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What Is High Functioning Anxiety?

What Is High Functioning Anxiety?

Updated on May 27, 2022

Reviewed by Dr. Nereida Gonzalez-Berrios, MD , Certified Psychiatrist

High functioning anxiety - Symptoms, Causes, and Treatment

Do you always live in a state of mental agitation and anxiety? Are you a perfectionist who always looks for high achievement? 

Do you prefer to put everything together in its perfect place, nothing of the way? Inside, you’re suffocating, yet performing flawlessly. 

If you are an anxious over-achiever walking around with these high levels of anxiety, you could be suffering from a mental health condition known as high functioning anxiety.

This type of anxiety actually propels you to perform well rather than freeze you in fear and agony. On the surface, you may look absolutely poised and picture-perfect. But, deep down you are suffering like hell.

You appear sociable, vibrant, dynamic, and successful to others, yet the dark corners of ‘you’ tell another grim story of pain and suffering.

To know more about the symptoms of this condition and how you can help yourself, stay tuned and continue reading….

High Functioning Anxiety Infographic

What Is High Functioning Anxiety
High Functioning Anxiety – Signs & Treatments

What is High functioning anxiety?

High functioning anxiety involves intense signs of worry and fret, yet the person can function normally in his/her day-to-day life. The person is busy, orderly, and an overachiever from outside, but dwells and simmer in doubt and fear.

High functioning anxiety is not a diagnosable clinical condition in DSM -5. People with this condition are detail-oriented, perfectionists types. They prefer to taste success at every footstep and avoid failures by any means.

They are the over-achievers who live in a constant state of anxiousness and worry. There is seldom any sign of anxiety that appears on the surface and disturbs their everyday schedule.

People with high functioning anxiety do not have obvious symptoms. Thus, their ability to function never gets disrupted. They always overthink and suffer from anticipatory anxiety.

The worries pervade every inch of their mind and body, but never show up as a mental health disorder.

The term high functioning anxiety means two distinct conditions.

  • The person has mild or moderate anxiety symptoms that do not interrupt their routine lifestyle and functioning.
  • The stress and worry that the person goes through act as a driving force to perform at the best levels. And thus, it is not regarded as a typical anxiety disorder.

One prominent thing about high functioning anxiety is it is a sub-clinical condition that is always present in the medical news.  But it gets less diagnosed because it doesn’t meet the diagnostic criteria for anxiety disorders in DSM -5.

If you are suffering from this condition, chances are high that you’ll not feel that your anxiety is debilitating and is holding you back in realizing your life goals.

Most people suffering from high functioning anxiety are sociable. They have a vibrant social life that may appear shiny and bright. You’re helpful and never turn down the requests of friends, family, and colleagues.

Your anxiety never freezes you in fear and despair rather turns you towards people-pleasing tendencies. What’s more in store? You are energetic and prefer to follow schedules.

A busy and cheerful life may make you look picture perfect in others’ eyes but the deepest corners are filled with fear, agony, insecurity, dread, and disappointments.

How does it feel to have high functioning anxiety?

High functioning anxiety leads to endless racing thoughts and the person is never at ease.

Sometimes, you may feel consumed by your anxious thoughts and are unable to put them on pause. Most of the time, the thoughts turn into endless rumination and make you worrywart.

You will manage your anxiety with smiles and laughter so that the world feels that everything is fit and fine with you. Ironically, your nervous state of mind drives you towards success and keeps you going all the time.

But, deep within, you’re broken into pieces, somehow trying to put the pieces of ‘you’ in one place. You have tried a lot to be better, to succeed more, and achieve the impossible. 

With a fair dose of brashness and extroversion, you have tried to hide your anxiety and pushed it into a dark corner that you want to get exposed to one day.

If you are suffering from this mental health condition, you must have seen that your nervous energy makes you work round the clock.

You may be the first one to reach the office every day so that you can always be on time. Failures irk you and success drives you towards more perfection. Maybe you have pushed hard your boundaries, never to miss a deadline.

