High-Functioning Anxiety
Signs You May Be Struggling More Than It Seems
By Sarah Rogers, MA, LPC, CCTP, NCC
Some of the most put-together people I work with are quietly drowning.
They are people who are able to live full lives that include attending work daily and being able to be a good friend or family member. From the outside, it may look like they are handling life just fine, even thriving in some instances. Internally, it can feel very different.
High-functioning anxiety is not an official diagnosis, but it is a term often used to describe people who experience significant anxiety while continuing to meet many of their daily responsibilities. Someone experiencing this kind of anxiety may be the person who rarely misses a deadline, remembers what everyone else needs, and can usually be counted on to handle the details. At the same time this is occurring, that same person could be replaying conversations, thinking about everything that can go wrong, and struggling to stay regulated in the moment.
This is part of what makes this type of anxiety so easy to overlook. There may not be an obvious crisis. Instead, there is a person who is constantly pushing themselves forward while quietly running on empty.
What Is High-Functioning Anxiety?
A misconception about anxiety is that someone has to “look” anxious for their anxiety to be serious. Understanding the depths of anxiety can lead to learning that that is not a necessary trait of the diagnosis. A person may be extremely uncomfortable internally while appearing calm and capable to everyone around them.
For some people, staying busy becomes a way of keeping uncomfortable thoughts at bay. If there is always another task to finish, there is less time to sit with the anxiety.
Sometimes these coping strategies work so well that nobody notices there is a problem.
One thing I have noticed in my work is that people do not always recognize their anxiety when it looks like productivity. A client may describe themselves as someone who is “doing fine” while feeling ran down and on edge more often than not. Sometimes it takes slowing down and looking at what is happening underneath the productivity for them to recognize how much anxiety they have actually been carrying. In my practice, I have seen it show up through overthinking and perfectionism.
There can also be a strong fear of letting other people down. For some people, being dependable becomes part of their identity. They are the person everyone calls when something needs to be handled. They may pride themselves on being able to manage everything without asking for help.
While this is a great personality trait, it is not always beneficial. The problem is that eventually, something has to give.
Anxiety can impact sleep, concentration, relationships, physical health, and overall quality of life. Anxiety disorders are also among the most common mental health conditions, which means these struggles are far more common than they may seem (McEvoy et al., 2015).
Even when someone continues functioning at a high level, they can have all the same results from the anxiety. The fact that a person is getting everything done does not necessarily mean they are doing okay.
Signs and Symptoms of High-Functioning Anxiety
It may look like:
Running through worst case scenarios
Feeling guilty when you feel like you “should” be doing something other than relaxing
Preparing for ordinary situations far beyond what is actually necessary
Needing things to be done a certain way
Feeling uncomfortable sitting still because your mind immediately starts searching for the next task
Having difficulty relaxing without feeling productive
Expecting yourself to handle everything independently
Experiencing physical tension, headaches, stomach issues, or trouble sleeping
One of the things I pay attention to is what happens when there is finally nothing that needs to be done.
A person may sit down after a long day, fully ready to relax. And then their mind starts racing and making that list that seems like it doesn’t have an end.
Did I forget something?
What do I need to do tomorrow?
Did I make someone upset?
What if something happens?
Should I be doing something right now?
For someone who has spent years staying busy to manage anxiety, slowing down can actually make the anxiety more noticeable. It means that there is a time for everything to play catchup, and that in itself can increase anxiety levels significantly.
A Self-Reflection Exercise for High-Functioning Anxiety
Here is something that I try to encourage people to pay attention to when in session with them:
What happens when your schedule opens up?
Take a minute and imagine that. No deadlines, no emails to send, no children to drive back and forth. Just a moment fully to yourself.
What is your first reaction to that?
Do you actually enjoy it, feeling relief ?
Or do you immediately start looking for something you should be doing?
Ask yourself:
When was the last time I did something simply because I wanted to, without feeling like I needed to justify it?
How often do I say "I'm fine" because explaining how I actually feel seems like too much work?
What would happen if I admitted that I am struggling?
Your answers may tell you something that your productivity doesn't.
How High-Functioning Anxiety Can Go Unnoticed
I see this pattern quite often with clients. “Most people don’t walk in and say ‘I have high-functioning anxiety.’ They say they’re just stressed, or tired, or that things have been a lot lately. Then we dig a little deeper, and it turns out they have been mentally planning the next day as they try to sleep and feeling a large amount of guilt if they even think about slowing down.
As previously mentioned, on the outside, they are often the high achievers and seem to be doing consistently great. Often, these are the clients who have the hardest time admitting that they need help.
For example, someone may tell me that they are “just stressed” because they have a lot going on. As we talk, we may discover that they are checking their work email late at night, mentally planning the next day's schedule while trying to fall asleep, and adding one additional thing after the other.
