Guide to High Functioning Anxiety and What To Do

There’s something wrong.

You can feel it, but how could there be anything wrong when you’re able to go to your job every day with the ability to function, and everyone thinks you’re fine. Being constantly anxious is something you’ve been accustomed to for a while now. You get up every day and try to push the anxiety to the back of your mind. What else are you supposed to do? You think to yourself that your stress can’t possibly be that bad if you’re still able to go about your life as if things were normal. In reality, you may have high-functioning anxiety, something you may have never even considered before.

You may be thinking that in order to have an anxiety disorder, it has to be debilitating enough to interfere with your day. And while this can be true, it is not always the case. Out of the estimated 40 million people who suffer from anxiety, 18% of those individuals fall under the category of high-functioning anxiety. This equates to around 7.2 million individuals who fit the criteria of high-functioning anxiety. If you are someone who suffers from an anxiety disorder, you may feel that you fall into this category as well. But what exactly does high-functioning anxiety mean, and how can it affect you.

What Is HFA?

To understand what high-functioning anxiety is, we first need to look at what general anxiety disorder looks like. According to the Diagnostic Statistical Manual of Mental Disorders, commonly known as the DSM(5), general anxiety disorder is characterized as excessive worrying or anxiety, most days than not, for a period of at least six months. It has to present itself in at least 3 of these different symptoms such as:

  • Irritability
  • Restlessness
  • Easily fatigued
  • Muscle tension
  • Sleep difficulty
  • Difficulty concentrating

Anxiety is a term that broadly covers a number of different anxiety disorders that include the following.

  • Generalized Anxiety Disorder
  • Social Anxiety Disorder – A chronic mental health condition that causes an individual to feel nervousness and discomfort during social interactions.
  • Panic Disorder – A type of anxiety disorder where there are episodes of unexpected and intense fear.
  • Obsessive Compulsive Disorder: Long-lasting condition where are person is affected by uncontrollable thoughts or behaviors that they feel must be continually repeated.
  • Post-Traumatic Stress Disorder- Often called PTSD, an anxiety disorder that develops after being exposed to a traumatic event in one’s life.

Those who have high-functioning anxiety may be diagnosed with an anxiety disorder but are able to hide it from others or even be dismissive of the seriousness of their anxiety. People with high-functioning anxiety seemingly are able to carry out their day-to-day lives without disruption from their anxiety. It is important to note that high-functioning anxiety is not actually categorized as a mental disorder in the DSM-5 but is more of a term popularized in today’s society as an individual who is able to “cope” with their anxiety without it causing a disruption to their lives.

Although it is not categorized as a mental health diagnosis, like all mental disorders, there is a spectrum of how anxiety affects individuals. Due to the lack of research on this form of anxiety, it is difficult to say precisely how many people suffer from it.

Characteristics and Symptoms

Those who suffer from high-functioning anxiety can present themselves as being fine on the outside, but inside they suffer from severe anxiety. Due to many who suffer from this form of anxious thought, it can sometimes be hard to identify what the characteristics are. What characteristics are known about those who are high-functioning is:

  • Fear of failure
  • Perfectionism complex
  • Managing anxiety symptoms while still managing daily tasks of living
  • High achieving
  • Masking symptoms of anxiety to others.
  • Hyper-focused on controlling all aspects of their lives
  • Good at problem-solving
  • Highly organized
  • Focused on success
  • Busy social life
  • Detail-oriented
  • Over thinking situations
  • Anger when situations don’t go as planned

People who have high-functioning anxiety and are in relationships might have a partner who may be unaware of what the other is going through. Sometimes, their partner might be the only person who knows what they are going through, which can lead to an unhealthy reliance on them for support. They may appear to be put together and successful but in reality, they are suffering from persistent anxious thoughts. Individuals with HFA may present the following while being in a relationship:

  • Hesitant to talk about how they’re feeling or confide in their partner
  • Negative self-talk
  • Seeking constant reassurance from their partner
  • Miscommunication about their feelings
  • Constantly busy or doing something
  • Over-analyzing their relationship
  • Always telling you that everything is “fine” and they are okay.
  • Over-achieving
  • Never able to tell you no
  • Control freak

While some of these characteristics may seem like good qualities to have, they can cause those who suffer from them to deny that their anxiety is a problem, and if you’re someone who is in a relationship, this can cause tension between you and your partner. In reality, whether an individual acknowledges their anxiety disorder or not, the anxiety and worriedness will persist. Denying that there is a problem may cause the symptoms of an individual’s anxiety disorder to worsen. It is important to note that someone who has these characteristics may not even have an anxiety disorder at all, which is why it is crucial to seek assistance from a mental health professional to get a proper diagnosis.

