What Is High-Functioning Anxiety?

Anxiety is a mental health condition that can take many different forms, including high-functioning anxiety. In this article, we explore what high-functioning anxiety is, its symptoms, causes, and what you can do if you think you might have high-functioning anxiety, including treatment options.

What is anxiety?

The American Psychological Association^[1] defines anxiety as:

An emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.

People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat.

Anxiety is not the same as fear, but they are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.

Over 40 million people (about 12% of the population) are affected by anxiety each year, making it the most common mental health condition in the U.S. While anxiety disorders are highly treatable, only about 36% of sufferers receive treatment.

If you want to know whether you have anxiety, complete our Anxiety Test. It’s not a diagnostic tool but will highlight how likely it is you might be living with anxiety. If you want to learn more about anxiety, you can find out more about what anxiety is, the causes of anxiety, and what anxiety feels like.

If you do think you may have anxiety, remember that help is available. You might want to find out about the many different types of anxiety as well as what your anxiety type is before speaking to a medical professional, such as the anxiety team at The Center • A Place of HOPE.

What is the difference between anxiety and high-functioning anxiety?

Generally speaking, the symptoms of anxiety are:

• Constant and excessive worrying that is disproportionate to whatever the person is worrying about
• Feeling restless or wound-up
• Physical symptoms like sweating, trembling, shortness of breath, and feeling hot
• Being easily fatigued
• Muscle tension
• Irritability
• Trouble focusing or concentrating
• Trouble falling, or staying, asleep

For many anxiety sufferers, their symptoms make daily life difficult, with those around them aware the person in question is having a difficult time. For example, social anxiety might mean you avoid or leave situations that cause you to feel anxious.

In contrast, high-functioning anxiety can be thought of as a ‘hidden’ condition. Those with high-functioning anxiety often use the image of a duck swimming on the water to describe their experience of anxiety. While the duck may appear calm and serene to observers, there is actually a huge amount of effort going on under the surface just to keep the duck afloat.

In other words, beneath the calm exterior of a person with high-functioning anxiety, there lies an invisible struggle, one that requires a huge amount of energy, and exhausting levels of focus to maintain a functioning appearance.

High-functioning anxiety and the stress response

One of the theories about anxiety is that sufferers find themselves in an almost-permanent state of high alert (the ‘fight-flight-freeze’ response to stress hormones released to keep us alive in dangerous situations^[2]). Flight and freeze both fit with the symptoms and experiences of those with anxiety.

What are symptoms of high-functioning anxiety?

In addition to the symptoms above, high-functioning anxiety sufferers may experience the following:

• Perfectionism and fear of failure
• A very negative inner critic voice or self-talk
• People-pleasing tendencies
• Overthinking
• Ruminating on past events or re-playing experiences over and over in your mind
• Worrying about the future, and fearing the worst
• Unfavorably comparing yourself to other people
• Procrastination
• Lack of self compassion
• Putting other peoples’ needs before your own, worrying about them while neglecting your own
• Pushing yourself to your limits
• Not living in the moment, inability to relax or enjoy yourself

One of the aspects of high-functioning anxiety that allows it to remain hidden is many of its symptoms are also prized in our society. Things like perfectionism, overworking, and pushing yourself to your limits fit with a type-A personality or high achiever profile. These toxic societal messages and pressures can cause huge amounts of harm to anxiety sufferers (and to those at risk of high-functioning anxiety) as they are often rewarded academically, financially, and culturally.

Diagnosing high-functioning anxiety

High-functioning anxiety is not a formal diagnosis, unfortunately, and sufferers may remain at a subclinical level or be diagnosed more broadly with Generalized Anxiety Disorder.

Many sufferers are never diagnosed with anything because the nature of high-functioning anxiety means that you may be always on the brink but never quite at a crisis point. It is something of a vicious cycle as the people-pleasing aspect of neglecting your own needs means you may be less likely to seek help and support.

How to treat high-functioning anxiety

Treatment for all types of anxiety is available, with a combination of psychological therapy (or talking therapy), and medication shown to be most effective^[3].

High-functioning anxiety is often an indicator of certain types of trauma in adults such as childhood trauma, relational trauma, or complex trauma, for which talking therapy is particularly effective.

You can access treatment at The Center • A Place of HOPE, where you will be able to talk to someone who cares and who is trained to be able to help you.

How can I manage my high-functioning anxiety?

Seeking professional treatment is important, as this will allow you to get to the root cause of your anxiety issues, as well as finding ways to cope with your symptoms.

If you would like to work on your high-functioning anxiety outside of formal treatment, there are several areas that will help you to learn to manage high-functioning anxiety more effectively, and to begin to find other ways to respond to your symptoms.

1. Taking care of your needs

When the gas light comes on in your car, you find a service station and fill up. When a pet lets you know they’re thirsty or hungry, you respond by feeding them. You are likely to be an excellent caregiver to others, but why is it so hard to meet your own needs?

