious episodes, are common physical manifestations of high-functioning anxiety. One may also experience tingling in the face due to anxiety.
- Decreased libido: Experiencing a reduced interest in sexual activities can also be a symptom of high-functioning anxiety.
Negative Impacts of High-Functioning Anxiety
Having any form of anxiety is difficult, and high-functioning anxiety presents unique challenges. A person with high-functioning anxiety often appears to have everything under control, but they constantly battle internal worry and stress. Because they seem capable and successful on the outside, others might not believe they have anxiety, which can make them feel isolated and frustrated. The pressure to keep their anxiety hidden adds to their daily struggle, making it exhausting to maintain the façade of normalcy.
High-functioning anxiety can also impact a person’s relationships. Their need for perfection and control can cause misunderstandings and conflicts with family and friends. Others may not understand why they are so stressed and might misinterpret their behavior as being distant or irritable. Additionally, making new friends can be difficult, as individuals with high-functioning anxiety might be overly critical of themselves in social settings. This constant self-criticism can make it difficult to be fully present and connect with others on a deeper level.
In the workplace, their high standards and strong work ethic can lead to professional success, but it also increases the risk of burnout. A person with high-functioning anxiety might also find it challenging to collaborate with colleagues because they are stuck in a perfectionism-procrastination cycle.
Advantages of High-Functioning Anxiety
Some 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 would not have the same standards of perfectionism and drive to prove themselves and, therefore, may not be able to accomplish their goals.
In fact, anxiety as a helpful tool has some scientific backing. This idea, known as the Yerkes-Dodson Law, suggests that a certain amount of anxiety can boost a person’s performance at work, school, or home.3 When their anxiety is balanced—not too high or too low—they might find themselves more productive and effective.
Options for Anxiety Treatment
Talk Therapy – Get help from a licensed therapist. Betterhelp offers online therapy starting at $60 per week and is FSA/HSA eligible by most providers. Free Assessment
Psychiatry for Anxiety – Looking for anxiety treatment that prioritizes you? Talkiatry can help. Find an in-network psychiatrist you can see online. Get started with our short assessment. Visit Talkiatry
How to Manage High-Functioning Anxiety
High-functioning anxiety can be tough and uncomfortable, but there are ways to not only cope but also thrive. Start by acknowledging your anxiety and understanding that it’s okay to feel this way. Then, focus on making lifestyle changes that can help calm your anxiety over time. It is important to learn and practice relaxation techniques to help calm your mind. Additionally, prioritize self-care by regularly exercising, eating well, and getting enough sleep. Remember, consistency in these habits is key, and over time, you’ll find that you can navigate your anxiety more effectively.
Here are ten coping strategies and some worksheets that can help you calm your high-functioning:4
1. Learn More About Anxiety & Your Specific Triggers
Understanding your anxiety is the first step in managing it. Spend some time learning about what specifically triggers your anxiety. Is it certain situations, people, or places? Notice how your body and mind respond when you’re triggered. Keeping a journal about your anxiety can be helpful to track patterns and reactions. This self-awareness will empower you to anticipate and prepare for anxiety-inducing situations more effectively.
Worksheets for High-Functioning Anxiety
2. Practice Active Relaxation
Relaxation isn’t just about passive activities like watching TV or napping; it also involves active relaxation techniques that directly target anxiety. Try incorporating practices like deep breathing exercises, progressive muscle relaxation, or havening techniques into your routine. Setting aside dedicated time for these activities can help train your body and mind to relax more effectively. There are many different apps, such as Headspace or Calm, that make practicing relaxation techniques easy.
3. Take Care of Your Physical Health
Your physical health is closely linked to your mental well-being. Make sure you’re getting regular exercise, eating a balanced diet, and staying hydrated. Physical activity can reduce anxiety and improve your overall mood. Taking care of your body can help you feel more capable of managing your anxiety.