How and When Does it Develop?

While high-functioning anxiety can not officially be diagnosed, there are factors that contribute to the development of anxiety disorders.

  • Past Traumatic Events

Many people who suffer from anxiety disorders develop it after being exposed to a traumatic event. Whether this is past family trauma, national disasters, war, or other traumatic events, it is very common for individuals to experience debilitating anxiety that manifests in different ways. One of these is being in a high-functioning state as a way of avoidance. This development of anxiety is most seen in people who are diagnosed with Post-Traumatic Stress Disorder.

  • Family History of Anxiety

The question of genetics playing a factor in developing anxiety has been long studied. While it is entirely possible to have an anxiety disorder without having it run in your family, if it does run in your family, you are more likely to develop it at some point in your life. Just keep in mind that this does not mean that you will automatically develop anxiety if a loved one has it.

  • Drug Use or Medications

Taking certain drugs may possibly cause an individual to develop an anxiety disorder. This can be from either recreational use or prescribed drugs, such as anti-psychotics or medications for certain physical disorders. Individuals who use alcohol as a coping mechanism can form an anxiety disorder after long-term alcohol misuse. Even if you do not suffer from alcohol addiction, excessive drinking can cause your anxiety symptoms to get worse. Anxiety can also present itself when an individual is going through withdrawals from drugs as well.

  • Physical Health

Sometimes physical illnesses can trigger an occurrence of persistent anxiety. This is more likely the case if you are someone who does not have a history of anxiety, your family does not have a history, or the onset of sudden anxiety is not related to any past traumas. Physical diseases that can be a trigger are:

– Heart Disease

– Diabetes

– Thyroid Conditions

– Respiratory Disorders

– Irritable Bowel Syndrome

– Chronic Pain

– Cancer

Those who suffer from physical illnesses can have ongoing anxiety because they fear their physical conditions worsening. Someone who has been diagnosed with cancer and is in remission might be plagued with the fear that their cancer will return, thus sometimes causing debilitating anxiety. If you are someone who has lived in chronic physical pain for a long time, there may be moments where you fear that the pain will get worse or the constant fear of there never being any relief to your pain

High-Functioning Anxiety vs. Generalized Anxiety Disorder

How is high-functioning anxiety different than generalized anxiety disorder?

High-functioning anxiety, while not an official diagnosis, can be considered a branch of generalized anxiety disorder. Someone with high-functioning anxiety can have all the same symptoms that fall under a “regular” anxiety disorder, the only difference being how an individual copes with their anxiety. People deal with anxiety differently, and for some, this may be debilitating. Anxiety can affect their work ethic, and personal lives, causing some people to withdraw from others.

Those who categorize themselves as being someone who is high functioning while having anxiety may be less likely to acknowledge their symptoms or let their anxiety affect their lives.

While some people may think this is healthy, it’s not. Having anxiety, like other mental health diagnoses, is serious. Even if you are able to carry out day-to-day activities, this does not mean your anxiety is any less important.

You may be someone who has been diagnosed with PTSD or another anxiety disorder that is not GAD. Suppose you consider yourself high functioning within these disorders. In that case, you can suppress your anxiety enough for you to get through social interactions or being exposed to something that triggers your PTSD.

How Does It Affect Our Bodies?

Although you may not realize it, having chronic anxiety can be detrimental to your physical health. People who have anxiety can experience a variety of physical symptoms, such as the following:

  • Excessive shaking
  • Accelerated heart rate
  • Nausea
  • Headaches
  • Fatigue
  • Muscle weakness
  • Insomnia

Having these symptoms present during times of stress does not necessarily indicate your physical health is terrible. Still, their continuous presence can make you susceptible to chronic health problems later down the road.

