High-Functioning Anxiety: Symptoms, Treatment, and Ways to Cope

In an always-on world with near-constant demands, many people are facing something known as  “high-functioning anxiety.” Forty million adults in the United States struggle with anxiety, making it the country’s most common mental health disorder, yet only about 35 percent get treatment due to challenges like stigma and lack of information. We’ll explore how high-functioning anxiety can impact people’s personal and work lives and why it’s important to get help.

What is high-functioning anxiety?

High-functioning anxiety isn’t a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). Rather, it’s a term that describes when people feel anxious but are still functioning, if not excelling, in everyday life.

A person with high-functioning anxiety is still able to take care of their responsibilities. People with more severe anxiety, or what some may call “low-functioning anxiety,” may have a hard time getting out of bed, handling everyday responsibilities, maintaining healthy relationships, and completing tasks at work.

Sometimes people move between high-functioning and low-functioning anxiety. You may be able to maintain a high level of functioning with anxiety, but at some point this could change. It’s like running a marathon in a sprint: Your body and mind can only take so much and eventually you may not be able to continue.

Symptoms of high-functioning anxiety

When people describe the symptoms of high-functioning anxiety, they’re often describing generalized anxiety disorder (GAD) symptoms. These include feeling irritable, worrying excessively, and having trouble sleeping and concentrating. Someone with high-functioning anxiety symptoms may be driven, productive, and successful, but inside they may be dealing with intense worry. It’s like a duck on a pond. They look calm and collected as they move across the surface, but below the water they’re paddling furiously. 

Signs of high-functioning anxiety may include:

Rigidity around time

People with high-functioning anxiety may have difficulty being flexible. Veering from a set schedule or routine can cause agitation and stress. Being chronically early also can be a sign of high-functioning anxiety, as people may fear being late or disappointing others if they’re running even just a few minutes behind.

Poor boundaries

People with high-functioning anxiety may find it hard to say no and might take on more than they can manage in their work or home life. Even if they feel like they’re being taken advantage of, saying no can feel scarier than the thought of people thinking badly of them. A lack of boundaries can lead to chronic stress, fatigue, and resentment.

Black-or-white thinking

Also known as all-or-nothing thinking, this is a thought pattern of extremes. People and situations may be seen as all good or all bad, with no middle ground. This way of thinking is a type of cognitive distortion, which often develops over time as a way of coping with trauma or adversity. Polarized thinking can feel comforting to people with anxiety because it simplifies the world into two predictable categories.

Sleep issues

Insomnia is a common symptom of high-functioning anxiety. People with anxiety may have a hard time turning off worries or relaxing their bodies because they feel keyed up. It often works in a cycle—high arousal from anxiety can cause sleep issues and lack of sleep can fuel anxiety.

Substance use

Research shows that people with an alcohol use disorder (AUD) are at over two times greater risk of also having anxiety than people without AUD. Sometimes people use alcohol or other drugs as a way of coping with anxiety symptoms.

Emotional challenges

Functioning anxiety may cause people to feel detached from their emotions or emotionally numb. When our mind and body are regularly in a high-alert state, our fight, flight, or freeze response is frequently activated. To cope, people may try to suppress their feelings through behaviors like avoiding relationships or steering clear of certain conversations or topics.

Ruminating

High-functioning anxiety can feel like a hamster wheel of thoughts. People may revisit past conversations or situations on a loop in their head and critique how they handled them. They may also imagine future scenarios and worry with anticipation over what might happen.

Repetitive behaviors

High-functioning anxiety symptoms can show up as nervous habits like nail-biting, fidgeting, and re-checking behaviors such as going to the kitchen several times to make sure the stove is off.

Restlessness

People with high-functioning anxiety may have trouble sitting still or staying in one place for a long period of time. Restlessness can also come in the form of insomnia, difficulty concentrating, and agitation.

Can high-functioning anxiety be good?

When most of us think of stress, we think of distress (the bad kind of stress). But there are actually two types: distress and eustress. Distress is unproductive, unwanted stress, while eustress can be a good thing.

Distress vs. eustress

Distress can be short- or long-lasting and feels beyond our ability to cope. It can arise from situations like divorce, abuse, the death of a loved one, financial problems, or strained relationships.

