High Functioning Anxiety: Signs, Characteristics, & Coping Methods

March 22, 2024

If you seem composed and successful externally but feel a constant buzz of anxiety internally, you may have high functioning anxiety. This article delves into its signs, impacts, and how to cope, providing the clarity and assistance you’ve been searching for. You can expect to learn more about how to cope with high functioning anxiety as well as how Resilience Lab can help.

Key Takeaways

  • High-functioning anxiety often masks itself behind a successful facade, leading to an undetected struggle with excessive worry, perfectionism, and physical symptoms like muscle tension and sleep difficulties.
  • The condition can be triggered by genetic predispositions, environmental factors such as childhood trauma and high-pressure family environments, and societal expectations, leading to significant impacts on personal and professional life.
  • Management and treatment of high-functioning anxiety can include a combination of therapy, medications, self-help strategies, and building resilience through individual and/or group therapy sessions, professional guidance, and the development of a support network.

What Is High-Functioning Anxiety

The concept traditionally referred to as "high-functioning anxiety" describes individuals who, despite experiencing the symptoms of anxiety, continue to meet daily obligations and appear outwardly successful. However, it's important to recognize that the term "high functioning" is increasingly outdated.

Using the “high-functioning” term may imply that others with anxiety are “low-functioning”, which can be offensive. Additionally, using this term risks minimizing the seriousness of the anxiety experienced by those labeled as "high functioning" by insinuating their challenges are less debilitating. Regardless of the level of your anxiety and the severity with which it impacts your daily life, you deserve an equal level of understanding, empathy, and access to care that can accommodate the specific nuances of what you’re feeling. With that said, we’ll continue to use this term here with these caveats in place.

Some common signs of high-functioning anxiety include:

  • Excelling in their career
  • Impeccably dressed
  • Never missing deadlines
  • Perfectionism and control
  • Muscle tension
  • Difficulty sleeping
  • Persistent worry

These individuals may appear to be the epitome of success, but beneath that calm facade, a storm of anxiety brews. It is important to recognize and address high-functioning anxiety to ensure proper support and treatment.

People with high-functioning anxiety often experience excessive anxiety, even in situations that may seem routine or unthreatening to others. They often maintain a calm exterior while internally struggling with stress and worry, making it challenging for others to recognize their anxiety. This is where high functioning anxiety differs from other anxiety disorders—it’s hidden behind a facade of normalcy or success.

High-functioning anxiety isn’t simply about feeling anxious or stressed. It persistently intrudes on both physical and mental well-being.

Physical Symptoms

Physical symptoms of high-functioning anxiety can range from subtle to debilitating. Individuals may experience muscle tension, difficulty sleeping, and an increased heart rate, often perceived as signs of stress rather than an anxiety disorder. It’s not unusual for these symptoms to creep up in quiet moments, such as when trying to fall asleep or during periods of rest, making them hard to ignore.

Gastrointestinal issues are another common physical symptom associated with high-functioning anxiety. These could manifest as stomach aches, nausea, or digestive issues, often triggered or exacerbated by stressful situations. Headaches, too, can be a frequent complaint, adding another layer of discomfort to an already challenging condition.

The identification of these physical symptoms is vital. While they might be brushed off as the result of a busy lifestyle or other physical health issues, they could be indicators of high-functioning anxiety. Recognizing these symptoms is the first step towards seeking help and developing coping strategies.

Emotional and Mental Symptoms

Emotional and mental symptoms of high-functioning anxiety can be as pervasive and disruptive as the physical ones. Some of the hallmarks of this condition include:

  • Perfectionism
  • Overthinking
  • Self-doubt
  • Persistent worry

Someone with high-functioning anxiety might appear calm and collected on the outside, but inside, they’re grappling with a whirlwind of worry and fear.

A person with high-functioning anxiety or social anxiety disorder may experience the following symptoms:

  • Constant self-doubt, even in the face of apparent success
  • Seeking incessant reassurance from others
  • Worrying about potential failure or negative outcomes
  • Heightened negative reaction to criticism, making them overly cautious or defensive
  • Irritability
  • Obsessive thoughts
  • Trouble concentrating
  • Behaviors such as micro-managing or avoiding rest
  • A tendency to struggle with overworking

These symptoms can make daily life a struggle for those with high-functioning anxiety. They may find themselves consumed with worry over minor details, or stuck in a cycle of overthinking that makes decision-making a challenge. Despite these challenges, remember that help is available, and with the correct strategies, managing these symptoms and leading a fulfilling life is achievable.

