Why High-Functioning Anxiety Isn’t Always Obvious

Imagine someone who is Type A, driven, outgoing, highly organized, detail-oriented, and high achieving. They have a successful career, a loving family, and a good head on their shoulders. They don’t seem like someone who struggles with anxiety. What’s there to worry about when their life appears to be perfect? High-functioning anxiety isn’t obvious for many reasons. Those who experience it are very good at hiding their worries.

What is High-Functioning Anxiety?

High-functioning anxiety isn’t officially listed as a condition in the Diagnostic and Statistical Manual of Mental Disorders. It refers to individuals who experience symptoms of anxiety but continue to function relatively well. Their anxiety doesn’t impair their ability to carry out their daily activities. In fact, for some, their distress serves as a driver for their success.

Despite their heightened anxiety, people with high-functioning anxiety often make it look like they’re not struggling at all. Those with high-functioning anxiety often excel at their work, relationships, and other areas of their life. It can be challenging to recognize their pain because they are so good at pretending everything is fine. 

Signs of High-Functioning Anxiety

Generally, symptoms of high-functioning anxiety are similar to those of Generalized Anxiety Disorder (GAD). However, someone with high-functioning anxiety is better at hiding them. Their symptoms do not interfere with their daily functioning. Signs of high-functioning anxiety include the following:

Overachievement

Individuals with high-functioning anxiety often set high standards for themselves. They strive for perfection in many aspects of their lives. They are driven by an intense fear of failure and overplan and overthink everything. 

This puts them on a mission to perform well in their careers, academics, and/or personal pursuits. Although they can often reach their goals, they experience inner turmoil where they don’t believe they are good enough, no matter how much they achieve.

Constant Worrying

Excessive worry and fear are common characteristics of high-functioning anxiety. Individuals may ruminate on potential future problems or dwell on past mistakes. Their mind is frequently preoccupied with “what if” scenarios, which puts them in a perpetual state of anticipation.

Physical Symptoms

The constant worrying and overthinking may cause those with high-functioning anxiety to experience physical symptoms. These include fatigue, muscle tension, headaches, digestive issues, or difficulty sleeping.

Difficulty Winding Down

It’s challenging for individuals with high-functioning anxiety to relax and enjoy the present moment. They persistently need to stay busy or check off tasks on their neverending to-do list. 

Excessive Need for Reassurance

High-functioning anxiety causes the person to doubt their skills and abilities. They have a deep fear of making mistakes. Therefore, they constantly seek reassurance from others to make sure they are doing things right. This might mean asking others to double or triple-check their work or procrastinating because they worry they will do something wrong.

Social Anxiety

Despite having many friends and a strong network, individuals may experience social anxiety. They may appear to be calm and collected in social situations. However, they often worry about how they are perceived and fear judgment from others.

Difficulty Saying No

People pleasers tend to suffer from high-functioning anxiety. They overcommit and find it difficult to say no to additional responsibilities or tasks. They struggle to be assertive and set boundaries with others. Their social lives are often jam-packed, and they value being overly busy and having an overcrowded schedule.

Why Are Those With High-Functioning Anxiety So Good at Hiding Their Internal Struggle?

People with high-functioning anxiety are often adept at hiding their struggles for several reasons. 

Social Expectations

Societal expectations and norms often emphasize strength, resilience, and success. There’s a ‘no pain, no gain’ narrative that glorifies working more than we can handle. Society promotes being busy and productive and overscheduling as the only way to reach your dreams. It also encourages the belief that we are supposed to overcome any obstacles that come in the way of our goals and dreams. They are seen as opportunities to challenge ourselves, and giving up or changing directions is a sign of weakness. 

Therefore, individuals feel pressure to conform to these expectations. They want to conceal their anxiety to maintain a positive image.

Mental Health Stigma

Sadly, there is still a stigma around mental health issues. An individual with high-functioning anxiety may view their struggles as a weakness. They may believe others will judge them and think they are weak.

Seeking external validation is common among individuals with high-functioning anxiety. They may derive a sense of worth and identity from external achievements and positive feedback. This reinforces their desire to maintain a facade of success.

Many individuals with high-functioning anxiety have perfectionistic tendencies. They may strive for flawlessness in their work and personal lives. This can cause them to want to project an image of having everything under control.

There might be concerns about how disclosing mental health challenges could impact their work or professional image. They pride themselves on maintaining a flawless reputation. Therefore, they may mask their mental health struggles due to their fear of discrimination or negative consequences to their career.

Too Effective Coping Mechanisms

Individuals with high-functioning anxiety may develop effective coping mechanisms that allow them to function well despite their internal struggles. These coping strategies might involve compartmentalizing difficult emotions or maintaining a busy schedule to distract from anxiety.