Others may not see your pain and suffering. The constant churning of worries and wounds has left you weak but still, you are functioning normally, just to hide what it really is.

You’ll be fully functional in your daily life, maintaining work-life balance as well as possible. Sometimes, you’ll be the best in handling finances and maintaining relationships.

At the core, you struggle with anxiety, worry, threat, and despair. If this condition remains with you for too long, you might end up having a diagnosable mental illness sooner than expected.

High functioning anxiety symptoms

People with high functioning anxiety do not show any outward symptoms of anxiety and thus it might not be diagnosed at all. Many sufferers go through lifelong agony without any medical treatment.

We know that any form of anxiety is challenging, even if it appears asymptomatic. The person goes through a lot of wear and tear. 

An array of physical and emotional symptoms can occur depending upon the impact of the disorder on a person’s thoughts, feelings, and actions.

The intensity of symptoms varies from person to person and no two people can actually think and behave in similar ways. The signs and symptoms of high functioning anxiety are as follows:

  • Physical symptoms
  • Emotional symptoms
  • Behavioral troubles

Physical symptoms

A person with high functioning anxiety may not manifest the typical fear responses and physical manifestations of anxiety disorders.

They will not have intense physical health problems in face of stress. The likely physical reactions could be – 

  • Sweating
  • Changes in heart rate
  • Slight breathing discomfort
  • You will easily get tired
  • Slight muscle tension
  • Sleep disturbances
  • An inability to sit idle 
  • Numb sensations in legs and hand, though mild
  • Quick pulse rate

Emotional/Psychological symptoms

Apart from the physical symptoms, there is a list of psychological and emotional symptoms that people with high functioning anxiety manifests on a regular basis.

  • Excessive worries that remain in a covert state
  • Feelings of mental restlessness and irritability
  • Mood swings
  • Feeling that something worse is going to happen
  • Always anticipate the worst
  • Constant whirlpool of negativity
  • Low attention span
  • Intense fear related to a person or situation
  • Deep-seated insecurities
  • Tendency to please others to avoid conflicts
  • Fear of failure
  • Inability to handle criticisms
  • May get frustrated in times of setbacks

Behavioral troubles

High functioning anxiety manifests in people who push themselves hard to achieve even the impossible.

In this way, they stretch their limits and suffer from behavioral troubles. Over a period of time, the symptoms may bring a host of physical and mental health issues as well.

  • You will endure long working hours
  • Over thinking about not doing enough 
  • There is a lot of struggle in saying ‘no’ to others
  • Poor quality of sleep occurs due to late falling asleep
  • Racing and intruding thoughts that never allows you to relax
  • You tend to overdo things even if it is not needed
  • Use of alcohol or other substances as a way to cope with anxiety
  • Your anxiety drives you towards perfection
  • You want to have everything in place
  • Try to follow the routine strictly
  • Always remain emotionally unsettled
  • Your evenings and weekends are busy and scheduled
  • You always plan ahead and try to avoid last hour rush
  • Needs assurance of others to feel good about oneself
  • A need to have control over the situation, otherwise feels frustrated
  • Avoids or stay away from crowds
  • You may arrive for meetings
  • Nervousness can be seen from outside, such as lip biting, playing with hair
  • Remains mentally agitated while talking to others
  • Tends to dwell and live in past mistakes
  • Poor eye contact 
  • You may repeat doing certain acts continuously like walking to and fro for a long time
  • You appear stoic and unemotional
  • Tends to compare with others
  • Never enjoys the precious moments of life
  • Remains preoccupied with thoughts about future

Causes and triggers of high functioning anxiety

High functioning anxiety is a catch-all term that refers to people who live with anxiety without a clear impact in their daily lives.

They are impeccably groomed and appear perfect as far as their success stories are concerned.

The irony is, they have broken into several pieces from inside and are trying to mend those pieces with a lot of effort and agony. 

