Eating Disorder Therapy

High-Functioning Anxiety: A Guide to Effective Management


Overwhelm and anxiety at work with a woman who is unable to function and needs to perform for her job

The mere reading or vocalization of the word can induce a jolt of uneasiness for some. The reason being? Most people don’t particularly enjoy the feeling of being anxious.

This makes sense when we stop and think about what anxiety actually is—a natural and adaptive human response to stress or perceived threats, often replete with feelings of overwhelm, apprehension, and worry. 

While everyone is susceptible to experiencing anxiety from time to time, some experience it more frequently, at longer durations, and at higher intensities than others. And despite common physical symptoms of anxiety, such as sweating, trembling, or fidgeting, many people mask it better than others and may have what is commonly called high-functioning anxiety. 

What is high-functioning anxiety?

High-functioning anxiety, sometimes referred to as “hidden” or “concealed” anxiety, is a term used to describe individuals who experience significant anxiety but are able to maintain a seemingly functional and successful life on the surface. These individuals may excel in their careers, maintain relationships, and meet their responsibilities, all while struggling with internal feelings of anxiety and distress.   

High-functioning anxiety can be challenging to detect because those experiencing it often go to great lengths to hide their symptoms. Common characteristics and features of high-functioning anxiety include:

  • Perfectionism: Individuals with high-functioning anxiety often have high standards for themselves and are perfectionistic in their pursuits, which can lead to constant self-criticism.
  • Overthinking: They tend to overanalyze situations, decisions, and potential outcomes, which can lead to indecision and heightened stress.
  • Restlessness: An inner restlessness and a need to stay busy or productive are common. Relaxation and downtime can be uncomfortable for them.
  • Difficulty Relaxing: It can be challenging for them to “turn off” their thoughts and relax, even when they have time to do so.
  • Constant Worry: Persistent worry about future events, even minor ones, is a hallmark of high-functioning anxiety.
  • Physical Symptoms: Anxiety can manifest physically, leading to symptoms such as tension, headaches, digestive issues, heart palpitations, shortness of breath, and muscle aches.
  • Avoidance: Some individuals with high-functioning anxiety may avoid situations that trigger their anxiety or seek reassurance excessively.
  • Difficulty Sleeping: Sleep disturbances are common, including trouble falling asleep, staying asleep, or experiencing restless nights.
  • Self-Doubt: A constant fear of failure or self-doubt is often present, even when there is no objective reason to doubt one’s abilities.
  • Hiding Symptoms: Those with high-functioning anxiety often hide their inner turmoil, making it challenging for others to recognize their struggles.

It’s important to note that while individuals with high-functioning anxiety may outwardly appear successful, composed, and put-together throughout their daily lives, they often internalize their anxiety, which can take a toll on their mental and physical health over time.

How high-functioning anxiety differs from Generalized Anxiety Disorder and Social Anxiety Disorder.

High-functioning anxiety, Social Anxiety Disorder (SAD), and Generalized Anxiety Disorder (GAD) are related but distinct conditions that differ in terms of their focus, symptoms, and how they manifest in individuals’ lives:

1. Focus of Anxiety:

  • High-Functioning Anxiety: High-functioning anxiety is not an official psychiatric diagnosis but rather a descriptive term. It refers to individuals who experience anxiety in various aspects of their lives but are able to maintain a relatively high level of functionality. The focus of anxiety may vary and can include concerns related to work, relationships, personal goals, and daily life stressors.
  • Social Anxiety Disorder (SAD): SAD, also known as social phobia, is characterized by an intense and often irrational fear of social situations. Individuals with SAD typically experience anxiety specifically in social settings, where they fear being judged, embarrassed, or humiliated. Social interactions, public speaking, and performance situations often trigger anxiety in individuals with SAD.
  • Generalized Anxiety Disorder (GAD): GAD is characterized by chronic stress and excessive worry and anxiety about a wide range of events or activities. Unlike high-functioning anxiety, which may focus on specific aspects of life, GAD involves pervasive worry about many areas, such as work, relationships, health, and finances.

2. Symptoms:

  • High-Functioning Anxiety: Symptoms of high-functioning anxiety can vary but often include generalized worry, restlessness, perfectionism, overthinking, obsessive thoughts, and a constant need for validation. These symptoms may be present in different areas of life.
  • Social Anxiety Disorder (SAD): SAD is associated with symptoms such as intense fear of social situations, physical symptoms like sweating or trembling, avoidance of social activities, and negative self-perception.
  • Generalized Anxiety Disorder (GAD): GAD symptoms include excessive worry, restlessness, muscle tension, irritability, sleep disturbances, and difficulty concentrating. Individuals with GAD may worry about various aspects of life but not necessarily in social situations.

