High-Functioning Anxiety: What It Is, How It Feels, and What to Do About It

Takeaway: I've had several clients describe their experience with anxiety like this: “I feel like a swimming duck. On the surface, I look calm and collected. But underneath the water, I'm paddling like hell just to stay afloat.”

I can't think of a better visual for understanding what high functioning anxiety feels like. People who struggle with high functioning anxiety often experience a disconnect between the outward calm they project to the world and the inner swirl of turmoil they feel on the inside.

In this blog post, I'll explore what high functioning anxiety is, its symptoms, causes, and coping strategies, how it usually affects high achievers (and how that connection isn't an accident), and what you can do to help calm the inner storm.

What is high functioning anxiety?

High functioning anxiety is a term used to describe anyone who experiences anxiety but still manages to function at a high level in their personal and professional life. On the outside, they may seem like they have everything together, but on the inside, they may be struggling with constant worry, fear, and self-doubt.

People with high functioning anxiety tend to be high achievers, who often have high expectations for themselves and feel the pressure to perform and succeed.

As a clinical psychologist who specializes in providing in-depth therapy for anxiety, I see firsthand how common it is for my high achieving clients to deal with the inner struggle of anxiety.

It's essential to understand and seek help for high functioning anxiety, as excessive anxiety can have a significant impact on your mental health and well-being. By recognizing the signs of high functioning anxiety and taking steps to manage, you can work towards creating a more fulfilling and peaceful life.

Symptoms of High Functioning Anxiety

High functioning anxiety can manifest in a variety of ways. People with high functioning anxiety usually have many positive traits--they are often hard-working, detail-oriented, organized, ambitious, loyal, and proactive. But they usually feel like they are on a knife's edge, trying to maintain their high performance while also managing their anxious thoughts and feelings.

Like many things in life, high functioning anxiety has both positive and negative characteristics. People with anxiety may always strive for excellence, but they also feel like any mistake or failure is unacceptable. This pressure to perform at a high level at all times is a double-edged sword because it can be a source of motivation, but when it goes too far, it's a significant source of anxiety.

However, your success as someone with anxiety can often come at a cost to your mental and emotional well-being. You may struggle with burnout, exhaustion, depression, and other negative consequences from all the chronic stress, anxiety, and overwhelm.

Perfectionism

When you're dealing with high functioning anxiety, you might feel like you need to be perfect in order to succeed or feel worthy. These anxiety symptoms can manifest as an intense drive to achieve flawless results, even when it's not necessary or realistic--i.e., perfectionism.

Perfectionism makes it hard to be satisfied with your achievements and can trigger anxiety and self-doubt. Perfectionism is often rooted in a fear of failure, fear of rejection, and/or fear of not being good enough as you are, as well as fears and beliefs that making mistakes isn't allowed or acceptable.

Procrastination or overpreparation

People with high functioning anxiety usually have patterns of either procrastination or overpreparation–and sometimes both!

While procrastination is often associated with “laziness” (I hate this term, but that's a story for another day…), it can actually be a sign of anxiety. Sometimes, the pressure of having to perform at a high level can be so overwhelming that it's easier to put things off than to face the fear of failure.

Alternatively, high functioning anxiety can lead to excessive planning and preparation that can interfere with daily life and long-term goals. For example, you may routinely spend hours planning and organizing a simple task or worrying excessively about something going wrong.

While being prepared can generally be a good thing, overpreparation is a sign of high functioning anxiety because it usually stems from a fear of failure.

Excessive need for control

When you have high functioning anxiety, you might feel like you need to control every aspect of your life to feel safe and secure. It's like you're constantly trying to keep everything in order, so you can avoid any potential negative outcomes or failures.

You might find yourself overthinking, obsessing over details, or micromanaging everything around you. It's easy to think that the more control you have over your life, the less anxious you'll feel.

But the truth is, an excessive need for control can actually trigger anxiety more than it helps it. You're living in a constant state of high alert when you overthink everything, which is a recipe for exhaustion, burnout, and increased anxiety.

Difficulties relaxing or enjoying yourself

When you're dealing with high functioning anxiety, it can be hard to switch off, slow down, and just enjoy the moment. You might find yourself constantly worrying about what's coming next or replaying conversations in your head. You might have several nervous habits such as biting your nails or grinding your teeth that make it hard to relax.