The actual causes of the condition are not known, yet psychologists think that a combination of factors does play a role. 

Genetics, family upbringing, personality, and stress can contribute to the development of high functioning anxiety.

Some people may have a strong family connection to anxiety and others may have picked up their worries from the environment. 


If you are a shy, quiet, and inhibited type, you may always remain anxious about your performance.

You will tend to overdo things, please people in order to get accepted. This constant try to become perfect in everything may lead to high functioning anxiety. 

Most people with this condition are extroverts. They will go out of their way to help others. Thus, you’ll try your best to be the one whom others like. 

The slightest criticisms can make you awry and break your self-esteem. You will push yourself to fit in everywhere, thus remaining in a constant state of anxiety and worry.

Stressful life experiences

Some highly stressful situations in life can lead to high functioning anxiety. If you have been exposed to trauma, childhood punishments for not achieving good results, you may develop anxiety symptoms in adulthood.

Children coming from chaotic home conditions are found to be more anxious than others who had an orderly childhood.

Moreover, parental fights, comparisons between kids can also lead to overachievement and anxiety.

Genetic factors

Several research findings have concluded that heredity factors play a very important role in the causation of high functioning anxiety. 

People who are born in homes that have at least one parent suffering from anxiety are more likely to develop the condition later in their life.

They may always feel nervous and agitated. This mental restlessness can make them too orderly and perfectly hone their skills, even if it’s not needed.

In 2017, a research report suggested that certain genes lead to anxiety and it runs in families. 

Health issues

There are many health problems such as thyroid, heart issues, and high blood pressure that can keep a person in a restless state of mind. 

People who suffer from some chronic illness always think about their physical well-being. They may get negative thoughts about not being able to perform well in various activities.

Thus, they suffer from unnecessary worries and mood swings.

The likely triggers and risk factors of high functioning anxiety

Apart from the above causes, we have complied certain likely triggers of high functioning anxiety that are given below –

  • Demanding parents who constantly criticize the child for not being ‘good enough’
  • Less loving and caring home
  • Shyness and too reserved people may become overly anxious
  • Emotional abuse during early childhood such as fierce punishments for some wrongdoing
  • Death of a loved one
  • High functioning anxiety is related to family history
  • Sexual abuse during childhood days
  • People pleasing tendencies seen t home
  • Highly stressful jobs
  • Personal history of agitated mood, anxiety attacks
  • Exposure to threats from others to perform at the best levels, such as parents, teachers, or even colleagues and bosses.
  • Long-term financial problems can make you an anxious being because you are on your toes to make your ends meet.

Prevalence of high functioning anxiety

High functioning anxiety is not regarded as a psychiatric condition because the symptoms do not interfere with the daily life of the person.

There are other forms of anxiety that can co-exist with high-functioning types.

The prevalence rate of this disease is high, though many still remain undiagnosed due to various reasons.

  • There are 40 million Americans aged 18 years and above who have suffered an anxiety disorder in a 12 month period.
  • 18% of the adult population suffer from high functioning anxiety
  •  The overall lifetime chance of Americans developing anxiety symptoms in their adult life is 28.8%
  • The rates of incidence of specific anxiety disorders in the adult population is:

There is little doubt that we have more high functioning anxiety patients in the general population than the actual diagnosed cases. 

As there is no full-proof data on their prevalence, we cannot say for sure how many of them are actually suffering from this mental health condition.

High functioning anxiety and depression

Anxiety and depression are two different mental health conditions. Yet, findings suggest that about 18 million people in the United States suffer from depression and about 85% of them also have some form of anxiety disorder as well. Thus, the picture tells you a story of silent suffering that remains out of sight due to various reasons.

People who suffer from both high functioning anxiety and depression do not fall into specific diagnostic criteria, but they suffer a lot, the problem shows up in people who are overachievers and perfectionists.

Their anxiety drives them to attain more than what is needed. They strive towards excellence and always want to be successful. 