3. Impact on Functioning:

  • High-Functioning Anxiety: Individuals with high-functioning anxiety may continue to meet their daily responsibilities and appear successful on the surface despite their internal anxiety. They may be skilled at hiding their anxiety from others.
  • Social Anxiety Disorder (SAD): SAD can lead to significant functional impairment in social, academic, and occupational areas. Avoidance of social situations may limit opportunities for personal and professional growth.
  • Generalized Anxiety Disorder (GAD): GAD can affect an individual’s ability to concentrate, make decisions, and carry out daily tasks due to excessive worry and anxiety. It may interfere with work, relationships, and overall quality of life.

4. Diagnosis and Treatment Options:

  • High-Functioning Anxiety: High-functioning anxiety is not an official psychiatric diagnosis, so treatment may vary based on individual needs and preferences. Some individuals may benefit from therapy, lifestyle changes, and self-help techniques.
  • Social Anxiety Disorder (SAD): SAD is a recognized psychiatric diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment often includes therapies like Cognitive-Behavioral Therapy (CBT), exposure therapy, and, in some cases, medication.
  • Generalized Anxiety Disorder (GAD): GAD is also a recognized psychiatric diagnosis. Treatment typically involves therapy (e.g., CBT), medication (e.g., antidepressants or anti-anxiety medications), and lifestyle changes to manage symptoms effectively.

In summary, high-functioning anxiety is a descriptive term used to characterize individuals who experience anxiety while maintaining functionality in various areas of life. SAD and GAD, on the other hand, are specific anxiety disorders with focused symptoms and criteria for diagnosis. While there can be some overlap in symptoms and experiences, the key differences lie in the focus of anxiety, symptoms, and their impact on daily functioning.

Holding the barometer of stress and anxiety down in order to function and no longer feel bad.

Specific Modalities to Modulate High-Functioning Anxiety

Handling high-functioning anxiety involves a combination of self-awareness, self-care, and, in some cases, professional help. Here are some strategies to help you manage it:

  • Recognize the Symptoms: Start by reviewing the symptoms (listed above) to help determine if you could have high-functioning anxiety. 
  • Seek Professional Help: If your anxiety is interfering significantly with your life, consider consulting a mental health professional. Therapy can be highly effective in not only treating anxiety but also in identifying the sources of your anxiety and how to address and/or modify those. Some modalities to employ and which a trained mental health provider can guide you through:
    • Practicing Mindfulness: Mindfulness techniques can help you stay grounded and in the present moment. Meditation, deep breathing exercises, and progressive muscle relaxation can reduce anxiety symptoms.
    • Setting Realistic Goals: High-functioning individuals often set very high standards for themselves, which can exacerbate anxiety. 
    • Prioritizing Self-Care: Make self-care a priority in your life. Ensure you get enough sleep, exercise regularly, eat a balanced diet, and practice relaxation techniques.
    • Time Management: Develop effective time management skills to reduce stress. Prioritize tasks, create a to-do list, set deadlines, and break larger tasks into smaller, more manageable steps.
    • Setting Healthy Boundaries: Learn to say no to other people and their requests of you. If there are people in your life, e.g. a manager, a partner, or a relative, who consistently ask or expect things of you that cause you stress or overwhelm (common precursors to anxiety), it’s imperative to set boundaries with these individuals on what you’re able and willing to do. 
    • Limiting Stimulants: Reduce or eliminate caffeine, alcohol, or other substances from your diet that have a history of increasing your anxiety symptoms.
    • Practicing Self-Compassion: Learning to be kind to yourself is crucial. This entails treating yourself with the same care and understanding that you would offer to a good friend and avoiding or challenging self-criticism and negative self-talk.
    • Validating Your Anxiety: Judging or criticizing your anxiety only makes it worse in the long run. You can validate anxiety by recognizing that just because it feels bad doesn’t mean it is bad (or that you are bad for feeling it). 
    • Seeking Social Support: Share your feelings and struggles with a support system of trusted friends or a family member whom you believe could provide emotional support, understanding, or an open ear. Consider joining a support group. It’s a wonderful way to speak with others going through similar situations and offer insight as well.
    • Journaling: Keep a journal to track your thoughts, feelings, and triggers. This can help you identify patterns and better understand your anxiety.
    • Progressive Exposure: Gradually expose yourself to situations that trigger anxiety. This can help desensitize you to these situations over time.
    • Seeking Medication: Consult a psychiatrist if medication is deemed necessary by your therapist or other primary care provider to manage your anxiety. Medications such as anti-anxiety medications may be prescribed.

Managing high-functioning anxiety is an ongoing process. It’s essential to be patient with yourself and seek help when needed. Everyone’s experience with anxiety is unique, so what works best for you may vary. Experiment with different strategies and techniques to find what helps you manage your anxiety most effectively. 

And remember, judging or criticizing your anxiety for showing up will likely only result in increased anxiety. Recognize that anxiety is a normal human emotion experienced by all, and the less power and meaning you give it, the less anxious you’ll feel overall.