Causes and Risk Factors

The causes of high-functioning anxiety are multifaceted, often interweaving genetic factors, personal experiences, and societal pressures. A 2017 study by Michael G. Gottschalk, PhD; Katharina Domschke, MD, PhD suggest a heritability of 31.6% for generalized anxiety disorder, indicating that anxiety can run in families. 

Genetic factors can influence the likelihood of developing generalized anxiety disorder, with certain genetic variations, or polymorphisms, increasing this risk. These polymorphisms affect how our genes work, particularly those related to neurotransmitters, the brain's chemical messengers, making some individuals more prone to anxiety. Understanding these genetic influences highlights the role of both inherited traits and environmental factors in the onset of anxiety disorders.

Environmental factors also play a critical role in triggering anxiety in those with a predisposition. Some common environmental factors include:

  • Childhood trauma
  • Stressful life events
  • Less secure family environments

Individuals who grow up in these environments may be more susceptible to developing high-functioning anxiety or other anxiety disorders.

Societal pressures, gender roles, and significant stressors in life can also increase the risk of high-functioning anxiety. Comprehending these causes and risk factors is instrumental in managing high-functioning anxiety. Knowing what triggers your anxiety can help in developing coping strategies and seeking appropriate professional help.

The Impact of High-Functioning Anxiety on Personal and Professional Life

High-functioning anxiety can have a significant impact on both personal and professional life. At work, it can lead to an excessive focus on success, often resulting in work-life imbalance and overextension. The relentless drive to excel can lead to longer work hours and additional assignments, leaving little time for rest and self-care.

In personal relationships, high-functioning anxiety may cause conflicts due to:

  • Difficulties in communication
  • Emotional withdrawal
  • Tendencies toward people-pleasing
  • Prioritizing work over personal connections

Loved ones may feel neglected, leading to strained relationships and further exacerbating feelings of anxiety and isolation.

The strain caused by high-functioning anxiety extends to overall well-being, leading to potential burnout, strained personal connections, and a neglect of self-care. It’s a vicious cycle—high-functioning anxiety can lead to overworking and neglecting personal care, which in turn can exacerbate anxiety symptoms. Breaking this cycle requires awareness, understanding, and the right healing and coping strategies.

Treatment Options and Self-Help Strategies

There’s no one-size-fits-all treatment for high-functioning anxiety, but there are several options available. These include therapy and medication, such as antidepressants, benzodiazepines, buspirone, and beta-blockers, or a combination of both. For individuals with high-functioning anxiety, honesty and transparency with mental health care providers are key to ensuring an accurate diagnosis and obtaining suitable treatments.

Self-help strategies also play a vital role in managing high-functioning anxiety. Some strategies to consider include:

  • Regular exercise
  • Mindfulness activities
  • Deep breathing exercises
  • Massage therapy

Therapy and Online Counseling

Get started with therapy today.

Our team can help you find the right therapist.

Among the treatments for high-functioning anxiety, Cognitive Behavioral Therapy (CBT) stands out for its focus on changing negative thought patterns to improve emotional regulation and behavior. However, Dialectical Behavior Therapy (DBT), with its emphasis on Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness, offers a broader skill set that can help individuals move beyond overthinking and develop practical coping strategies.

Somatic-based therapies also play a crucial role by connecting mind and body, using physical awareness and movement to reduce anxiety. This approach is particularly beneficial for those who might find CBT's cognitive focus less effective, providing an alternative path to manage anxiety through bodily engagement.

Resilience Lab Therapists offer:

  • Personalized therapy sessions that utilize an evidence-based approach
  • A diverse team of experienced therapists
  • An accessible platform, accepting a broad range of insurance providers
  • Facilitating the process of connecting with a therapist quickly

Clinicians can gain insights on client progress and the effectiveness of the recommended strategies through a proprietary electronic medical record (EMR) system and Resilience Lab’s Measurement Informed Care approach.