Eustress, on the other hand, can be motivating and even exciting at times. It’s usually a short-term experience that feels stressful but within our ability to cope. Situations that may accompany eustress include becoming a parent, learning new skills, playing competitive sports, or moving to a different city.

Eustress helps us because it gives us energy and clarity. It may involve something we find enjoyable, challenging, or fulfilling. If we don’t care about something, we have no intrinsic (internal) or extrinsic (external) motivation, and we usually don’t perform well at it. On the other hand, if we’re invested in something, we perform better. Managing stress so that we’re able to stay in eustress is ideal. It still feels like work, but it’s satisfying and rewarding. This is when we’re in “the zone,” at optimal performance.

If we don’t manage our stress and  have no self-care, no work-life balance, and we’re catastrophizing, this tips us into distress. That’s when our performance suffers. Eventually, you’re going to burn out. You could be more effective if you could stay in the eustress, where you’d not only perform better, but feel better.

Risks of high-functioning anxiety and stress

Living in “fight or flight” mode is detrimental mentally and physically. The high levels of cortisol and adrenaline wear on our body. High-functioning anxiety is the equivalent of fight mode, while low-functioning anxiety is being in the flight or freeze mode. What we want is that assertive eustress experience, which is healthier and more balanced.

Chronic stress can raise the risk of:

• Increased heart rate and cardiovascular disease
• Cancer
• Impaired immune system
• Memory
• Insomnia
• Headaches and migraines
• Sexual dysfunction
• Gastrointestinal issues
• Mental health disorders

What causes high-functioning anxiety?

Anxiety is typically caused by a combination of factors. Some people are genetically predisposed to mental health disorders. If a person’s close family member(s) struggles with a mental health disorder, their risk of developing one is higher. Other factors that can contribute to anxiety disorders include past trauma, challenging childhood relationships, physical conditions like thyroid disease, and a history of other mental health disorders.

What are some high-functioning anxiety treatments?

There are several proven treatments for anxiety disorders. These include both therapy and medications.

Therapy

There are many types of therapy, but one that’s been proven particularly effective for anxiety disorders is cognitive behavioral therapy (CBT). This type of high-functioning anxiety treatment helps people understand how thoughts, feelings, and behaviors are connected. Therapists can help people identify unhealthy or inaccurate thoughts and see how reframing them affects their feelings and behaviors. We learn that assuming the worst outcome probably won’t happen, and even if it does, we find a way to navigate it.

One way CBT can help with anxiety is by teaching people to pause and engage in cognitive restructuring or positive self-talk when they feel anxious. We can ask ourselves things like: Am I being a perfectionist? What are my motivations here? How can I give myself compassion and grace, and not be too hard on myself?

Another way it can help is by incorporating CBT behavioral activation techniques. While CBT helps us understand the way our thoughts and feelings affect our actions, behavioral activation teaches us how our actions impact our mood, behavior, and feelings. We identify what we’re doing when we feel depressed, anxious, calm, or energized and intentionally engage in activities that support the desired emotion or effect.

Medication

Medication can also help with anxiety. There are two types of anxiety medications: those that people take as needed, and ones that are daily and cumulative. People with persistent anxiety may need to take medication long term. A physician or psychiatrist can help you assess the best option.

Tips for coping with high-functioning anxiety

In addition to high-functioning anxiety treatments like cognitive behavioral therapy and medication, practicing good self-care is something everyone can do to help manage stress and anxiety. Self-care can include things like:

Adequate sleep

Sleep is so important to our physical and mental well-being. If you don’t have adequate sleep, you’re not functioning and thinking at an optimal level.

Mindfulness

Mindfulness can be especially helpful for people with symptoms of high-functioning anxiety who spend a lot of time in their head. Grounding yourself in the present moment helps slow down ruminations about the past or future.

Nutritious meals

Eating well-balanced meals helps keep your brain and body healthy. You can even make eating your meal a mindfulness practice. Slow down and pay attention to the taste, textures, and aromas of each bite.

Exercise

Exercise can help combat high-functioning anxiety symptoms, and you don’t need to run 10 miles to get the benefits of it. Walk around the block. Take the stairs instead of the elevator. Do some gentle stretching. It doesn’t take much to get the blood flowing, and it can boost mood and concentration.

