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High-functioning anxiety can manifest in perfectionism, overthinking, avoidance, procrastination, and a need for control. Even though individuals with high-functioning anxiety may appear to perform well in daily life, they often experience significant internal turmoil, worry, and physical symptoms like restlessness or fatigue.

In today’s fast-paced world, anxiety has become a common companion for many. When stress and worry begin to interfere with everyday life, it can be an indication of an anxiety disorder. However, there is a form of anxiety that often goes unnoticed – high-functioning anxiety. Individuals grappling with this condition can maintain a facade of normalcy, managing their day-to-day responsibilities effectively, even as they are besieged by worry within.

The problem with high-functioning anxiety is that it is cloaked in the guise of success. On the outside, individuals appear to be overachievers, impressing those around them with their capabilities and diligence. Yet, on the inside, they are constantly wrestling with their anxiety. This duality often makes it difficult for the condition to be recognized and addressed.

This article aims to illuminate the signs of high-functioning anxiety, to help you or your loved ones identify if you might be dealing with this invisible foe. Armed with this knowledge, you can take the necessary steps towards finding effective treatment and returning to a life of peace and balance.

What is High-functioning Anxiety?

High-functioning anxiety is not a clinically recognized term, but it is widely used to describe individuals who suffer from anxiety but can still function effectively in their daily lives. These individuals often excel in their work or studies and maintain healthy social relationships. However, the success is frequently accompanied by constant worry, fear, and feelings of impending doom.

High-functioning anxiety can be thought of as a mask. On the surface, people with this type of anxiety project a picture of competency, assurance, and ambition. They might even be viewed as overachievers. But behind the mask, they grapple with perpetual inner turmoil.

Contrary to common perception, this relentless drive and restlessness are not merely the result of a strong work ethic or ambitious nature. Rather, they are symptoms of a deeper, internal struggle. It is important to note that even though high-functioning anxiety can lead to significant achievements, it is not a healthy or sustainable state of being.

What are the Signs of High-functioning Anxiety?

Recognizing high-functioning anxiety can be challenging because it often masquerades as high achievement. However, a range of distinct signs can help to identify the presence of this condition. Not everyone with high-functioning anxiety will experience all these symptoms, but these are common signs that individuals might exhibit.


Perfectionism is a common trait among people with high-functioning anxiety. They often set extremely high standards for themselves and are rarely satisfied with their performance, regardless of the positive feedback they might receive. They are constantly pushing themselves, chasing after unattainable perfection. The fear of failure or making mistakes can become all-consuming, leading to significant anxiety and stress.


People with high-functioning anxiety tend to overthink everything. They worry about future events, replay past conversations, and anticipate worst-case scenarios. They can find it hard to relax or let go of their worries, even when they are engaging in supposedly relaxing activities. Overthinking can interfere with their ability to sleep and concentrate, leading to fatigue and cognitive difficulties.


Avoidance is another sign of high-functioning anxiety. Despite their apparent competence, individuals may shy away from new experiences or situations that could potentially trigger anxiety. This avoidance can limit their personal and professional growth as they may miss out on opportunities due to their fear of failure or judgment.


Procrastination is not uncommon among those with high-functioning anxiety. Despite their generally efficient nature, they can delay tasks, especially those they consider challenging or anxiety-provoking. The fear of making mistakes or not meeting their own high expectations can lead them to put off tasks until the last possible moment. This often results in additional stress as they rush to meet deadlines.

Need for Control

A strong need for control can also signal high-functioning anxiety. Individuals with this condition often feel the need to control every aspect of their life, including their work, personal relationships, and even leisure activities. This need arises from the fear of uncertainty and the desire to prevent anything that could trigger anxiety. It is an exhausting endeavor that can lead to increased anxiety and tension.

Physical Symptoms

High-functioning anxiety can also manifest in physical symptoms. These might include frequent headaches, stomachaches, muscle tension, and sleep disturbances. People with this condition might also experience a racing heart, excessive sweating, or shortness of breath, even when they are not engaged in physical activity. These physical symptoms can further exacerbate their anxiety and worry.

Imposter Syndrome

Imposter syndrome is a psychological phenomenon where individuals doubt their accomplishments and fear being exposed as a “fraud.” This is common among people with high-functioning anxiety. Despite their achievements, they often feel undeserving of their success and live in constant fear of being found out. This can lead to even more anxiety and stress.

Causes of High-Functioning Anxiety

The exact causes of high-functioning anxiety are not well understood. However, like other forms of anxiety, it’s likely to be a combination of genetic factors, personal experiences, and environmental factors. Childhood trauma, high levels of stress, and a history of other mental health conditions can also contribute to its development. It’s essential to understand that it’s not a character flaw or a sign of weakness, but a serious mental health condition that requires appropriate treatment.