Even when you're doing something fun or relaxing, it can be hard to let go and just be present. It's like your mind is always on high alert, scanning for potential problems or issues. This can be exhausting and make it hard to be fully present in your life.

Overthinking & excessive worry

When you have high functioning anxiety, your brain can feel like it's in overdrive. You might find yourself overthinking every little detail, replaying conversations in your head, or analyzing every possible outcome of a situation. Racing thoughts are a daily reality.

It's like your mind is on a constant loop that is buzzing with nervous energy, and it can be hard to quiet the noise. Overthinking and overanalyzing can be exhausting and make it hard to make decisions or move forward.

People-pleasing tendencies

People pleasing tendencies can be a way to cope with the fear of rejection or failure that often accompanies high functioning anxiety. You may feel like you're walking on eggshells and having to hide your true feelings when both people-pleasing and anxiety take root.

It may feel like people-pleasing is the only way to maintain your relationships or be successful. But people-pleasing is exhausting and overwhelming, and it usually leads to feelings of resentment, burnout, and low self-esteem.

Physical symptoms

While anxiety is often thought of as a mental health issue, it can also manifest with physical health problems. People with high functioning anxiety may experience symptoms such as headaches, digestive issues, muscle tension, chest pain, heart palpitations, or other physical conditions.

Your body can also experience physical symptoms that can be hard to understand or explain. You might feel tense or restless, have trouble sleeping, have digestive concerns, or even experience muscle pain and headaches. Your heart might race, your palms might sweat, or you might feel short of breath. You might even struggle with panic attacks.

Imposter syndrome

You might struggle with persistent feelings of inadequacy, feeling like you're not good enough, or feeling like you don't deserve your achievements. This is often referred to as imposter syndrome.

Even when you have evidence of your skills and accomplishments, you might still feel like a fraud or worry that others will discover that you're not as competent as you appear. You may beat yourself up over past mistakes. It can be hard to shake these anxious feelings, and they can take a bad toll on your self-esteem and confidence.

Needing constant reassurance

When dealing with anxiety, you might find yourself constantly seeking validation from others, especially when it comes to your performance or self-worth.

Wanting reassurance and comfort is a natural human need we all have. But when you rely on it too much, it can make your anxiety worse, lead to feeling like you're never good enough, and make it hard to maintain relationships that are mutually fulfilling.

Other signs of an anxiety disorder

While high functioning anxiety itself may not meet the diagnostic criteria for a formal diagnosis of a mental illness, other anxiety disorders do exist--there are many other severe symptoms of anxiety that may be consistent with an actual anxiety disorder.

For example, Generalized Anxiety Disorder, Social Anxiety Disorder, and Panic Disorder are three common types of anxiety disorders that are recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). If you suspect that you may have mental health concerns that are consistent with an anxiety disorder diagnosis, it's important to seek help from a qualified healthcare professional who can evaluate your symptoms and provide appropriate treatment.

What Causes High Functioning Anxiety?

The causes of high functioning anxiety can vary from person to person, but here are some common ones:

Excessively high standards

Setting extremely high expectations for oneself–be it in work, relationships, or your personal life–can create a constant pressure to perform and achieve.

Personality

High functioning anxiety can often unfold from certain personality traits such as being highly conscientious, “type A”, people-pleasing, emotionally sensitive, or needing to be in control.

These traits can make it challenging to switch off and relax, leading to constant worry and an ongoing sense of pressure.

Overthinking

Constant analysis of the past and future can lead to overthinking, which can exacerbate feelings of worry and doubt. “Analysis paralysis” is another useful term for understanding how overthinking affects people.

Trauma

Past experiences such as childhood trauma, bullying, neglect or abuse can lead to anxiety and many other mental health disorders, particularly if not addressed or treated. When someone has experienced a traumatic event or prolonged stress, their brain and body may become wired to constantly be on high alert.

This can result in symptoms of anxiety, including difficulty relaxing, overthinking, and a constant sense of urgency or worry.

Genetic and environmental factors

A family history of anxiety disorders can increase the likelihood of developing high functioning anxiety, which can be a result of both genetic and environmental factors.