4. Share Your Situation With Loved Ones
Opening up to loved ones about your anxiety can be incredibly beneficial. They may not understand what you’re going through unless you share it with them. Trusted friends and family members can offer support, understanding, and practical help when you need it most. Let them in on your struggles and learn to ask for help when you need it, so they can be there for you.
5. Limit Caffeine & Sugar Intake
Sugar and caffeine can exacerbate anxiety symptoms. Pay attention to your diet and consider reducing your intake of these substances. Opt for a balanced diet rich in whole foods, which can support overall mental health.
6. Avoid Negative Coping Mechanisms
It’s easy to fall into the trap of using quick fixes like drugs and alcohol to cope with anxiety, but these can lead to greater harm in the long run. Instead, focus on healthy coping mechanisms that promote long-term well-being. Activities like exercise, engaging hobbies, or talking to a friend can provide relief without the negative consequences.
7. Look at the Big Picture
Anxiety can narrow your focus, making it hard to see beyond your immediate concerns. Try to zoom out and look at the bigger picture. What else is happening in your life that brings you joy or fulfillment? Broadening your perspective can help put your anxiety into context and remind you of the many positive aspects of your life.
8. Reflect on Any Potential Positives
While anxiety is often seen as a negative force, it can also have its positives. For instance, the drive to achieve and perform well can be partly fueled by anxiety. Think about how your anxiety might be helping you stay organized or motivated. Finding these silver linings can help you develop a more balanced view of your anxiety and its role in your life.
9. Practice Unconditional Self-Compassion
Be kind and patient with yourself, just as you would with a friend going through a tough time. Self-compassion and loving yourself involve treating yourself with the same understanding and support you offer others. Remind yourself that it’s okay to struggle and that you’re doing your best. Self-care, mental health gifts, and loving-kindness meditations are great ways to practice self-compassion.
10. Join a Support Group or Community Talking About Anxiety
Connecting with others who experience anxiety can provide a sense of community and shared understanding. Support groups, whether online or in-person, offer a space to discuss your experiences, learn new coping skills for anxiety, and feel less isolated. These groups can be a valuable resource for support and practical advice.
When to Seek Professional Support
If you find that your anxiety is interfering with your daily life, relationships, or job performance, it’s time to consider getting help. It’s also important to reach out if your usual coping mechanisms are no longer effective or if you’re relying on unhealthy habits like excessive drinking, substance use, or avoiding responsibilities to manage your anxiety.
To find professional support, start by talking to your primary care doctor, who can provide referrals to mental health professionals. You can also use an online therapist directory to research therapists who specialize in anxiety disorders. Online therapy services like BetterHelp or Talkspace are also excellent options, offering convenience and access to licensed therapists from the comfort of your home.
How to Ask for Help With High-Functioning Anxiety
Asking for help with high-functioning anxiety can be difficult because you may feel like you should be able to handle things on your own, especially if you appear successful and composed on the outside. However, it’s important to remember that everyone needs support sometimes, and seeking help is a sign of strength, not weakness. To push past the stigma surrounding mental health, start by confiding in someone you trust, whether it’s a friend, family member, or mentor. Opening up about your feelings can be incredibly liberating and is the first step towards getting the support you need.
Would You Like to Have Less Anxiety?
Anxiety is treatable with therapy. BetterHelp has over 30,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week and is FSA/HSA eligible by most providers. Take a free online assessment and get matched with the right therapist for you.