Nothing about that person necessarily looks like a crisis from the outside. But internally, they may rarely feel at ease.
There can be this belief that because they are technically functioning, they don't have a reason to slow down. They may say things like, "Other people have it worse," or "I don't really have time for therapy right now”.
Unfortunately, too many times I have seen this catch up with people. Eventually, the anxiety that they have been carrying for months or years starts showing up somewhere else. A person may notice that they are sleeping poorly, becoming more irritable, having a harder time concentrating, or feeling less connected to the people and activities they normally enjoy.
Sometimes they recognize the change themselves. Other times, a partner, friend, or family member notices it first. Sometimes their body starts giving them signs that their mind has been trying to ignore. Often, when we get to that point, the person is still trying to push through it.
One of the hardest things for these individuals is giving themselves permission to take time for themselves before they reach that point. There can be a lot of guilt attached to saying, "I need help."
But needing help does not mean you are incapable. Two opposite things can exist within the same situation. I often remind clients that being successful does not cancel out the fact that they may be struggling. You can be the person everyone depends on and still reach a point where you need support yourself.
Strategies for Managing High-Functioning Anxiety
Pay Attention to What Happens Between the Big Moments
Anxiety is not always easiest to recognize during a crisis. Sometimes it is more noticeable in the quiet moments. Notice what happens the next time you have 20 or 30 minutes with nothing you have to accomplish. Does your mind settle, or does it immediately start looking for something to solve? If your thoughts immediately start looking for the next problem, that is worth paying attention to.
Notice When “This Is Just Who I Am” Becomes the Explanation
"I've always been this way" is something I have heard people say many, many times. Maybe you have always been the planner. The responsible one. The person who gets things done.
Those traits aren’t unhealthy. However, if being that person means you never allow yourself to rest, it may be worth looking at whether anxiety has become intertwined with your identity. You do not have to stop being responsible. You may simply need to learn that responsibility includes yourself, too.
Practice Doing Things Imperfectly
Perfectionism and anxiety frequently work together.
Try intentionally allowing something to be good enough instead of perfect. Send the email without rereading it ten times. Let someone else handle a task. Leave something unfinished for the evening.
This can feel surprisingly uncomfortable. That discomfort is part of the point. You are teaching your brain that something does not have to be perfect for you to be safe.
Make Time for Yourself Before You Need It
If you only allow yourself to rest once you are completely exhausted, rest can start to feel like another emergency task. Instead, consider what actually helps you feel like yourself again. Some examples from clients I have seen are reading, exercising, seeing a friend, sitting outside, or simply having some uninterrupted time alone.
You do not need to wait until you have earned it.
Let Someone Know How You Are Actually Doing
If you are someone who automatically says "I'm good," try being a little more honest with someone you trust. You do not have to have a full explanation. "I've actually been pretty overwhelmed lately" is enough to start.
Rethinking What It Means to Be “High-Functioning”
What if being good at functioning does not mean you have to keep functioning at this level?
Being good at keeping everything together doesn’t mean you have to keep doing it at this pace forever. ‘I can handle it’ and ‘I should have to handle it alone’ are two very different sentences.
When to Seek Therapy for High-Functioning Anxiety
If anxiety is consistently affecting your sleep, relationships, concentration, mood, physical health, or ability to enjoy your life, it may be time to consider professional support.
Contrary to the belief of some, you do not need to be in crisis to go to therapy. In fact, therapy can be particularly helpful before anxiety reaches the point where functioning becomes impossible.
Therapy doesn't have to begin when everything has fallen apart. In many cases, it can begin when someone simply realizes, “I don't want to keep living this way.”
Therapy can provide a place to look at the patterns underneath the anxiety. You don't have to arrive with everything figured out. Figuring out what is happening is part of the work.
If you find yourself thinking, "I don't really need therapy, I just have a lot going on," that may actually be worth exploring.
High-Functioning Anxiety Can Be Easy to Miss
High-functioning anxiety can be easy to miss because productivity can hide how someone is feeling. If worry, perfectionism, pressure, or the need to stay busy has become a constant part of your life, consider what it is costing you.
Asking for help doesn’t mean that you failed. What it can mean is that the way you have been coping and going throughout your life is not working as well as it once did before.
Psychotherapy can provide a space to better understand patterns, emotions, and behaviors while developing healthier ways of coping (American Psychological Association, 2023).
Functioning is not the same thing as feeling okay.
Reach out for support today!
References:
American Psychological Association. (2023). Understanding psychotherapy and how it works. https://www.apa.org/topics/psychotherapy/understanding
McEvoy, P. M., Grove, R., & Slade, T. (2015). Epidemiology of anxiety disorders in the Australian general population: Findings from the 2007 National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 49(9), 817–827. https://doi.org/10.1177/0004867415573055
