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Is high-functioning anxiety really a thing?


Everyone experiences anxiety in their lives. In fact, some anxiety can be a useful motivator at times. But some people may suffer from anxiety to such an extreme that they are diagnosed with and treated for an anxiety disorder. And, then there are other people who, while appearing to be accomplished and successful from the outside, are suffering extreme levels of anxiety on the inside that impair their quality of life and increase risk of other health issues. The latter group are suffering from what has come to be known as high-functioning anxiety.

What is it?

High-functioning anxiety is not a recognized mental diagnosis, largely because people who live with it function reasonably well in their lives. But it is nonetheless a serious condition that should be addressed. People with high-functioning anxiety typically excel in their work lives and appear to do well socially, but internally they experience many of the same symptoms as someone suffering from a full-blown anxiety disorder –  intense feelings of impending doom or spiraling out of control, fear, anxiety, rapid heart rate, and gastrointestinal distress.1 According the National Health Institute of Mental Health, about 40 million adults deal with an anxiety disorder at any given time, and approximately 18 percent of that population fall into the high-functioning category.2

Not easy to detect

High-functioning anxiety, however, is not that easy to detect for a variety of reasons, including:

  1. Typically, the condition lacks the recognizable symptoms found with other anxiety disorders; 3
  2. Symptoms that are noticeable may look like depression;3 and/or 
  3. Treatment is not sought because of perceptions that: (i) everyone struggles to succeed in this fashion and that it’s normal; (ii) it’s the anxiety that actually drives achievement and success; or (iii)  because of the high level of achievement, help is not needed or deserved.4

As a result, high functioning anxiety often goes undiagnosed until seeing a provider – primary care, therapist, or otherwise – about some other issue.

Common Symptoms

High-functioning anxiety can affect anyone and is often the result of either a combination of chemical imbalances and/or a lifetime experience.3 While not easy to diagnose, there are some common combinations of symptoms to be aware of, including:

         Outward facing

  • Facade that they do not suffer from any anxiety
  • Worry-free
  • Stress-free
  • Type-A personality
  • Perfectionist
  • Successful in the workplace
  • Overachiever
  • Proactive
  • Productive
  • Positive
  • Outgoing
  • Appearance of being level-headed
  • Appearance of being calm
  • Organized
  • Detail-oriented
  • Appearance of having it “all together”

         Inward feeling

  • Shortness of breath
  • Sweating
  • Shaking
  • Nausea
  • Frequent urination or diarrhea
  • Exhaustion
  • Muscle weakness
  • Muscular tension
  • Dizziness
  • Irregular body temperature
  • Increase in heart rate
  • Flustered thoughts
  • Insomnia2


Untreated, long-term anxiety can have adverse impacts on mental and physical health. Some of the more common effects are:

  1. Depression, which is the most common co-occurring disorder;
  2. Chronic conditions can be exacerbated like heart disease, gastrointestinal issues, stroke, COPD, asthma and irritable bowel syndrome;
  3. Substance use disorders;
  4. Eating disorders; and/or
  5. A lower quality of life and, possibly, a shortened lifespan.

But there is help

Treatment usually includes therapy and/or medication. On the therapy side, cognitive behavioral therapy is an often-used and effective approach. It helps people identify the root causes and manage the negative thoughts that lead to their anxiety (e.g. becoming overwhelmed with multiple negative thoughts and spiraling out of control).1 Working with a therapist, people with high-functioning anxiety can develop tools for identifying and addressing their perceived fears before they become overwhelming.

Medication is also a useful tool in treating high functioning anxiety. Types of medication often prescribed are antidepressants, anti-anxiety medicines and beta blockers. While treatment of high-functioning anxiety can be limited to medication, it is often recommended that a combination of medication and therapy be implemented.

What to do

High functioning anxiety is a tricky thing. It can feel as if it’s part of your very make up – as if it’s a necessary evil to assure success and achievement. In reality, that’s not the case though. You can still achieve and succeed without the turmoil and angst of hidden anxiety. If you identify with some of the symptoms or characteristics of high-functioning anxiety and would like to learn more, please reach out to us. We’re here to help.