High-Functioning Anxiety Treatment
Treatment for anxiety often involves a blend of therapy, mindfulness practices, and sometimes medication. Therapy helps by challenging and reframing those anxious thoughts, while mindfulness can ground you in the present, reducing the hold anxiety has on your daily life. In addition to therapy, there are many different anti-anxiety medications that can increase levels of calm by balancing certain chemicals in the brain. Finding the right medication can be a bit of a trial-and-error process, so it’s important to be patient.2
Common types of therapy for anxiety include:
- Cognitive behavioral therapy (CBT): CBT for anxiety is the most common, and perhaps most effective, form of therapy for high-functioning anxiety. It involves meeting with a therapist to review your thoughts, feelings, and behaviors that contribute to anxiety and learn to replace them with more balanced and realistic perspectives.2
Acceptance and commitment therapy (ACT): ACT for anxiety is focused on helping people live in the moment and accept the present without judgment as a way to cope with discomfort. This approach is valuable for those with high-functioning anxiety as it emphasizes accepting anxious thoughts and feelings rather than fighting them and instead focusing on living a meaningful life.5 - Dialectical behavior therapy (DBT): For those with high-functioning anxiety, DBT for anxiety offers tools to manage intense emotions and improve interpersonal relationships, which are often sources of stress. The mindfulness aspect helps individuals stay present and reduce anxiety about the future, while the skills for emotion regulation and distress tolerance provide practical strategies for managing anxiety when it arises.5
- Mindfulness-based stress reduction (MBSR): Mindfulness practices, such as meditation and deep breathing, can help individuals with high-functioning anxiety stay present and reduce worry about the future. MBSR programs teach mindfulness techniques that can lower stress and anxiety, promoting a sense of calm and balance.
Causes of High-Functioning Anxiety
High-functioning anxiety can be quite complex, with its roots often lying in a mix of biological and environmental factors. Some people might have a genetic predisposition to anxiety, and they’re more likely to experience it from a young age. On the other hand, life experiences play a significant role too. Traumatic events, stressful situations, or even the pressure to perform well can trigger or worsen anxiety. It’s really a blend of these elements—your genetic makeup and the things you go through in life—that shape how anxiety manifests.
How to Get Help for a Loved One With High-Functioning Anxiety
If your loved one isn’t convinced they need treatment for their anxiety, it can be a bit tricky to navigate getting them help for their anxiety. You might want to gently suggest some reasons why therapy or medication could be beneficial for them. Offering to find local treatment providers and even going with them to the appointment can really show your support. Being there every step of the way can make a big difference.
Let them know you’re always on their side, and discuss the appointments and treatments as much as they’re comfortable with. Sometimes, it takes time for someone to be ready to seek help, and they might need to hear your suggestions more than once.
In My Experience
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.
Frequently Asked Questions
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.
Can You Have Anxiety & 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.
How Can I Know If Someone Else Has 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:
- Perfectionist traits
- Being distracted or inattentive when someone is speaking
- Going to bed late or getting up early to complete a project
- Appearing dissatisfied or annoyed when others attempt to help a situation
- A need for total control over the situation or decisions
- A tendency to stay inside or away from crowds
- Blaming others for their stress
- Avoiding vacations or free time
High Functioning Anxiety Infographics
Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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4.3 Million Adults Who Are Employed Full Time Had a Past Year Anxiety Disorder. (n.d.). https://www.samhsa.gov/data/sites/default/files/report_1968/Spotlight-1968.html
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Anxiety disorders. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/anxiety-disorders
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Gino, F. (2024, March 27). Are you too stressed to be productive? or not stressed enough? Harvard Business Review. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough
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Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
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Tips and strategies to manage Anxiety and stress | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/tips
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Author: Eric Patterson, LPC (No Change)
Reviewer: Lynn Byars, MD (No Change)
Primary Changes: Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LPC (No Change)
Reviewer: Lynn Byars, MD (No Change)
Primary Changes: Added sections titled”Can You Have Anxiety and Not Know It?”, “High Functioning Anxiety and Depression,” and “How Someone’s Level of Anxiety Is Determined.” New material written by Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C, and medically reviewed by Kristen Fuller, MD. Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LPC (No Change)
Reviewer: Lynn Byars, MD (No Change)
Primary Changes: Added sections titled “Signs of High Functioning Anxiety” and “9 Ways to Cope With High Functioning Anxiety.” New sections reviewed by Dena Westphalen, PharmD. Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LPC
Reviewer: Lynn Byars, MD
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