One common physical response to anxiety is an accelerated heart rate or even heart palpitations. If your anxiety is also accompanied by panic attacks, the increase in your heart rate can often be a scary experience, as many do report that it feels as if they are dying. Others may wonder if they are experiencing a major heart condition such as a heart attack. While this may seem scary, know that this is very common and is not indicative of a heart attack. However, if you are someone who suffers from a heart condition, anxiety can cause additional risk to your heart health.

Research has also shown a link between anxiety and your immune system. Chronic anxiety can lower your immune system, making you more susceptible to infections and colds. Cortisol, a stress hormone, simulates a fight or flight response in your body, alerting you of potential danger. While this response is not necessarily bad for your body, the prolongment of this hormone suppresses vital white blood cells, thus making it harder for your body to recover from illness.

Lack of sleep is another symptom people with anxiety disorders may suffer from. According to the Sleep Foundation, those who are affected by an anxiety disorder have higher sleep reactivity; a higher likelihood of experiencing sleep disruptions when stress is present. This can be concerning because sleep deprivation can cause your anxiety disorder to worsen. Sleep is essential for both your emotional and physical health and has been linked with chronic health problems.

When Is It Time To Seek Professional Help?

One common trait among individuals who have high-functioning anxiety is the need for control. This can cause issues if you are someone who does not want to address that your anxiety might be worsening, or maybe you don’t acknowledge your anxiety at all. Many people who fall under this sub-category of anxiety often feel as if they have things under their control. Knowing this, some people could be less likely to reach out to a mental health professional for help.

Even more so, they may not know when it is time to reach out for help. If this sounds like you, you may be asking yourself when is a good time to seek professional help for your anxiety.

Here are some things to look out for when deciding on if you want to reach out for help:

  1. Persistent sleep issues – We know that sleep can harm our mental and physical health, but even if you’re someone who can still get your work done on limited sleep, it still does not mean that your lack of sleep isn’t harming your body. Lack of sleep affects your ability to concentrate and perform tasks and can also affect your hormones. Regardless of how high functioning you believe you are, after a certain time without proper sleep, you will be affected by it if you are not already so.
  2. Physical health concerns – If you’re experiencing physical health issues such as digestive issues or chronic pain, it may be time to reach out to your doctor to see what the underlying cause is. Because we know that anxiety is linked to conditions such as these, expressing these concerns to your doctor will set you on the right path to getting treatment.
  3. Unwarranted anger when things don’t go as planned – A common trait among people who suffer from high-functioning anxiety is the need to control every aspect of their lives. This control can cause problems when things do not go according to their plans. If you find yourself with persistent anger and frustration that may be projecting onto yours or others, this may be a sign to seek help.

Treatment Options

Luckily, there are several treatment options for high functioning. The way you would seek treatment as someone with “regular” anxiety is the same way someone under the high-functioning umbrella would seek out treatment.

  1. Medication – Not everyone with anxiety wants to be on medication. This should be a decision you make under your doctor’s guidance; however, know that this is always an option if you feel that other non-medicated coping mechanisms are not working.
  2. Cognitive Behavioral Therapy (CBT) – This is one of the most popular treatments for those who suffer from anxiety. CBT is a practice that challenges your negative thoughts by addressing them head-on, altering how you respond to them in an effective manner.
  3. Psychotherapy – Psychotherapy is a broad form of therapy that covers not only cognitive-behavioral therapy but three other main types such as psychodynamic therapy, dialectical behavior therapy (DBT), and humanistic/ experiential therapy. Each form of psychotherapy focuses on different aspects of the individual behavior, nature, etc.
  4. Mindfulness and Meditation- If you are someone wanting to take a more holistic approach to your anxiety, practicing mindfulness and meditation may be a better starting place. Mindfulness allows you to explore the reason behind your stress in a manner that is safe, as well as letting you feel that stress without aiding or suppressing it. It is important to note that mindfulness and meditation do not work for everyone, and if you are someone who suffers from severe trauma, it should not take the place of treatment under the guidance of a health care professional.