Pros and Cons of High-Functioning Anxiety

While high-functioning anxiety might lead to high levels of productivity and achievement, it’s not without its drawbacks. On the positive side, it can propel individuals to excel in their endeavors, pushing them to achieve more than they might have without the constant fear of failure or underachievement.

However, this constant push can also result in burnout, physical health issues, and relationship problems. The constant worry and anxiety can also lead to other mental health conditions, like depression. It’s a precarious balance, and in the long run, the costs usually outweigh the benefits.

Normal Anxiety vs. High-Functioning Anxiety

Normal anxiety is a natural response to stress or potential danger. It typically occurs in response to specific events or situations and subsides once the threat has passed. On the other hand, high-functioning anxiety is more constant. Even when there are no apparent stressors, individuals with high-functioning anxiety can feel restless and anxious.

Prevalence of High-Functioning Anxiety

High-functioning anxiety, despite not being an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a prevalent phenomenon. Its indirect measures can be discerned from studies on general anxiety disorders, which are quite common in the population.

According to the Anxiety and Depression Association of America (ADAA), anxiety disorders affect around 40 million adults in the United States every year, accounting for roughly 18.1% of the population. The National Institute of Mental Health (NIMH) further states that approximately 31.1% of U.S. adults experience an anxiety disorder at some point in their lives. These numbers give an inkling into the potential extent of high-functioning anxiety, as many of these individuals might fit the criteria.

A study by Ruscio et al., published in the Journal of the American Medical Association (JAMA) Psychiatry in 2017, found that about 33.7% of people will experience an anxiety disorder in their lifetime, with the highest level of impairment noted in those with comorbid conditions. The study suggests that even among high-functioning individuals, the co-existence of anxiety with other mental or physical health conditions can substantially affect their quality of life.

Coping With High-Functioning Anxiety

Coping with high-functioning anxiety involves a multi-faceted approach. This may include a combination of the following:

  • Seek Professional Help: Reach out to a mental health professional to diagnose your condition and develop a tailored treatment plan.
  • Therapy: Engage in Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT) to learn strategies for managing your anxiety.
  • Mindfulness and Meditation: Practice mindfulness techniques or meditate to stay focused on the present moment and reduce anxiety.
  • Regular Exercise: Physical activity can help reduce anxiety by boosting your mood and acting as a natural stress reliever.
  • Balanced Diet: A healthy diet can improve your overall well-being and help manage anxiety symptoms.
  • Adequate Sleep: Prioritize good quality sleep, as lack of sleep can exacerbate anxiety.
  • Social Connection: Stay connected with friends and family. Isolation can worsen feelings of anxiety.
  • Avoid Caffeine and Alcohol: These substances can trigger or worsen anxiety symptoms.
  • Self-care: Prioritize time for activities you enjoy. This can help reduce stress and anxiety.
  • Deep Breathing Exercises: These can help calm the body and mind, particularly during periods of heightened anxiety.
  • Journaling: Writing down your thoughts and worries can help manage anxiety by providing an outlet for your concerns.
  • Positive Affirmations: Remind yourself of your strengths and accomplishments to counteract feelings of self-doubt and fear.
  • Set Boundaries: Learn to say no and avoid overcommitting yourself, which can trigger or exacerbate anxiety.
  • Mind-Body Therapies: Practices such as yoga and tai chi can help manage anxiety by promoting relaxation and stress reduction.
  • It’s also important to create a supportive environment, which can include finding supportive relationships and reducing exposure to stressful situations.

Treatment Options for High-Functioning Anxiety

The experience of high-functioning anxiety can be incredibly taxing on both your physical and mental health, but fortunately, there are various treatment options available that can help manage this condition effectively.

Cognitive-Behavioral Therapy (CBT)

CBT is often the first line of treatment for high-functioning anxiety. This form of therapy helps individuals understand the connection between their thoughts, feelings, and behaviors. It equips them with the necessary tools to identify and challenge their negative thought patterns, which in turn helps in managing anxiety symptoms. By re-evaluating these patterns, individuals learn to respond to stressors in healthier, more positive ways.

Dialectical Behavioral Therapy (DBT)

DBT is another therapeutic approach that can be highly effective in managing high-functioning anxiety. It helps individuals learn to live in the moment, manage stress, control their emotions, and improve their relationships with others. DBT is particularly useful for those struggling with emotional volatility, a common symptom among people with high-functioning anxiety.


While therapy is typically the first step, medication can also be beneficial in some cases. Certain antidepressants, like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), are often used to manage anxiety symptoms. Benzodiazepines can also be prescribed for short-term relief from acute symptoms of anxiety. However, these are usually not the first choice for long-term management due to the risk of dependency.