Factors such as high stress environments, demanding jobs or relationships, and stressful life events (particularly difficult parental relationships) can trigger or exacerbate anxiety symptoms.

Social or cultural pressures to succeed

People who have a strong need to conform to societal expectations or who place excessive value on external validation may experience high functioning anxiety.

This may include pressure from family, difficult parents, friends, difficult relationships in your life, or society as a whole to excel in certain areas such as academics, career, or appearance.

By identifying and addressing these symptoms and triggers, you can help yourself cope with your high functioning anxiety more effectively.

Managing high functioning anxiety as a high achiever

It can be a delicate balance to manage symptoms of high functioning anxiety. On the one hand, it's important to set goals and strive for excellence. On the other hand, it's equally important to practice self-care, manage stress, and maintain a healthy work-life balance.

Here are some tips for managing anxiety as a high achiever:

Recognize your limitations

It's important to recognize that you are human and have limitations. You cannot do everything, and that's okay. Focus on what's most important and prioritize your time accordingly.

Practice self-compassion

Treat yourself with kindness and understanding, even when things don't go as planned. Be gentle with yourself and avoid negative self-talk.

Learn to delegate

Delegating tasks can help alleviate some of the pressure you feel to do everything yourself. Identify tasks that can be delegated and delegate them to others.

Set realistic goals

Set goals that are challenging but achievable. Avoid setting unrealistic goals that are likely to lead to disappointment and increased anxiety.

Maintain a healthy work-life balance

Make time for hobbies, relaxation, and self-care. It's important to take breaks and recharge your batteries regularly.

Seek support

Reach out to friends, family, or a therapist for anxiety if you need help managing your high functioning anxiety. Sometimes it's helpful to have a sounding board or a safe space to talk about your fears and concerns. Sharing honestly can also help you foster healthier relationships with people in your life.

High Functioning Anxiety Treatment

If you're struggling with anxiety, there is hope. There are many effective treatment options available.

Working with a mental health professional through talk therapy is one of the primary treatments for anxiety disorders. Through the therapy process, you can explore the root causes of your anxiety, learn healthy coping strategies, and develop a personalized treatment plan that works for you.

In-depth therapy is a form of psychotherapy that can be particularly beneficial to treat anxiety. This type of therapy focuses on exploring your thoughts and emotions at a deep level in order to gain an understanding of yourself and the root causes of your anxiety.

As a clinical psychologist specializing in providing high achievers with in-depth therapy for anxiety, I frequently help my clients with anxiety on their path to healing and personal growth.

Some other common treatment options for include lifestyle changes and mindfulness. Many peer reviewed studies show the effectiveness of such measures for anxiety disorders.

Lifestyle changes can include reducing caffeine intake and drug or alcohol use, getting regular exercise, and practicing relaxation techniques such as deep breathing, progressive muscle relaxation, yoga, and meditation. Mindfulness techniques can help you develop greater awareness and acceptance of your thoughts and emotions, focus on the present moment, and reduce feelings of worry and stress.

In some cases, prescription medications may also be helpful in managing symptoms of anxiety. Antidepressants and anti-anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs), are often prescribed for anxiety. Please remember: it's important for you to be monitored by a medical professional if you take these medications.

Ultimately, the most effective treatment for anxiety is one that is tailored to your individual needs and goals.  With the right support and resources, you can learn to manage your anxiety and lead a fulfilling, purposeful life that is driven by joy and ease, rather than constant worry and stress..

You don't have to keep living under the chokehold of anxiety anymore

High functioning anxiety can be a challenging and overwhelming experience, particularly for high achievers who place a lot of pressure on themselves to succeed.

While it can be easy to dismiss anxiety as a normal part of life, it's important to recognize when it becomes problematic and seek help when necessary. Understanding the symptoms, causes, and impacts of high functioning anxiety is the first step towards managing it effectively.

Seeking help from a mental health provider who specializes in providing therapy for anxiety through an in-depth approach can be a valuable tool in managing your anxiety and achieving a greater sense of calm and peace.

Interested in learning more? I encourage you to reach out to schedule a free consultation.

Written by Annia Raja, PhD