This keeps them in an anxious state and whenever they cannot achieve it, signs of gloom, helplessness, bad mood, and self-criticism take over.

The patient doubts about their ability and suffers silently until symptoms start to show up in everyday life.

In most cases, the condition is hard to spot and the sufferer can continue doing their daily chores without much problem.

They are Type A personalities who prefer to excel in all walks of life. Though they appear fine outwardly, they are far from being called mentally healthy.

Signs of high functioning anxiety and depression

People with high functioning anxiety and depression show the following signs:

  • Excessive anxiety over past issues or what can happen in the future
  • Self-blaming is obvious
  • Self-criticism to the extent of hating oneself for not achieving something
  • Gloom and sadness that doesn’t occur due to any other medical condition
  • Never feels happy about one’s own achievements
  • Never slows down and enjoys life
  • Shows judgment about self and others

Potential complications of high functioning anxiety and depression

Most people suffering from both anxiety and depression tend to survive their conditions by continuously performing without any obvious complaints. But, they suffer from many health complications. 

  • There will be fluctuations in heat rate and blood pressure
  • Sleep disturbances occur
  • Hormonal imbalance 
  • Lifestyle diseases
  • Stress 
  • Chronic illness
  • Risk of cardiovascular disease
  • Stroke
  • Mood swings
  • Poor concentration
  • Alcoholism or substance abuse

Challenges of high functioning anxiety – negative effects

If your anxiety remains untreated for a long time, you may develop other physical health complications and mental illnesses. 

With high functioning anxiety, a person shows no obvious signs that suggest impairment in daily life, but the hidden dangers can be very dangerous in the long run.

Several pieces of research have shown that anxiety causes cognitive problems such as poor memory, short attention span, poor logic, and reasoning. 

Prolonged anxiety is found to decrease heart health and bring a host of lifestyle problems such as obesity, stomach issues, diabetes, and heart ailments.

People with high functioning anxiety remain in a state of heightened stress. Thus, they cannot enjoy life fully. They are always worried about things that may not ever happen.

Signs of anticipatory anxiety cause them to fear the unknown and push their limits to become perfect beings.

Many other physical diseases such as breathing difficulties can occur as a result of high functioning anxiety. Thus, the overall quality of life of the person decreases over time.

Diagnosis of High functioning anxiety 

People with high functioning anxiety do not show any obvious signs of anxiety and thus it is not considered a mental health problem. It does not meet the diagnostic criteria of anxiety disorders in DSM-5.

Thus, there is no official diagnosis for this mental health illness.

If you are an overachiever and stay in a constant state of anxiety and worry to get things done, you are considered as having high functioning anxiety. 

Perhaps you will be doing everything so perfectly that nobody understands what it actually feels from within. But the point is you’re suffering in solitude and it’s all-consuming in nature.

If you are suffering, it is always best to visit a doctor or psychiatrist and discuss your issues with them. The mental health professional will interview you in detail so as to know the symptoms and causal factors.

They will do a detailed mental status examination to understand the intensity and nature of anxiousness.  Your doctor may find it hard to diagnose the case because your anxiety is not impairing your everyday living.

In such a situation, they may tell you to follow a few lifestyle changes and see if it gets better.

If the symptoms persist and lead to other mental health issues such as depression, or generalized anxiety disorder, you may be called for psychotherapy sessions.

High functioning anxiety affects your quality of life in subtle ways that you may overlook. If the condition goes on for a long time, you’ll suffer in silence, much more than what you can actually take in.

The treatment plan for high functioning anxiety

High functioning anxiety can be treated with psychotherapy or a combination of medication and therapy. The almost same type of treatment is followed as we have for treating anxiety disorders.

From your end, you need to include certain lifestyle changes to manage symptoms well and feel better. Here, we will discuss the various effective treatment options for high functioning anxiety.

Lifestyle changes 

You can bring some changes in your daily life such as having a healthy diet, going for regular walks; meditate for 10 minutes a day.

