Signs You Have High-Functioning Anxiety

Confident and organized on the outside; worried and fearful on the inside
mental health, anxiety, cognitive-behavioral therapy (CBT), perfectionist, high-functioning anxiety, talk therapy

When we think of anxiety disorders, we tend to think of someone who feels nervous, worries excessively and is restless.

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But what if on the outside that person comes across as confident, outgoing and organized? They don’t have any anxiety, right?

That’s not necessarily the case. They might have high-functioning anxiety, an undiagnosable anxiety condition.

“The term high functioning anxiety describes an individual who, despite feeling anxious, seems able to effectively manage the demands of day-to-day life,” says psychologist Adam Borland, PsyD.

Sound like you or someone you know?

Dr. Borland explains what signs to look for and the pros and cons of having high-functioning anxiety.

What is high-functioning anxiety?

According to the National Alliance on Mental Illness, more than 40 million adults in the United States have an anxiety disorder.

You may feel fear and dread when in certain situations to the point where it makes it hard for you to function. You may overreact at times. Physically, you can become sweaty or have a pounding heart.

But how does high-functioning anxiety differ from general anxiety disorder (GAD)?

“The primary difference is how an individual responds to anxiety,” says Dr. Borland. “With generalized anxiety, we tend to think of the fight or flight response.”

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An individual who experiences GAD might try to remove themself from an anxiety-provoking situation.

“With high functioning anxiety, there tends to be more of a fight response, where an individual pushes themself to work harder in order to combat the anxiety,” says Dr. Borland.

What are the signs of high-functioning anxiety?

Those with high-functioning anxiety may demonstrate the following traits:

  • High achiever.
  • Highly organized.
  • Detail oriented.
  • Outgoing personality.
  • Proactive.

“An individual with high-functioning anxiety may appear calm on the outside but feel very anxious internally,” explains Dr. Borland. “These individuals may try to mask their symptoms by taking control of the situation.”

Causes of high-functioning anxiety

While high-functioning anxiety can’t be diagnosed, certain factors may contribute:

  • Family history of others who have an anxiety disorder.
  • Negative or stressful life events or experiences.
  • Certain medical conditions like thyroid issues.

Pros and cons of having high-functioning anxiety

People with high-functioning anxiety tend to be highly organized, meet deadlines and troubleshoot problems. All of which can be positive traits on the surface.

But on the flip side, you may feel shame and embarrassed to let your guard down for fear you’ll seem weak.

“Individuals with high functioning anxiety tend to do a good job at hiding their symptoms from others,” says Dr. Borland.

You also tend to strive for perfectionism to a fault, are an overthinker and often need reassurance from others.

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“People with high-functioning anxiety tend to have difficulty with assertiveness and the ability to say ‘no,’” says Dr. Borland. “They tend to dwell on negative thoughts, worst-case scenario thinking.”

How to treat high-functioning anxiety

If you have high-functioning anxiety, there are treatments available:

  • Cognitive behavioral therapy (CBT). “We use CBT to assess the connection between the thoughts and the behaviors,” says Dr. Borland.
  • Solutions-focused brief therapy (SFBT). “What kind of coping tools do you already have?” asks Dr. Borland. “Sometimes, people overlook tools that they already have that can be effective.”
  • Deep-breathing exercises. “The nice thing is that our bodies naturally respond to these exercises,” says Dr. Borland. “And our bodies naturally calm themselves when the parasympathetic nervous system is activated.”
  • Medication. Your doctor will work with you to find the right kind of medication, like selective serotonin reuptake inhibitors (SSRIs).

“It’s always important to monitor work-life balance,” says Dr. Borland. “An individual with high-functioning anxiety can get so focused on success that their work-life balance suffers.”

Dr. Borland says focusing on self-care, exercise, diet and your social life are all things that can help keep anxiety in check, too.

“Don’t be afraid to say ‘no,’” Dr. Borland reiterates. “It’s not a sign of weakness or sign of failure.”

When to ask for help

There’s no standard answer for when someone should seek help, says Dr. Borland. It’s different based on everyone. And it can be especially hard for those with high-functioning anxiety to feel like they can ask for help.

“Someone with high-functioning anxiety may view mental health treatment as a sign of weakness or failure,” says Dr. Borland.

But if you’re having difficulty sleeping, experiencing a loss of appetite or finding it hard to manage day-to-day tasks, it’s time to speak with your doctor.

“Acceptance is important when dealing with any kind of anxiety disorder,” says Dr. Borland. “Don’t be afraid to take steps towards asking for help and receiving help.”

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