High-Functioning Anxiety: Management and Coping - Verywell Health

Anxiety is a normal reaction that occurs when we experience stress. However, if it consistently and negatively impacts your life, it can be diagnosed as a mental health disorder. High-functioning anxiety isn't a clinical mental health condition, but it is a form of anxiety.

It can be difficult to spot high-functioning anxiety. From the outside, a person with high-functioning anxiety may appear driven, hardworking, and perfection-seeking. Unlike many people with generalized anxiety disorder (GAD), people with high-functioning anxiety are able to get things done and seem to handle situations well. This can mask the struggle the person is dealing with.

Read on to learn what high-functioning anxiety looks like and how it can be managed.

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Anxiety Statistics in America

About 40 million adults in the United States are affected by anxiety disorders each year, making anxiety the most common mental health condition in the United States.

General anxiety disorder is the most common of these disorders, affecting about 6.8 million U.S. adults (about 3% of the population). Unfortunately, many people with generalized anxiety aren't aware they have it, and if they are aware, many of them do not receive treatment for it. Only about 43.2% of people with GAD receive treatment.

Of adults with any anxiety disorder, approximately 43.5% experience mild impairment, 33.7% have moderate impairment, and 22.8% have serious impairment.

Anxiety vs. High-Functioning Anxiety

The main difference between clinical anxiety disorders and high-functioning anxiety is in the ability of people with these disorders to function. This can be difficult to discern since "functional" is subjective.

Difficulty from living with high-functioning anxiety isn't always obvious, even to the person experiencing it. It likely affects their quality of life, their physical and mental health, and their relationships, but in less obvious ways than are present with clinical anxiety disorders.

Because they often channel their anxiety into productivity, people with high-functioning anxiety may even appear from the outside to be functioning better than the average person.

What's the Baseline?

In addition to excessive worrying and other symptoms, one of the criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose an anxiety disorder is its disruption or impairment of life activities. In other words, people with anxiety disorders experience symptoms that are severe or intrusive enough to make it difficult for them to function.

People with high-functioning anxiety do not officially meet this criterion because they are observed as still being able to function well in areas such as work, school, personal lives, and finances. This doesn't mean that they are not struggling or that their quality of life is not impacted. It means that they are functioning well enough—at least outwardly—not to meet the criteria of having an anxiety disorder.

Some professionals feel that high-functioning anxiety should be classified as mild anxiety instead.

Unofficial Definitions

Despite its lack of an official diagnosis, high-functioning anxiety is a very real condition.

People with high-functioning anxiety appear to function normally, or even more productively than most, but they also experience the symptoms of an anxiety disorder internally.

High-functioning anxiety is most likened to GAD because of its ambiguous but omnipresent nature. As with people with GAD, people with high-functioning anxiety may experience intense feelings of fear and impending doom and other symptoms associated with anxiety disorders.

Unlike GAD and other anxiety disorders, high-functioning anxiety does not cause such intense physical symptoms. Some may be present, such as elevated heart rate, but they usually are not enough to influence behavior, limit activity, or be noticeable to others. People with high-functioning anxiety are also less likely to avoid situations that trigger their anxiety than people with anxiety disorders are.

People with high-functioning anxiety tend to "push through" and manage what they need to do, although they feel the discomfort and effects of anxiety while doing so.

Default Diagnosis

High-functioning anxiety is a "default diagnosis." This means that if a healthcare or mental health professional notes the symptoms of anxiety, but the person does not meet the criteria for a diagnosis of an anxiety disorder, the label of high-functioning anxiety may be given.

Characteristics 

While it may not obviously impair functioning, high-functioning anxiety affects people in a number of ways.

Personality and Personal Effects

People with high-functioning anxiety tend to:

• Be busy all the time, unable to sit still, slow down, or relax
• Seek perfection and fear failure
• Be ambitious, determined, and get things done
• Have trouble sleeping because they are thinking too much
• Be people pleasers and have difficulty saying no
• Engage in numbing behaviors, such as smoking, substance use, overeating, or overexercising
  

Work Life

At work, people with high-functioning anxiety may:

• Agonize over making decisions and stress out over details
• Be regularly dissatisfied with their performance due to perfectionism, even when their colleagues and their employer view them positively
• Be a workaholic, constantly working, staying late, refusing vacations, and not pausing between goals or projects
• Revise work over and over
• Push themselves too hard
  

Relationships 

High-functioning anxiety can also affect relationships. When interacting with others, people with high-functioning anxiety may:

• Want to please others
• Avoid telling people no, thinking the person will see them as a failure or view them negatively if they do
• Give too much of themselves without getting enough in return
  

More Than Being an Overachiever 

The overachieving nature of people with high-functioning anxiety can make it seem like having high-functioning anxiety is beneficial. While there are positive effects of it, high-functioning anxiety can have a significant negative impact as well.

