High-Functioning Anxiety

By: Suzanne Feinstein, PhD

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What Is High Functioning Anxiety?

People who have high functioning anxiety (subset of generalized anxiety disorder) appear, on the outside, to be strong, competent and productive. Yet, on the inside they struggle emotionally to get through each day. Given the high level of functionality, the anxiety often goes undetected. Unlike most people who cope with anxiety through avoiding stressful triggers, people with high functioning anxiety push through their fears without exhibiting any obvious symptoms. Due to the fact that high functioning anxiety does not interfere with a person’s ability to function, it is not classified as a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

It is a normal part of life to experience a certain degree of stress and anxiety. A healthy dose of anxiety can be beneficial in motivating us to reach our daily goals. However, high functioning anxiety takes a considerable toll on the person’s overall quality of life. Individuals with high functioning anxiety may feel significant stress and anxiety both professionally and socially. They may have a constant stream of worry rushing through their heads. Did I shut off the faucet? Will I lose my job if I make a mistake? What if I get a flat tire on the way to the airport? I need everything to go as I planned or else something catastrophic may happen.

The high levels of responsibility, over analysis, perfectionism and fear of disappointing people make it increasingly difficult to emotionally regulate. Heightened tensions and self-imposed pressures can lead to a variety of secondary mental and physical problems. 

What Does High Functioning Anxiety Look Like?

You find yourself pushing through fatigue, illness, pain, tension or stress to complete chores, work assignments, schoolwork, social obligations, and family expectations. You have racing thoughts, overanalyze, strive for perfection, struggle with sleep, anticipate the worst, feel on edge, and have difficulty saying no. You are resistant to treatment because you focus more on the rewards of being super productive than the sleepless nights, irritability, anxiety and tension your high functioning anxiety brings.

People with high functioning anxiety experience a number of distressing physical symptoms. Some of these might include:

  • Tense muscles
  • Lightheadedness and dizziness
  • Restlessness
  • Stomach issues
  • Excessive sweating

What Causes High Functioning Anxiety?

High functioning anxiety can be a result of a number of factors. A person may be more likely to be predisposed to it due to:

  • Genetics
  • Exposure to stressful life events 
  • Personality traits 
  • Environmental triggers 
  • Hormones 
  • Overactive amygdala (the part of your brain that controls the fear response)

What Are the Types of High Functioning Anxiety?

As we mentioned earlier, those with high functioning anxiety might feel anxious in highly specific situations. Others might feel anxious in any social, personal or professional role. Levels of severity can be mild, moderate or severe.


Those with mild high functioning anxiety typically regulate their emotions without building dependency on any substances or self-harming behaviors. They can generally tolerate the psychological and physical symptoms that come with the high standards they place on themselves.


People with moderate high functioning anxiety might drink too much, emotionally eat, gamble or participate in other maladaptive behaviors to self-soothe. Their anxiety symptoms cause physical strain and discomfort on the body and may be accompanied by sleep difficulties and mood disturbances.


A person with severe high functioning anxiety might experience panic symptoms before or during what they perceive to be high stake encounters. Unhealthy coping mechanisms contribute to significant physical and psychological symptoms. The individual struggles with low self-esteem and feelings of personal failure despite their achievements.

How Can High Functioning Anxiety Affect Your Life?

Unfortunately, high functioning anxiety can hurt many areas of your life. The high levels of self-imposed pressures and self-criticism can have negative consequences in personal relationships, in a classroom or in the workplace.

When you take on too much responsibility and push yourself beyond what is healthy, you might experience the following effects:

  • Depression
  • Feelings of isolation
  • Negative thoughts
  • Low self-esteem
  • Irritability 
  • Resentment toward others 

How Can I Treat My High Functioning Anxiety?

All is not lost if you are suffering from high functioning anxiety. Various therapeutic methods can help diminish anxiety symptoms, improve your quality of life, and increase opportunities for personal growth. 

Cognitive Behavioral Therapy

A highly trained behavioral therapist will work with you to identify what situations trigger anxiety and how to manage the related physiological effects. They will help you change your negative thinking patterns and will set up exposure exercises to help you desensitize to your feared scenarios. You will be introduced systematically to various triggers as your brain and body learn the difference between real and perceived threats. 

Emotional Regulation Treatment 

Through a variety of CBT techniques, the individual can learn to reduce the triggers, the intensity and the duration of the emotions that accompany the high functioning anxiety.  Distress tolerance training, mindfulness, and interpersonal communication skills are all effective in modulating fluctuating emotions. 

Relaxation Therapy

In addition, people can learn some relaxation methods to help ease their symptoms. Some of these techniques include:

  • Meditation
  • Exercise
  • Breathing


Get Help With High Functioning Anxiety Management

You don’t have to suffer through your anxiety alone. There are steps you can take to decrease your high functioning anxiety symptoms and live a happy life. Working with a licensed psychologist experienced in treating anxiety disorders can make it easier.

Advanced Behavioral Health is here to help you identify and manage your anxiety. Our compassionate team looks forward to providing you with a mental healthcare plan that is personalized to you and your needs. Contact our office to schedule an appointment.

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