Self-reliance is one of the coping mechanisms people with high-functioning anxiety often develop. They may be conditioned to manage their challenges independently. They might hesitate to share their struggles with others and ask for help.

Causes of High-Functioning Anxiety

There isn’t a well-understood explanation or cause for why someone would develop high-functioning anxiety. Multiple factors contribute to its risk. For instance, genetics may play a role. If someone in your family has an anxiety disorder, you may be predisposed to developing it, too. Additionally, women are more likely to develop General Anxiety Disorder (GAD).

Anxiety can be triggered for those who have experienced stressful events or trauma or are exposed to adverse environments. For instance, children who are raised by caregivers who have impossibly high expectations may contribute to their anxiety. Their caregivers emphasize a mission to succeed no matter what. The child grows up believing that their self-worth is solely tied to the achievement of their goals. They fear failure and are deeply insecure about their abilities. 

Lastly, having a certain personality is associated with high-functioning anxiety. Examples of traits include perfectionism, overanalyzing, and controlling. 

Treatment Options and Coping Strategies

Even though high-functioning anxiety doesn’t always manifest in obvious ways, it’s important to recognize that it is a valid and impactful experience. Seeking support from mental health professionals can be beneficial in managing anxiety symptoms and developing coping strategies.

Therapy (Counseling)

Cognitive-Behavioral Therapy (CBT) helps you identify and change negative thought patterns, beliefs, and behaviors. Exposure Therapy gradually exposes you to anxiety-inducing situations to build tolerance. Antidepressants or anti-anxiety medications are sometimes prescribed to manage symptoms.

Psychedelic Therapy

There has been a recent surge of interest in the potential of psychedelics in treating mental health conditions. Psychedelic therapy for anxiety is a new approach that appears to be promising. In 2024, LSD received a Breakthrough Therapy designation by the FDA after a trial of 198 individuals showed a single LSD dose without psychotherapy rapidly reduced anxiety symptoms with clinically meaningful improvements lasting at the 12-week time point.

Other studies are looking at microdosing as a way to reduce anxiety symptoms. Microdosing involves taking sub-hallucinogenic, repeated doses of psychedelic substances.

Research has also shown that full doses of psilocybin or MDMA may be effective for treating anxiety-related conditions.

Lifestyle Changes

Getting regular exercise and eating a balanced diet can help reduce anxiety and improve mood. Adopting healthy sleep habits can improve your quality of rest and help you feel better. 

Mind-Body Techniques

Incorporating various mind-body techniques that promote mindfulness can help you wind down. Practicing mindfulness can help you stay in the present moment and manage overwhelming thoughts. Techniques include deep breathing exercises, muscle relaxation, yoga, meditation, guided imagery exercises, and acupuncture.

Coping Strategies

Other coping strategies that can help with high-functioning anxiety are:

• Improving self-awareness: Develop awareness of your triggers and early signs of anxiety.
• Boundary Setting: Learn to say no and establish healthy boundaries to manage stress.
• Time Management: Organize tasks and prioritize responsibilities to reduce feelings of overwhelm. Streamline your to-do lists and only focus on the most important tasks.
• Social Support: Opening up about high-functioning anxiety can be a crucial step toward understanding and managing these challenges. Sharing feelings with trusted friends or family members can provide emotional support and help reduce the stigma associated with seeking help.
• Creative Outlets: Engaging in creative activities or hobbies such as painting, dancing, drawing, or writing can be a great form of self-expression to destress and calm the mind.

It’s important to note that what works for one person may not work for another. A combination of approaches is often the most effective. Seeking guidance from mental health professionals can provide personalized strategies tailored to your needs.

References

Arlin Cuncic. (2017, May 22). The Characteristics of High Functioning Anxiety. Verywell Mind; Verywell Mind. https://www.verywellmind.com/what-is-high-functioning-anxiety-4140198

Chang, J. (2023, January 27). What Is High-Functioning Anxiety? NewYork-Presbyterian. https://healthmatters.nyp.org/what-is-high-functioning-anxiety/

Cleveland Clinic. (2022, May 16). Signs You Have High-Functioning Anxiety. Cleveland Clinic. https://health.clevelandclinic.org/what-is-high-functioning-anxiety

Ellen, R. (2023, June 20). What Is High Functioning Anxiety? https://www.psycom.net/anxiety/high-functioning-anxiety

Gardner, A. (2022, July 30). What Is High-Functioning Anxiety–and Could You Have It? Health.com. https://www.health.com/condition/anxiety/high-functioning-anxiety-disorder-symptoms

Mayo Clinic Health System. (2023, July 11). Managing high-functioning anxiety. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/managing-high-functioning-anxiety

Queensland Health. (2023, January 16). What is high-functioning anxiety, and do I have it? Queensland Health. https://www.health.qld.gov.au/newsroom/features/what-is-high-functioning-anxiety-and-do-i-have-it