High Functioning Anxiety: Signs, Treatment, and Resources – PsychCentral.com

People with “high functioning” anxiety may look successful to others but often deal with a critical inner voice.

People with high functioning anxiety can be described as hardworking and organized on the outside but filled with worry inside.

Those with high functioning anxiety can skillfully handle the daily demands of life. But inside, they may be “motivated by a constant fear of failure or doing or saying the wrong thing,” Idil Ozturk, LMSW, explains.

Many people have high functioning anxiety and don’t know it. Recognizing the symptoms of anxiety — even if they’re mild — is the first step to managing it.

High functioning anxiety isn’t an official mental health diagnosis, but it often falls under generalized anxiety disorder (GAD). It can be helped by many of the same treatments used for anxiety disorders. With practice and patience, there are ways to calm your mind and thoughts.

High functioning anxiety is when someone experiences anxiety symptoms but still functions well in their daily lives, such as work, school, and relationships.

They may appear calm and confident to others. All the while, their inner voice is screaming with fear, worry, and harsh self-talk.

“They can be really hard on themselves if something is not up to their very high standards, and they often constantly overthink their choices,” says Ozturk.

“High functioning” anxiety is not officially recognized as an anxiety disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Instead, that person might have a specific type of anxiety disorder.

Some people might be described as having “high functioning” anxiety but still experience significant distress. They might just hide their symptoms well. And some may have subclinical anxiety, meaning they don’t meet the standard for an anxiety disorder — but they still experience anxiety symptoms.

Subclinical anxiety symptoms can show up as:

  • mild
  • hidden
  • brief but recurrent

Erica Cramer, LCSW, adds, “Others may perceive them as hardworking, diligent, and competent. Meanwhile, the inner experience of being them is much different. It is stressful, draining, and debilitating. They get things accomplished. But at what cost?”

Several factors can contribute to the development of high functioning anxiety. However, there are some commonalities, according to Ozturk.

“High functioning anxiety may be caused by a fear of failure, fear of not being enough, or doing enough. Oftentimes, these fears are built after being in a competitive environment that encourages success by setting ‘high achieving’ as the standard,” Ozturk explains.

Some people develop high functioning anxiety as children, while it’s a learned behavior for others. People who deal with perfectionism also experience this type of anxiety. Self-critical parenting or a history of disappointment from oneself or others can also be an initial cause.

High functioning anxiety can also be caused by beliefs that high levels of worry are functional to be prepared or feel in control.

Genetics can also play a role by increasing the risk of developing anxiety for some people.

People living with high functioning anxiety may not be aware it’s behind the symptoms they regularly experience.

Symptoms are most similar to those of generalized anxiety disorder and may include:

  • restlessness or inability to relax
  • racing heart
  • ruminative thoughts
  • irritability
  • sleep issues
  • muscle tension
  • becoming easily fatigued
  • excessive worry or anxiety on most days for at least six months
  • negative self-talk
  • overthinking situations or racing thoughts

These symptoms can range from slight to severe and manifest in different ways.

There are many types and subtypes of anxiety disorders. However, four common types may be behind high functioning anxiety.

Generalized anxiety disorder

GAD is chronic anxiety that involves an exaggerated sense of worry and physical symptoms — even when there’s no trigger. Someone with this disorder experiences anxiety persistently and excessively about a wide variety of things.

They may be concerned about their health, natural disasters, family, work, and several other issues. Sometimes they worry about events or situations that may or may not happen. However, sometimes the anxiety and worry are about the possibilities of what could happen.

A GAD diagnosis comes after the person has experienced chronic anxiety on most days for at least six months. The difference between this type of anxiety and many others is the presence of preoccupied worry and rumination, and extensive efforts to be prepared for or handle the things you’re worrying about.

Panic disorder

A person with panic disorder experiences unpredictable and repeated episodes of intense fear. These episodes include physical symptoms like dizziness, heart palpitations, chest pain, or abdominal pain or discomfort.

Episodes are often called panic attacks, where the intensity of the experience can make a person feel out of control. The unpredictability of the attacks is a part of the disorder. Many people also develop a fear of the attacks themselves.

Having a single panic attack does not mean that someone has panic disorder. Someone with diagnosed panic disorder has recurrent attacks with at least one month of worry about the next attack. Many people start to avoid situations where having a panic attack would make them feel embarrassed or unsafe.

Social anxiety disorder

Social anxiety disorder (SAD) is also known as social phobia. This type of anxiety involves excessive worry and anxiety surrounding common social interactions. People living with this condition feel extreme self-consciousness and fear of humiliation around others. They often feel they’re being judged negatively and scrutinized by others.

This leads to avoidance of social situations. The stress of interacting can interfere with personal relationships, affect daily routines, and become a professional barrier.

Social anxiety disorder goes beyond the regular nervousness or even feelings of shyness around strangers or new situations. It’s one of where the associated avoidance interferes with daily life.

Treatments for GAD are also used to treat high functioning anxiety. You don’t need an official diagnosis of anxiety to treat high functioning anxiety. Many people benefit from the help of a mental health professional or management with self-care techniques.

Cognitive behavioral therapy

Talking with a therapist can help you sort through your thoughts to discover where they may be linked to feelings rather than facts.

A trained mental health professional can help you apply cognitive behavioral therapy (CBT) techniques to challenge and rewire your feelings, thoughts, and behaviors. CBT targets thoughts and beliefs about the nature of anxiety and perfectionistic behaviors.

When your brain starts overthinking a situation or you’re being unfairly hard on yourself, CBT gives you a quick way out of snowballing thoughts.

Cramer says, “Through the therapeutic process, someone can analyze the origins of their anxiety as well as detect patterns. Thoroughly unpacking and understanding the anxiety is the first step towards combating it.”


Anxiety can cause a feeling of urgency or feeling scattered, says Ozturk. It may bring up worries about the past or future that become obsessive thoughts.

Mindfulness is a state of being where you keep your thoughts and feelings in the present moment, bringing you out of racing thoughts about what did or might happen.


Some people benefit from selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Anxiety disorders are often closely linked with depression. Consequently, some counselors or therapists may prescribe antidepressants.

High functioning anxiety may not be a clinical disorder, but it can still interfere with your quality of life.

If you suspect you’re living with high functioning anxiety, you can learn more techniques to lessen your symptoms in these articles:

If your inner turmoil is hurting your quality of life, you may want to consult with a doctor or mental health professional. A therapist or counselor can teach you coping techniques to help you live an inner life that’s as calm as your outer life.