Group Therapy

Group therapy provides an opportunity for individuals to connect with others experiencing similar struggles. Sharing personal experiences and coping strategies can offer new perspectives and enhance the sense of community and understanding. It can also help reduce the feelings of isolation that often accompany high-functioning anxiety.

Family Therapy

High-functioning anxiety does not just affect the individual suffering from it but also their families. Family therapy can help family members understand what their loved one is going through and equip them with strategies to provide effective support. It can also help address any family dynamics that might be contributing to the individual’s anxiety.

Lifestyle Modifications

In addition to therapy and medication, lifestyle modifications can also play a significant role in managing high-functioning anxiety. Regular physical exercise, a balanced diet, adequate sleep, and mindfulness techniques can all contribute to reducing anxiety levels. Limiting caffeine and alcohol, both of which can exacerbate anxiety symptoms, is also beneficial.

Experiential Activity Therapy

This is a form of therapy that uses activities, action, and movement to facilitate healing. It can include art therapy, music therapy, adventure therapy, and equine-assisted therapy. It allows individuals to explore their feelings and manage anxiety in a safe, controlled environment.

Choosing the right treatment option depends on the individual’s specific symptoms, the severity of their anxiety, their personal preferences, and their overall health. An experienced mental health professional at Verve Behavioral Health can provide guidance on the most suitable treatment approach for high-functioning anxiety.


This section will delve into commonly asked questions about high-functioning anxiety, providing insights into the nature, causes, and management of this condition.

What are the red flags of high-functioning anxiety?

Red flags of high-functioning anxiety include perfectionism, overthinking, procrastination, avoidance of situations causing anxiety, a strong need for control, physical symptoms like headaches or sleep disturbances, and feelings of imposter syndrome.

What triggers high-functioning anxiety?

Triggers for high-functioning anxiety can include high-stress situations, fear of failure or making mistakes, demanding work environments, personal conflicts, and social events.

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

The difference between anxiety and high-functioning anxiety is that individuals with the latter can still effectively fulfill daily responsibilities despite their anxiety. They may appear successful and composed, but they are grappling with constant worry internally.

What are 5 signs of excessive anxiety?

Five signs of excessive anxiety are constant worry about different aspects of life, restlessness, difficulty concentrating, irritability, and experiencing sleep issues such as insomnia.

How do people with high-functioning anxiety act?

People with high-functioning anxiety may appear successful, diligent, and perfectionistic. However, they often overthink situations, avoid new experiences, procrastinate, and are constantly trying to maintain control over their environment.

How do you treat high-functioning anxiety?

High-functioning anxiety can be treated through therapy options like Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), medication, lifestyle changes, and stress management techniques. It’s essential to seek help from a mental health professional for a tailored approach.

Getting Help for High-Functioning Anxiety

Do you find yourself always aiming for perfection, overthinking every situation, or grappling with a sense of impostor syndrome? If these concerns are accompanied by physical symptoms like persistent headaches or sleep disturbances, you might be experiencing high-functioning anxiety. While it often goes unnoticed due to the veneer of success it presents, this condition can silently erode your peace of mind and overall well-being.

At Verve Behavioral Health, we offer an Intensive Outpatient Program (IOP) that are designed to address conditions like high-functioning anxiety. Our programs are tailored to your specific needs and circumstances, allowing us to provide personalized care that addresses your unique symptoms and challenges. We use evidence-based treatments like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), which have been proven effective in managing anxiety disorders.

Imagine regaining control over your life, free from the constant fear and worry that high-functioning anxiety brings. Picture yourself with renewed confidence, no longer feeling like an impostor but truly embracing your achievements. Envision a life where perfectionism does not drive you, but where you can strive for excellence without the debilitating fear of failure. With our comprehensive treatment approach, these possibilities can become your reality.

Do not let high-functioning anxiety keep you from leading a balanced, fulfilling life. Contact Verve Behavioral Health today at 202-816-6006 or via email at [email protected]. Our highly qualified clinical staff is ready to help you define and achieve your life goals, guiding you on your journey towards recovery. Act now, because your mental health is worth prioritizing.


High-functioning anxiety can be a confusing and often invisible condition. However, by understanding its signs and symptoms, it’s possible to recognize it and seek appropriate help. 

While it might offer the illusion of success, the toll it takes on mental and physical health is substantial. Remember, it’s not a sign of weakness to seek help. On the contrary, it’s a step towards strength, health, and overall well-being.


ADAA (2023). Facts & Statistics. Anxiety and Depression Association of America, ADAA.

NIMH (2023). Any Anxiety Disorder. National Institute of Mental Health.

Ruscio, A.M., Hallion, L.S., Lim, C.C.W. et al. (2017). Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA Psychiatry, 74(5), 465-475.

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