These will help you to follow a proper schedule and boost your immunity to fight your problems. 

By making certain small adjustments in your work schedule, balancing your work-life patterns will help you reduce stress in daily life. 

Many people who suffer from high functioning anxiety struggle with busy schedules. Thus, it is important that you prioritize things accordingly and avoid being on your toes. This will also ensure proper sleep and dietary habits.

You should also take care of your mental well-being. For this, you can spend time with your loved ones or bond with your pet. Avoid bringing office work home so that you can spend some quality time with your family.

Avoid quick fixes to your problems and never try to become a perfectionist. It is always easy to be slow with yourself. Remember that lifestyle changes can help but with effort and consistency.


The aim of psychotherapy is to help the person manage stress and its associated symptoms. It is usually done in a therapist’s office or a family setup to ensure maximum support of the family members.

The therapist will plan a treatment that aims to reduce the target symptoms by teaching coping skills to improve the condition. 

The best type of therapy to be used is customized to meet the needs of the patients. The various symptoms, their duration, and their impact are all considered before the choice of a particular therapy are done.

They will help the patient in the following ways-

  • Help you to understand the role of anxiety in your life
  • They will educate you about the various symptoms and the ways by which they can be well-managed 
  • Seeking your cooperation to follow the treatment plan in a proper way
  • Self-care will be encouraged
  • Promotion of healthy lifestyle choices so that your condition doesn’t get worse
  • Discussing the condition with your family members so that they know what you are going through

The therapy sessions for high functioning anxiety can take place in:

  • In the clinician’s office
  • A community center
  • School/colleges
  • At the workspace of the patient

Many people with high functioning anxiety never seek medical treatment because they may feel that the therapy sessions may decrease their motivation to work hard and do their best. They may become a slowcoach, and start living like a mediocre person, and not an overachiever. But speaking to a professional is always a healthy choice to stay fit and fine.

Cognitive behavior therapy (CBT)

This is the most common therapy practice used for treating high functioning anxiety.  The treatment helps the person to review his/her thoughts and feelings.

You will be asked to monitor your thoughts and note down your feelings and associated behavior.

In this way, the therapist targets irrational thoughts and helps the patient to alter mind states. Moreover, they may expose you to several stress triggers that cause an immediate anxiety response.

Slowly, you will notice improvements in the way you perceive situations and deal with them in everyday life.

CBT sessions should continue for 8 to 12 weeks to get good results. For others, it may take many more months of treatment to achieve good results.

Acceptance and commitment therapy (ACT)

This form of therapy aims to help patients live in the moment. The method is helpful to reduce negative thinking either about the past or future. The patient is guided to use various grounding methods to stay tuned with the present.

You will be able to accept the present without evaluating it. This means you’ll no longer feel frustrated if things do not happen in your way. 

Now you have unconditional regard for the situation you’re in. Acceptance helps to develop newer perspectives. It fosters a commitment to improving your condition and promotes better self-care.

Dialectical Behavior Therapy (DBT)

This therapy helps patients to deal with difficult emotions. It helps patients to develop insight into their problems so that they can manage their symptoms in a better way. 

The method uses mindfulness that helps patients to be present in their moments and put a stop to the negative thoughts. 

It also teaches patients how to tolerate distress and regulate their emotions. The patient is prepared to face intense emotions and cope with them in a healthy manner.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR technique was first used by psychologist Francine Shapiro in 1987 in her clinical practice with anxiety patients. 

Here, the patient is asked to imagine a distressing situation, then notice the sensations and emotions that they are experiencing.

The patient is trained to shift their attention from negative thoughts to more positive ones. In this way, their anxiety decreases, and they are able to gain control over their feelings.


In some cases, the treatment plan involves the use of medicines such as anti-anxiety drugs and anti-depressants to reduce the intensity of the symptoms. 

The selective serotonin reuptake inhibitors (SSRIs) are used to modify serotonin levels in the brain. Sometimes, beta-blockers are prescribed to reduce anxiety. These drugs also help to reduce high BP that may happen with increased levels of anxiety and fear response.

