What Is High-Functioning Anxiety? A Neuropsychologist Shares Symptoms and Ways to Cope
People with high-functioning anxiety may excel at work, school or caregiving while privately struggling with self-pressure and worry. Learn an expert’s tips to recognize and manage it.
On any given day, there are probably dozens of worries, big and small that race through your mind: Is my kid settling in at school? Did my email sound OK? Did I shut off the stove? Is my friend mad at me? Yet despite this steady stream of concerns, you always have a calm demeanor – even when the stress is making it difficult to function.
If this sounds like you, you could be dealing with high-functioning anxiety, a condition in which you experience the symptoms of anxiety, such as persistent feelings of fear, unease, or worry, while appearing to successfully manage the demands of daily life.
“I like to think of high-functioning anxiety as a duck gliding peacefully across a lake,” says Dr. Heidi Allison Bender, a neuropsychologist at NewYork-Presbyterian/Weill Cornell Medical Center. “It looks effortless on the surface, but you don’t realize how furiously he’s paddling underneath.”
High-functioning anxiety isn’t a recognized clinical disorder — it isn’t included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — but that doesn’t mean its impact isn’t real.
How can you tell if the level of anxiety you feel is “normal”? And what can you do about it? Health Matters spoke with Dr. Bender about all this and more.
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Normal Stress or High-Functioning Anxiety?
“I’ll often ask my patients what is motivating them to perform,” says Dr. Bender. “Is it the desire to do your best? Or is it the fear of what might happen if you don’t do your best? If it’s the latter, that’s a red flag. Ask yourself: How much energy is going into maintaining the appearance of function for others?” says Dr. Bender.
Think, for example, of an executive, who may get positive feedback on their excellent work presentations, but spends three stressful hours a day obsessively checking and rechecking their work. Or a student with a big exam coming up: They may feel a certain level of nervousness that helps them prepare better, but if that feeling causes them to lose sleep every night, it can impact their physical and mental health.
“If left untreated, the physiological symptoms can worsen — along with long-term immune system responses and inflammation,” explains Dr. Bender. “This chronic level of stress can cause damage to your body and impede the very things you're trying to push forward."
Those with high-functioning anxiety often struggle to make the connection between their symptoms and their chronic stresses, explains Dr. Bender. If you’re developing thoughts like, “This is too stressful,” or “I just can’t handle this anymore,” that is a red flag and a sign to reach out and get care.
Signs and Symptoms of High-Functioning Anxiety
On the surface, those with high-functioning anxiety can appear to be:
- Perfectionists
- Punctual, if not early
- Highly organized
- Overachievers
- Detail-oriented
- Proactive
Below the surface, however, they often struggle with:
- Overthinking/overanalyzing
- Fear of disappointing or angering others
- Self-doubt
- Frequently double-checking details
- Repetitive thoughts
- Inability to relax
Physical symptoms can include:
- Heart palpitations or a high resting heart rate
- Rapid breathing or hyperventilating
- Tension headaches
- Sweating
- Diarrhea, constipation or other gastrointestinal issues
- Issues falling or staying asleep
What To Do If You’re Suffering
“At its core, high-functioning anxiety is driven by internal fears and perceived threats,” explains Dr. Bender. “The constant effort to manage uncertainty can be exhausting, as fear of ‘what will happen’ is often the primary force fueling these behaviors.” People with high-functioning anxiety often feel like they have no control over their situations, but there are some coping strategies that can help:
- Think concretely: Talking through your options and their realistic potential impact can help you recognize what choices you do have. Major project at work producing an untenable level of stress? Try asking yourself: What happens if I take a day off? How will that impact my goal? How will it impact my wellness? Could taking a day off actually help me return to work more refreshed and productive so you can still meet deadlines?
- Set realistic guardrails around stressors: Instead of sweeping lifestyle changes, consider limits and goals that fit into your life as it is. Consider picking one day a week to work reduced hours, take 10-minute breaks throughout your day to stand up and stretch or go for a walk. If specific worries are intruding on your thoughts, schedule time to think about them and time to set them aside.
- Prioritize hobbies and downtime: Make time for relaxation and activities you enjoy away from work or responsibilities. If doing so feels uncomfortable, sit with that discomfort and see how long you can tolerate it.
- Seek professional help: Working with a mental health professional can help you build awareness of how you’re coping with anxiety and explore different types of therapies — for example, cognitive behavioral therapy or mindfulness practices — for when it starts to feel like too much. A psychiatrist can help determine if medication should be part of your treatment.
Thriving With High-Functioning Anxiety
“People with high-functioning anxiety can feel reluctant to get treatment because they are scared that they will lose their ‘edge,’ or the traits that have made them successful,” says Dr. Bender. “If that’s you, try reminding yourself, ‘You don’t need to rely on your anxiety to function or do your best.’”
"It’s okay to not be the version of yourself that everyone thinks that you are. It’s okay not to have an answer to everything, or to be a little messy or imperfect. You don’t have to have to get to the point of falling apart to get help — if you feel discomfort, that’s reason enough.”
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