Medication can be an effective tool in managing high-functioning anxiety, especially when symptoms are severe. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines are among the medications used to treat symptoms of high-functioning anxiety through the regulation of neurotransmitters.

It’s vital to bear in mind that medication should be administered under the guidance of a healthcare provider. Genetic markers may help predict how patients with generalized anxiety disorder respond to SSRIs and SNRIs.

Medication is a part of broader treatment strategies, which include various self-help and professional interventions, to alleviate symptoms of high-functioning anxiety.

Building Resilience: Tips for Managing High-Functioning Anxiety

Cultivating resilience is a key element in managing high-functioning anxiety. It involves strengthening self-differentiation, setting boundaries, prioritizing self-care, managing negative thoughts, and building a support network. Strengthening self-differentiation involves recognizing personal thoughts and feelings, and being confident and comfortable with oneself, even when differing from others.

Setting clear boundaries, such as not answering calls from parents during work hours, helps to reinforce self-differentiation. A comprehensive self-care plan should include proper nutrition, regular exercise, and taking sufficient breaks. Monitoring and managing negative thoughts is a strategy to improve resilience against high-functioning anxiety.

Building a support network that provides care regardless of outcomes can buffer against the pressures of high-functioning anxiety. Keep in mind that building resilience is a process that doesn’t occur instantly. But with patience, effort, and the right strategies, it’s possible to manage high-functioning anxiety effectively.

Building resilience against high-functioning anxiety involves recognizing your own thoughts and feelings, setting clear personal and professional boundaries, and engaging in comprehensive self-care including nutrition, exercise, and rest. Managing negative thoughts and fostering a supportive network are also key. Importantly, developing interests and relationships outside of work or areas prone to perfectionism helps create a well-rounded identity, lessening the pressure of high-functioning anxiety. Remember, resilience building is a gradual process that, with consistent effort, can significantly improve how you manage anxiety.

How Resilience Lab Therapists Can Help

Resilience Lab therapists offer therapy sessions personalized for each individual, evidence-based approaches, and a diverse team of experienced therapists to help individuals manage high-functioning anxiety. For example, we often offer group therapy programs which have focused on managing stress and overcoming anxiety. These group therapy options provide tools and strategies to manage mild to moderate anxiety, focus self-compassion and self-help skills. Group therapy can work together with individual therapy, and offer a unique opportunity to interact and learn with others facing similar challenges.

Frequently Asked Questions

Anxiety disorders and anxiety symptoms can vary greatly based on the individual as well as their current mental health situation. The answers below are general answers but you should reach out to the therapists at Resilience Lab for a more personalized answer.

What are the traits of high-functioning anxiety?

Traits of high-functioning anxiety often include perfectionism, overthinking, fear of failure, and the constant need for reassurance, despite appearing highly competent and calm on the outside. People with high-functioning anxiety might also experience physical symptoms like restlessness, fatigue, and trouble sleeping, all while managing to keep up with their daily responsibilities and social appearances.

How do you support someone with high-functioning anxiety?

Supporting someone with high-functioning anxiety involves offering patience, understanding, and encouragement without judgment. It's crucial to listen actively and empathize with their experiences, acknowledging their feelings without dismissing them. Encourage them to seek professional help if needed and offer to help with small, manageable tasks to alleviate their stress. Remember, sometimes just knowing they have a supportive and safe space to share their feelings can make a significant difference.

What personality types have high anxiety?

Anxiety isn't exclusive to any one personality type; it can affect anyone, regardless of their personality traits. However, individuals with perfectionist tendencies or those who are naturally more prone to worry and overthinking, may be more susceptible to high levels of anxiety. It's important to note that anyone, regardless of personality type, can develop high-functioning anxiety due to a combination of genetic, environmental, and psychological factors.

Clinically Reviewed by Christine Carville, LCSW-R.

Christine Carville, LCSW-R, is the co-founder and Chief Clinical Officer of Resilience Lab. Christine developed the Resilience Methodology, a trans-theoretical training model for therapists to provide individualized, flexible, trauma-informed care. She has also been teaching at the Columbia School of Social Work since 2016 and continues to maintain her own private psychotherapy practice.

Get started with therapy today.

Our team can help you find the right therapist.