Effect on Mental Health 

People with high-functioning anxiety feel consistent— even constant—discomfort and regularly feel unsettled. This feeling is so omnipresent that people with high-functioning anxiety consider it part of their daily experience.

While this is part of what drives their productivity, it isn't sustainable and eventually takes its toll on the person's mental, emotional, and physical health.

People with high-functioning anxiety may:

• Worry constantly and have racing thoughts they can't turn off, even when things are going well
• Find it hard to relax
• Become irritable or frustrated easily

Chronic anxiety, including high-functioning anxiety, can be associated with other mental health conditions, such as:

Physical Effects of Anxiety

Anxiety problems can contribute to a number of physical conditions, including:

Theories About the Cause

The exact cause of anxiety disorders isn't known but may be related to a combination of:

• Genetics
• Brain chemistry
• Personality
• Life events

High-functioning anxiety may also be linked to personality traits and life experiences.

Self-Help Strategies

In addition to seeking help from a mental health professional, there are things you can do to manage your high-functioning anxiety.

Validating Yourself 

Acknowledging how you are feeling is powerful. Saying, "I am feeling overwhelmed," or, "I am overcome with worry," can help you manage the emotions you are experiencing. This can be said to yourself or to a family member, friend, or therapist.

Doing this helps you take some responsibility and gain some control over your anxiety.

Mind and Body Exercises 

Because people with high-functioning anxiety are constantly on the go (sometimes physically, always mentally), taking time to relax the body and mind can be challenging, but it is important.

Some exercises that may help include:

People with high-functioning anxiety often struggle with getting quality sleep, which can impact their mental and physical health. Some ways to foster healthy sleep include:

• Take measures to relax and quiet your mind before bed, such as by taking a bath or shower, reading, or meditating.
• Stick to a firm bedtime.
• Block out sensory stimuli by using items such as earplugs, an eye mask, blackout curtains, or a mouth guard.
• Keep the bedroom at a consistent, comfortable temperature.

Making a Treatment Plan

As do people with anxiety disorders, people with high-functioning anxiety can benefit from treatment from mental health professionals.

Therapy

Psychotherapy (talk therapy) can be highly effective for treating anxiety, particularly cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

• Cognitive behavioral therapy: CBT is a well-established treatment for anxiety. It involves identifying and understanding problematic thought processes and behavior patterns, then changing them (over time) through exercises laid out by a mental health professional.
• Acceptance and commitment therapy: ACT is a newer form of treatment. Through ACT, a person learns to feel their anxious thoughts without judgment and accept them. ACT doesn't aim to reduce unwanted thoughts, but rather takes away their power by changing how the person reacts to them.

With Medication

Medication may be helpful for some people with high-functioning anxiety and may be used in combination with therapy.

The classes of medications most commonly prescribed for anxiety are:

Social Support 

While not a substitute for professional or medical advice, joining a support group for people with high-functioning anxiety can help you connect with others who understand and can relate to your experiences. It can also be a place to share resources.

Summary

High-functioning anxiety is not a clinical diagnosis, but it is a form of anxiety that has a significant effect on those who experience it. People with high-functioning anxiety appear to function well and are often highly productive, but they struggle with symptoms of anxiety in less obvious ways.

Treatment for high-functioning anxiety is similar to that of other anxiety disorders. Options include talk therapy, medication, and/or social support resources like support groups.

A Word From Verywell 

If you are experiencing regular symptoms of anxiety, even if you don't think you meet all the criteria for an anxiety disorder diagnosis, talk to your healthcare provider or mental health professional. You may be experiencing high-functioning anxiety or another type of anxiety disorder. Know that what you are experiencing is real and valid and can be managed with proper help.

Frequently Asked Questions

• Ways to help stop an anxiety attack include:

  • Remind yourself anxiety attacks usually go away within a short period of time.
  • Do relaxation exercises such as deep breathing techniques.
  • Exercise, such as going for a walk.
  • Visualize a place, real or imagined, that makes you feel calm.
  • Use sensory stimuli, such as touching an ice cube or smelling something strong like peppermint oil.

• Therapies such as CBT and ACT that are used for anxiety disorders can also be effective for managing high-functioning anxiety.

• Anxiety disorders are official mental health illnesses. High-functioning anxiety does not meet the criteria for a diagnosis of an anxiety disorder but is still very real and impactful.