Calming techniques

Deep breathing and other types of breathwork are great for managing symptoms of high-functioning anxiety. Muscle relaxation techniques such as flexing and releasing different muscle groups, or grounding exercises, like focusing on what your five senses are experiencing in the moment, are also useful.

Journaling

Putting pen to paper and writing about feelings and anxiety triggers can be cathartic. You can also come back at another time and read your entries to gain perspective on the situation and reframe unhelpful thoughts and inaccurate beliefs.

Realize anxiety isn’t serving you

It’s always nice to get praise or compliments, but people with high-functioning anxiety can be so dependent on this external validation that they feel unable to move forward without it. There’s a real disconnect between your internal experience and external presentation if you have high-functioning anxiety. That’s because you’re trying to keep up the facade that “I have it all covered, and I’m excelling,” but inside there’s a lot of distress. It’s important to move away from that space that thinks anxiety is serving you because that’s what’s maintaining it.

How high-functioning anxiety manifests at work

We’ve explored recognizing and addressing high-functioning anxiety generally, but anxiety also follows people into their professional lives. In fact, for some people, symptoms of high-functioning anxiety are triggered by work. While employees with high-functioning anxiety tend to be detail-oriented, punctual, and able to think of several solutions, they’re also at greater risk of burnout and turnover. Recognizing signs of high-functioning anxiety in an employee can be difficult because with this condition, impairment is subtle and mostly internal. Externally they may be presenting very well, but internally they’re churning with anxiety.

Some symptoms of high-functioning anxiety in an employee:

Has trouble saying no

Employees may volunteer for work or accept new projects even when they don’t have the capacity to take on more. If the company culture encourages overwork, overtly or subtly, or disrespects boundaries, workers with high-functioning anxiety can be at even greater risk of burnout.

Needs excessive reassurance

Every employee needs clear instruction and tools to do their job well, but an employee with high-functioning anxiety may ask an excessive number of questions and check in with their manager far more frequently than expected or desired to make sure they’re meeting expectations.

Avoids asking for help

A lot of people with high-functioning anxiety struggle with imposter syndrome. They may think things like, “I don’t know what I’m doing. I can’t ask questions or ask for help because they’ll know I’m a fraud.”

Spends excessive time on tasks

Workers with high-functioning anxiety may spend an inordinate amount of time on tasks because of perfectionism. Perhaps they take five hours on a task when they could have just as good of an outcome in two hours.

Procrastinates

For some workers, high-functioning anxiety manifests in procrastination rather than spending too much time on tasks. The employee may get so anxious about not getting an assignment perfect that they delay getting started and end up turning in work late or submitting work that could’ve been better if they’d devoted more time to it.

Doesn’t take time off work

People with high-functioning anxiety may struggle with work-life balance. They may worry that taking paid time off looks bad, they won’t be able to catch up when they get back, or they’ll miss out on something important while they’re gone.

Has trouble accepting praise

Perfectionism can show up as self-criticism in employees with high-functioning anxiety. They can be hard on themselves and feel uncomfortable accepting compliments. For example, when their manager tells them they did amazing work on a project, they may insist that it was “just OK” or dwell on small missteps.

How to help an employee with high-functioning anxiety

If you notice signs of high-functioning anxiety in an employee, there are a few things you can do to support them. Give them the reassurance they crave, but in a measured way so they don’t become dependent on it. Encourage them to become self-validating. You can say things like, “Trust your instincts,” “You’re doing a good job,” or “I know you can do this.” Empower them to trust their own voice by asking for it during meetings. Saying things like, “What do you think?” or “I’d love your thoughts about this” could be a great way to foster independence and growth.

You could also offer support without singling them out. This could come in the form of general education on managing stress and anxiety for the whole team. You may also consider referring them to company-provided mental health resources. If your organization has mental health benefits like Lyra Health, the employee can see a therapist or mental health coach or access self-guided help. The research on effective outcomes for people who use teletherapy for anxiety is significant. It’s effective and convenient, and people get services faster.

Move from functioning to thriving

Anxiety is a challenging but treatable condition. With help addressing the root causes of anxiety and managing symptoms, people can feel better. You may believe anxiety is why you’re accomplishing so much, but with support you can be just as effective—and you can enjoy the journey so much more.