Many of us grow up prioritizing the needs of others over our own, so much so that we may not even recognize we have needs.

So, how to remedy this? Start small. Talk to yourself as a loving parent, asking yourself ‘what do I need right now?’ Take a breath. Notice what you’re feeling. Try to meet whatever need arises. If you can get into the habit of checking in like this in the morning and evening, you can re-learn the self-awareness you need to take care of yourself.

Beginning to acknowledge your own needs is a great way to let yourself know you are important. If it feels too much of a stretch to put yourself and your needs first, consider that loving yourself is essential to fully loving another. It’s akin to putting your own oxygen mask on first before helping other people.

2. Self-compassion vs self-criticism

Dr Kristin Neff is one of the world’s leading experts on self-compassion. She has dedicated her professional life to studying self-compassion, and to developing tools to help people to develop self-compassionate practices.

Dr Neff defines self-compassion as representing the balance between increased positive and decreased negative self-responding in times of personal struggle.

“Self-compassion entails being kinder and more supportive toward oneself and less harshly judgmental. It involves greater recognition of the shared human experience, understanding that all humans are imperfect and lead imperfect lives, and fewer feelings of being isolated by one’s imperfection. It entails mindful awareness of personal suffering and ruminating less about negative aspects of oneself or one’s life experience.”
– Dr. Kristin Neff

The perfectionism that is often a hallmark of high-functioning anxiety can be a difficult habit to break. Reminding yourself that you are human, fallible, but still worthy of love isn’t always easy. Dr. Neff’s website features a range of self-compassion guide practices and exercises that are designed to help you to overcome self-criticism.^[4]

There are many self-compassion studies^[5] demonstrating that being compassionate to oneself is associated with emotional resilience and psychological well-being, meaning it’s an incredibly impactful practice to take up.

3. Mindfulness

Mindfulness is an important aspect of self-compassion. Here’s Dr. Neff again:

“Mindfulness is a type of balanced awareness that neither resists, avoids, nor exaggerates our moment-to-moment experience. In this receptive mind state, we become aware of our negative thoughts and feelings and are able to just be with them as they are, without fighting or denying them. We recognize when we’re suffering, without immediately trying to fix our feelings and make them go away.”

Mindfulness can be a very powerful way to counter symptoms such as the rumination and inability to enjoy the moment that arises for sufferers of high-functioning anxiety. There are many free mindfulness activities and resources available online – try these 5 Simple Mindfulness Practices for Daily Life.

Taking care of your needs, self-compassion, and mindfulness all work together towards creating a more accepting view of ourselves.

Self-kindness means we prioritize our needs and fiercely protect ourselves to prevent harm. Self-compassion allows us to connect with humanity, helping us to recognize we are not alone in our suffering, and that it is nothing to be ashamed about. Mindfulness helps us to see clearly and to speak the truth, both to others as well as to ourselves.

4. Practical ways to manage high-functioning anxiety

Amy is a 45-year-old woman living with high-functioning anxiety. Here she shares her advice for how she manages her high-functioning anxiety for fellow sufferers.

“If I’m feeling overwhelmed, I always make a list. It’s the most helpful thing for me. I have lists on my phone which I use to park something out of my head. For example, when it’s 2am and I remember that the insurance needs renewing, that may keep me awake, but writing it down helps me feel it’s ‘in progress.’

“For work, it’s always a paper to-do list. It makes me instantly feel calmer, and that things are more achievable.

“Crossing things off my lists also plays into my reward mechanism which I seem to have for all things from cleaning to work. If I cross something off my list then I reward myself with something fun!

“I’d also advise anxiety-sufferers to allow yourself time to yourself, particularly after a day of calls or a weekend of being sociable. That time could be as simple as walking the dog, taking a swim or just driving the long way back from the grocery store or school run.

“I would also recommend people get acquainted with the feeling of anxiety rising, and learn to ask for help. This is a big one for me, and I don’t always catch it! If you can try to tell a loved one or friend that you’ve got a lot of balls in the air then you start to break the cycle.”

Recognizing you have high-functioning anxiety is the first step towards recovery. Remember, you do not have to suffer in silence.

Asking for help may feel challenging. The skilled and experienced team at The Center • A Place of HOPE is here to help you on your recovery journey. Contact us today to learn more about treatment for your anxiety.

[1] https://www.apa.org/topics/anxiety
[2] Öhman, A. and Wiens, S., 2004, April. The concept of an evolved fear module and cognitive theories of anxiety. In Feelings and emotions: The Amsterdam symposium (pp. 58-80). Cambridge, UK: Cambridge University Press.
[3] Borwin Bandelow, Sophie Michaelis & Dirk Wedekind (2017) Treatment of anxiety disorders, Dialogues in Clinical Neuroscience, 19:2, 93-107, DOI: 10.31887/DCNS.2017.19.2/bbandelow
[4] https://self-compassion.org/category/exercises/
[5] https://self-compassion.org/the-research/