Some medicines cause physical dependence and tolerance. Thus, it is always important to take these drugs after consulting your doctor. The correct dose needs to be followed to reduce side effects and avail the best results.

How to deal with high functioning anxiety? (Self-help tips)

You can always try out some healthy tips on your own to achieve good results. 

  • Commit to self-care every day at least for 10 to 15 minutes in a day. You can do things that you like. Develop self-compassion and show more love towards yourself. It helps you to accept yourself the way you are. Your negative thoughts and self-blaming tendencies will slowly take a backseat.
  • Do as many lifestyle changes as possible, such as eating healthy, regular exercise; plan your day well to remove unnecessary stress, etc. 
  • Proper sleep hygiene is important such as going to bed at the same time, not allowing yourself to try to sleep if you are getting racing thoughts. Walk around in the room or distract yourself by doing something else, till you again feel sleepy
  • Stop making negative predictions about things that will never happen. Try doing a lot of positive self-talk. Slowly it will improve your self-confidence and self-acceptance. It will also help to lower your achievement motivation. Positive affirmations are used to reduce your constant search for perfection and excellence.
  • Whenever you notice a negative thought coming in, try to replace it with positive ones. Change the way you see things and your feelings will also alter in a definite way
  • Practice deep breathing to remove your nervous habits like lip biting, breaking knuckles
  • Use progressive muscle relaxation to reduce mental tension 
  • The grounding methods such as 54321 techniques can help to reduce your immediate anxiety response. Focusing your senses on the present moment helps to reduce irritation and nervousness
  • Try to analyze your fears and develop better insight into your condition. Remember that you’re your best help. When you know the root cause of your anxiety and do something about it, you’ll be able to deal with symptoms easily
  • You can join an anxiety support group where you will be able to meet similar sufferers. There are many online and in-person groups available that can help you learn new coping skills through mutual discussions and supportive therapy
  • Avoid negative people in life who can give you more stress rather than doing any good. Just trust your intuition and be who you are. In case, you feel the need to visit a doctor, seek help to take a charge of your life again.

Is high functioning anxiety real?

High functioning anxiety is a real mental health problem regardless of its clinical status. The medical experts know that the condition can pose a threat to the well-being of the person, but cannot consider this condition as a recognized clinical disorder.

In most cases, the sufferer does not have any real-time issues and can perform at an optimum level. Outwardly the person seems to be like this-

  • Overachiever
  • Proactive
  • Too productive
  • Have many successful feathers in his/her cap
  • Calm and level headed
  • Appears to be perfectly fine in dace of stress
  • Organized
  • Driven by details
  • Never accepts failure

If high functioning anxiety is left untreated, it may cause depression, substance abuse, eating disorders, and some chronic physical illness. 

The quality of life will slowly come down because the negative spiral of thoughts and overwhelming emotions will become all-consuming in no time.

Thus, high functioning anxiety is a tricky disorder that cannot be identified quickly. It is an evil cover-up of your internal struggles, beneath which lies the angst of silent anxiety and emotional turmoil.

No one sees the pain from outside, yet it’s there all the time and has become a part of your makeup.

The video link given below shows the symptoms and impact of high functioning anxiety. Do check out.

Summing Up from ‘ThePleasantMind’

People with high functioning anxiety may not know that they are suffering from a mental health problem.

Thus in most cases, they end up suffering silently. Living with this condition is tough yet the person seems to function normally.

Anxiety causes many unpleasant symptoms that can affect normal life in the long run. With the right kind of treatment and medical advice, the person can gain awareness about their condition and help themselves in a better way.

The nature of overthinking will reduce. You will no longer exhaust yourself with unnecessary thoughts that can make you dwell on problems.

The’ Ifs’ and ‘buts’ will reduce and you’ll never feel on the edge. The earlier the treatment, the better are the recovery rates.

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