The Surprising Signs Of High-Functioning Anxiety, Per A Psychologist
If you've been feeling anxious lately, you're not alone. Between the never-ending news cycle, juggling your personal and professional responsibilities, and more, it can be hard to keep it all together. You may have even heard about high-functioning anxiety and wondered if the label applies to you—especially if you're a high achiever who loves being productive. But what does the term mean, exactly, and how do you know you have it?
Unlike other anxiety disorders, high-functioning anxiety is not an official clinical term that you'll find in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders in the U.S. It's more of a psychology buzzphrase than a technical diagnosis, says clinical psychologist Lauren Cook, PsyD, author of Generation Anxiety. And although symptoms can mimic other forms of anxiety (like social anxiety, panic attacks, and more), the "high-functioning" addition just means that you might be hiding it better.
Although feeling overwhelmed is a natural part of life, anxiety (whether high-functioning or not) can be a major challenge that impacts your physical, emotional, and mental health. If you're feeling unsettled lately and suspect you have high-functioning anxiety, here are the potential signs, symptoms, and how to cope, according to a psychologist.
Meet the expert: Lauren Cook, PsyD, is a clinical psychologist and author of Generation Anxiety.
What is high-functioning anxiety?
Although it's not a clinical diagnosis, high-functioning anxiety is marked by similar symptoms of generalized anxiety disorder (GAD), which typically involves a persistent feeling of worry, fear, or dread. You may also experience difficulty sleeping, irritability, poor concentration, feeling restless, and worry that feels out of control, Cook says. People who have high-functioning anxiety often appear to be successful and well-functioning (hence the name) on the outside, but are often struggling on the inside.
“Two hallmarks of [an anxiety] diagnosis include that the symptoms are distressing for the person and that they're experiencing dysfunction in their lives,” Cook says. But with high-functioning forms, the worry and dysfunction might not be as noticeable on the surface, and it's easy to hide behind a successful facade. “For various reasons, some folks can continue to seem ‘fine’ on the outside while still feeling like they're drowning,” she says.
What causes high-functioning anxiety?
There are various biological and environmental factors that can cause a person to be anxious, per the National Institute of Mental Health (NIMH). That said, high-functioning anxiety may have roots in your early childhood experiences, Cook says. “It often goes back to the messages we learned as children—when we associate our worth in our achievements, we learn that our value is in what we do, not who we are,” she says. When this happens, it can feel like you're constantly striving for praise and chasing the high of success, Cook says. But in reality, you're likely burning yourself out.
Remember: High-functioning anxiety isn't a real diagnosis, so if you've been clinically diagnosed with an anxiety disorder and don't feel like you're functioning well, it doesn't mean you are weaker if you struggle to manage your symptoms, Cook says. “In some ways, high-functioning anxiety [situations] can be just as problematic—if not more so—because they can go more under the radar and others will not notice that a person needs support.”
Signs And Symptoms Of High-Functioning Anxiety
A key aspect of high-functioning anxiety is being consistently preoccupied with what others think, says Cook. “High-functioning anxiety can often include people-pleasing, a fear of making others angry, and obsessions about what others think about them,” she explains. “It can be so much about keeping appearances up, and letting people see a peek behind the curtain can be anxiety-provoking in itself.”
Mental symptoms of high-functioning anxiety can include:
Overthinking and overanalyzing
Fear of disappointing or upsetting others
Self-doubt
Having racing thoughts
Not being able to relax
Being excessively detail-oriented
Physical symptoms can include:
Gastrointestinal issues (diarrhea, constipation, nausea, and vomiting)
Frequent headaches
Body aches
Brain fog
Excessive sweating
Muscle tension
Racing heart rate
Difficulty sleeping
Tingling or numbness in toes or fingers
High-achievers often have trouble asking for mental health support, but the longer you wait, the more likely it is that your anxiety can manifest physically, Cook says. “Because you can put off getting help for so long, the body can manifest symptoms as a cry for help," she says. You may also find that you get sick often in the morning, when cortisol, the stress hormone, is the highest, Cook adds.
Who is at risk for high-functioning anxiety?
While all types of anxiety can affect anyone, women, mothers, caregivers, high-achievers, and people-pleasers are all more likely to experience high-functioning anxiety, Cook says.
It can also specifically impact minorities and people from underrepresented groups, Cook adds. “We can also see minorities outwardly excelling but struggling with high-functioning anxiety because they are having to do *that* much more to keep up when others have the privilege to push them ahead,” she adds. “So many people suffer in silence with high-functioning anxiety because they are afraid of people perceiving them as a failure if they don't achieve or if they need a break.”
Folks who deal with imposter syndrome—when you doubt your skills, talents, and accomplishments—may also be more at risk for high-functioning anxiety, Cook says. In some cases, imposter syndrome may very well give you motivation to succeed at work and in life—but consistent self-doubt can also exacerbate your anxious feelings long-term.
How To Cope With High Functioning Anxiety
Although high-functioning anxiety isn’t something you’ll receive an official diagnosis for, there are strategies you can implement to manage it on your own, Cook says.
Give yourself permission to rest.
If you tend to have a busy schedule with no down time for yourself, try scheduling self-care as a task, Cook says. “It may sound silly, but rest is productive—especially with high-functioning anxiety,” she says. “You cannot continue on long-term if you truly do not stop to recover and restore yourself.” Stress-relieving techniques like music, movement, and taking a social media break can help you relax and recharge.
Practice saying "no."
If you're a people-pleaser, you likely struggle to set boundaries with others. “This is when high-functioning anxiety goes into overdrive, because we are so busy living for everyone else's demands that we have no time to meet our own needs,” Cook says. “The more we can practice mindfully considering what we choose to say 'yes' and 'no' to, the more we can practice setting boundaries and learning to live with others potentially being frustrated when we set those limits.”
Saying "no" will also allow you to see what it feels like to sit with someone else's disappointment, and recognize that setting a boundary doesn't have to derail your world, Cook says. “The way to break out of the high-functioning anxiety cycle is to realize that you can be both a loving and kind person as well as one who doesn't do everything for everyone all of the time,” she says.
Try giving yourself a 24-hour window before responding to requests whenever possible, that way you're not just responding out of the need for approval, she recommends. Of course, you probably shouldn't ignore your boss' important email for that long—but if it's a less urgent matter from, say, a friend, that can wait, don't be afraid to sleep on it.
Speak to a therapist.
Therapy is a great option for high-functioning anxiety since it can help you understand your behaviors, receive support, and make tangible changes moving forward, Cook says. To find a therapist, you can use a platform like Psychology Today, Inclusive Therapists, Open Path Collective, or the To Write Love On Her Arms (TWLOHA) Find Help Tool, which allow you to search for providers by zip code and your unique needs. If you have insurance, you can also search for in-network providers, or for a more affordable option, try a virtual or in-person community support group.
Ask your doctor about medication.
If your provider thinks it's a good option, taking medication for anxiety can also help. “Medication can be a useful support if you're finding that you're struggling with panic attacks, insomnia, and you're unable to focus enough to get your tasks done for the day,” Cook says. “[However,] medication isn't just for when you're not able to focus for a few days or few weeks—this is when you've noticed a pattern for several weeks and you're continuing to struggle."
Anxiety (high-functioning or not!) isn't the most enjoyable feeling, but you don't have to struggle alone. If you start to notice patterns of the same physical or mental symptoms popping up in your life after many weeks, months, or years, but you're generally functioning pretty well on the surface, it could be a sign that you're dealing with high-functioning anxiety. No matter what form it takes, don't be afraid to ask for help and support.
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