HHigh-functioning anxiety is a term that describes a paradox that many face. On the outside, a person may appear to have everything under control, but inside he is dealing with a relentless undercurrent of worry, fear, and doubt.
Unlike other forms of anxiety that can cause significant disruptions in daily life, high-functioning anxiety often goes unnoticed by others, sometimes even by the person experiencing the anxiety.
It is the silent struggle of the overachievers, the perfectionists and the seemingly even-tempered people who are privately exhausted from managing their inner turmoil.
The mask of high-functioning anxiety
One of the reasons why high-functioning anxiety is so difficult to detect is because it often presents itself as a series of positive traits. People with this form of anxiety can be very driven, organized and detail-oriented. They often excel in their careers, are reliable friends, and always seem to stay on top of their responsibilities. But beneath this polished exterior lies a different story. Something Simone* knew all too well.
Simone, a successful banker and mother of three, first came into my office for her therapy session thinking she was overwhelmed and burned out from juggling too much in her life. But as we went deeper, it became clear that Simone was constantly tense, even though she seemed calm to her colleagues and friends. Her mind was constantly racing with worst-case scenarios, “what if” scenarios, and fear of failure. She was a perfectionist at work and at home, not because she only strived for success, but because she was terrified of making mistakes and failing as a corporate employee and as a mother.
High-functioning anxiety manifests itself in a range of symptoms and traits that can be emotionally draining. Individuals often measure their success against society’s standards, leaving them feeling dissatisfied even after significant achievements. They are very sensitive to criticism and rejection and constantly compare themselves to others in an endless treadmill of self-doubt.
They are hypervigilant and prone to overplanning. They prefer to be in control, but often take on more than they can handle. Boundaries can become blurred if they have difficulty saying no and their emotions are often charged. This form of anxiety can stem from early attachment issues, such as abandonment or growing up in an environment where parents placed extremely high expectations on them. This deep-seated dynamic fuels a constant struggle to meet impossible standards, leaving them emotionally exhausted despite the outward appearance of success.
The praise they receive for their achievements can often feel hollow, as they know they’re struggling behind the scenes to keep it all together – and this can be exhausting. There is a constant need to be productive, to prove yourself and to avoid failure at all costs. This constant state of hyper-alertness leaves little room for rest or relaxation. Over time, this can lead to burnout and in some cases the anxiety can become more pronounced or develop into more debilitating mental health issues, leading to a breakdown.
Why high-functioning anxiety often goes unnoticed
High-functioning anxiety does not always fit the stereotypical image of someone who struggles with anxiety. When we think of anxiety, we often imagine someone who is visibly stressed, withdrawn, or unable to cope with everyday tasks. But people with high-functioning anxiety often do the opposite: they overcompensate. Their anxiety manifests as a desire to stay busy, achieve, and maintain control over every aspect of their lives.
Friends, family members, and coworkers may not be aware of the internal problems of someone with high-functioning anxiety because there are no obvious signs of anxiety. Even healthcare professionals can miss this during routine checkups, because people with high-functioning anxiety often don’t realize they have a problem, or may downplay their symptoms. They believe that their performance should negate any sense of unease or anxiety, so they continue to push on, dismissing their anxiety as “normal” or “just life stress.”
The impact on daily life
While high-functioning anxiety may not stop people from completing their tasks, it does take a toll on their mental and emotional well-being. Living in a constant state of heightened anxiety can lead to physical symptoms including fatigue, muscle tension, headaches, digestive problems and sleep problems. There’s also the mental burden of feeling like nothing is ever good enough, no matter how much is accomplished.
Social relationships can also suffer. Someone with high-functioning anxiety may struggle with imposter syndrome, fearing that they will be “exposed” as a fraudster despite their success. They may avoid situations where they feel vulnerable, or they may put pressure on themselves to always present a perfect image. Over time, this can lead to isolation as they push people away for fear of being judged or misunderstood.
One of the main challenges of dealing with high-functioning anxiety is recognizing that it is a problem in the first place. Because it is so closely linked to positive qualities, including productivity and organization, it can be difficult to distinguish when normal stress has crossed the line into something more harmful. There are a few important signs to look out for:
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Constantly feeling tense or overwhelmed
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Difficulty relaxing or unwinding
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Worrying about past mistakes or excessively worrying about future scenarios
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Perfectionism, so even small mistakes feel like personal failures
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Physical symptoms including tension headaches, digestive and stomach problems or insomnia.
Seek professional help
The good news is that high-functioning anxiety, like other forms of anxiety, can be managed with the right tools and support. Mindfulness techniques, including meditation and breathing exercises, can also help calm the mind and reduce the constant need for productivity.
It’s also important to reshape the way we think about success and productivity. High-functioning anxiety often stems from fear of failure or the need to prove oneself. It’s important to learn to accept imperfection, set boundaries, and prioritize self-care. This doesn’t mean you have to give up ambitions or goals, but rather recognize that rest and relaxation are equally important for long-term success.
We worked with Simone on cognitive restructuring to help her reframe negative thoughts. We also explored her core beliefs and identified activities she enjoyed outside of family and work so she could make time for them. Simone kept a journal of her thoughts and emotions for several weeks, which helped guide discussions about setting healthy boundaries. For her, this meant recognizing that it was okay to say no to extra work tasks and social events. Improving sleep patterns, focusing on a balanced diet and prioritizing self-care all helped reduce her anxiety.
High-functioning anxiety is not something to be glorified, even though society often rewards those who push themselves to their limits. While it may seem like having anxiety is part of what drives success, the reality is that it can be detrimental to our mental health. With awareness, compassion, and the right tools, high-functioning anxiety doesn’t have to go unnoticed or untreated.
*The name has been changed for privacy reasons and Simone’s story is an amalgamation of several things
Dr. Ashwini Padhi is a psychiatrist at South Pacific privatea treatment center for trauma, addiction and mental health care