Making A Change

At this point, you may be asking yourself, how do you make a plan to treat your anxiety? What changes do I need to make to help my anxiety? We all know that the biggest challenge when coping with anxiety is making the necessary changes. Change is not only hard, but for those who suffer from high-functioning anxiety, this means giving up control of certain things and changing the routine you’re probably a stickler for. There are several things you can do to get on the path to dealing with your high-functioning anxiety in a safe and healthy manner.

  1. Acknowledge Your Anxiety – This tip is for individuals who, because they consider themselves high-functioning, may not realize their anxiety disorder is serious. It might be challenging, but acknowledging that you need help is always the first step. Just because you can “function” throughout the day does not mean your anxiety disorder is not a priority.
  2. Recognize Your Symptoms – You may be ignoring your symptoms, but it doesn’t mean they’re still not present. Recognizing your symptoms makes them less intimidating and scary. Anxiety can be irrational and abrupt, and confronting your anxiety and rationalizing your anxious thoughts for what they are can go a long way when adopting healthy coping mechanisms.
  3. Seek out Support – If you’re someone with high-functioning anxiety, there might be people in your life who aren’t aware of what you’re going through. Once you acknowledge your anxiety, let your loved ones in your life know what’s going on. This enables you to have a support system of people who can offer their assistance in your journey of coping with your anxiety disorder. If you don’t have people in your life that can provide support, or maybe you want help from others but aren’t ready to let your family and friends know, there are support groups for those suffering from anxiety. The Anxiety & Depression Association of America has a search catalog that allows you to find virtual or in-person support groups; you can find out more here.
  4. Write Down Your Goals – Having goals for your mental health is essential, and if you’re someone who lives with anxiety, setting these goals can be a great way to make a plan for coping and treating your anxiety disorder. If you are interested in finding out more about setting mental health goals, this article is an excellent place to start.
  5. Adopting A Healthy Lifestyle – Changing your lifestyle can be tricky, but it is an effective way to cope with your anxiety. Exercise can be a great lifestyle change you can make to help with your anxiousness. Exercise can reduce your symptoms as well as elevate your mood. Another lifestyle change that you can implement is within your diet. Making sure you are taking care of your body can go a long way in helping your anxiety symptoms. For example, if you’re someone who drinks alcohol, it may be best to limit the amount you consume. Alcohol can actually make your anxiety worse.

Self Care Tips

If you’re looking for some tangible self-care tips that you can utilize to help with your high-functioning anxiety, here are some tips to use so you can start prioritizing yourself.

  • Get a gratitude journal.
  • Meditate for at least five minutes
  • Practice breathing exercises
  • Talk to someone in your support system
  • Search for local therapists in your area
  • Take time off from work
  • Get outside more
  • Take a break from social media
  • Get enough sleep
  • Declutter your space
  • Say no

If you’re dealing with high-functioning anxiety, prioritizing self-care might be the last thing on your endless list of things to do. Putting yourself first is hard, but while you may have a busy schedule, your anxiety is just as important. Write down some self-care to-do’s you’d like to implement in your life and see how it helps your mental health.


Having high-functioning anxiety can be harmful to your health. Those who suffer from it are more likely to put their needs on the back burner while over-achieving in other aspects of their lives. You may be telling yourself that you’re fine, but in reality, you’re suppressing your symptoms unintentionally, causing your anxiety to progressively worsen over time. Suppressing your emotions and anxiety is not healthy.

Considering yourself high-functioning while living with an anxiety disorder should not come with a badge of honor. There may be a time when you’re no longer able to be high-functioning. Our bodies are not made to suppress trauma continuously, and preventing your anxiety disorder from progressing is always the best option.

Knowing the what and how of your symptoms is the first step to getting yourself treatment. There are ways for you to safely- and in a healthy manner- cope with your high-functioning anxiety. For things to get better, you have to want them to, and as daunting as it may seem, there are ways you can live a happy and healthy life while dealing with your disorder. Know that you are not alone with your struggles and that there are resources available whenever you decide you’re ready for them.

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