High Functioning Anxiety: Signs, Treatment and More

August 17, 2022

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About The Editor
About The Editor

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor’s in Communication in 2017 and has been writing professionally ever since.

About The Writer
About The Writer

Taylor Cameron is a Licensed Professional Counselor and mental health copywriter.

About The Medical Reviewer
About The Medical Reviewer

Dr. Angela Phillips is a licensed therapist and clinical researcher.

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Anxiety isn’t always visible. People with high functioning anxiety may be able to mask their symptoms so that the rest of the world doesn’t see them. However, this anxiety still negatively impacts a person’s health and overall well-being, which makes it important to get treatment. Learning more about the signs of high-functioning anxiety can help you find the support you need.

What Is High Functioning Anxiety? 

An individual with high functioning anxiety experiences excessive levels of intense worry, fear and nervousness. To the outside world, however, they appear calm, organized and successful. High-functioning anxiety is not a specific diagnosis within the Diagnostic Statistical Manual of Mental Disorders (DSM), but it has become a popular way to describe people who suffer from anxiety but seem to maintain daily functioning. 

These individuals may be dealing with all of the symptoms of anxiety, but they are often able to conceal their distress from those around them. However, they are likely not functioning as well as they think they are. In reality, they may be walking around with severe anxiety but are somehow able to trudge their way through life. 

Signs of High Functioning Anxiety

A person may have a difficult time recognizing that they need anxiety treatment because they meet society’s standards of success. Their anxiety leads them to behave in ways that are labeled as positive traits and skills to other people. 

External positive traits may include:

  • High-achieving
  • Organized
  • Detail-oriented
  • Hardworking
  • Diligent
  • Timely
  • Appears put-together and calm
  • Active
  • Sensitive to other people’s needs and wants

Others may see these positive external traits, but they rarely see that the person is working to mask or conceal the internal struggle and suffering they deal with because of anxiety.

Internal negative traits include:

  • Difficulty setting boundaries
  • Struggling to say no; overcommitting
  • People pleasing
  • Overthinking; excessive worrying
  • Racing or intrusive thoughts
  • Overplanning
  • Exhaustion
  • Fear of failure 
  • Striving for perfection
  • Trouble falling or staying asleep
  • Difficulty resting; needing to stay busy and accomplish a to-do list
  • Irritability or being on edge
  • Difficulty concentrating
  • Panic attacks once the person lets their guard down

High Functioning Anxiety vs. Anxiety

A person with high functioning anxiety might have all the same symptoms as another person with anxiety, but they still appear to be functioning well. For the most part, their anxiety symptoms do not prevent them from going to work or school or completing other daily tasks. 

What Are Silent Panic Attacks?

A silent panic attack is simply when a person has a panic attack and the people around them don’t realize it. When you think of a panic attack, you probably first think of a person with visible signs of distress. For example, they may be hyperventilating, trembling or crying. However, not all people show these signs, as some individuals may experience panic attacks in ways that aren’t as visible. 

Signs of a silent panic attack can include

  • Zoning or checking out; feeling detached from your body, surroundings or reality
  • Stomach pain
  • Chest pain
  • Heart racing
  • Intrusive or racing thoughts
  • Sweating
  • Difficulty sitting still
  • Dizziness
  • Numbness or tingling sensations in your extremities
  • A lump in your throat or difficulty swallowing
  • Changes in your vision or hearing

Causes of High Functioning Anxiety

It’s still unknown what causes a person to develop an anxiety disorder. It’s generally believed to be a combination of genetic, environmental, developmental, and psychological factors that make a person more prone to developing anxiety. 

Risk factors may include:

  • Trauma (e.g., abuse, neglect, community violence, disaster, accident, death of a loved one)
  • Medical conditions (e.g., hypothyroidism)
  • Stress resulting from chronic, acute or terminal illnesses
  • Unmet physical needs (e.g., housing or food insecurity, poverty)
  • Family history of anxiety disorders
  • Substance use and withdrawal
  • Other mental health conditions

An individual with high functioning anxiety may have specific personality traits, skills, access to resources or other environmental factors that enable them to appear well-functioning despite their anxiety. 

Pros and Cons of Having High Functioning Anxiety

Individuals with high functioning anxiety often have traits that make them successful in the workplace. They’re typically high achievers who push themselves to perform and succeed. They appear to everyone else as organized, detail-oriented and hardworking. Their employers typically sing their praises because they’ll go the extra mile and always get the job done. 

While these individuals may go far in the workplace and life in general, it comes at a price. High functioning anxiety puts you at a higher risk for burnout because you’re constantly working to avoid failure. You’re likely striving for perfection, trying to please other people or consistently afraid of making a mistake. 

High Functioning Anxiety and Depression

It’s not uncommon for individuals to experience both anxiety and depression. Research has found that 45.7% of participants with lifetime major depressive disorder also had at least one anxiety disorder. There appear to be similarities in brain structure, personality traits and risk factors when comparing people with depression to people with anxiety. 

Symptoms of depression include

  • Frequent or persistent feelings of sadness or hopelessness
  • Feelings of numbness or emptiness
  • Irritability or anger
  • Loss of interest in activities that were once pleasurable
  • Sleeping habit changes
  • Fatigue; feeling mentally, physically and emotionally exhausted 
  • Appetite changes
  • Anxiety, agitation or restlessness
  • Slower thinking, speaking and moving
  • Feeling worthless or like a failure
  • Difficulty focusing and making decisions
  • Brain fog, impaired memory
  • Thoughts of death or suicide, suicide attempts or suicide
  • Aches and pains

The anxiety spurs the individual to accomplish tasks and perform in front of other people, so the depressive symptoms may be more noticeable when the individual is alone or isn’t busy with a task. It can be difficult to recognize that a person is dealing with both anxiety and depression when they appear to be someone who has it all together.

How To Treat High Functioning Anxiety

Treatment for high functioning anxiety follows the recommended treatment for anxiety disorders, which is a combination of psychotherapy, medication and mindfulness activities. Upon starting treatment, each individual will work with their health care professional to determine the best course of action. 

Mindfulness and Deep Breathing Exercises

Individuals can use mindfulness and deep breathing exercises to reduce stress and calm themselves when dealing with feelings of fear, worry and being overwhelmed. Mindfulness activities can help you identify and address thoughts that are leading to or worsening anxiety. Combined with these activities, breathing exercises can also be used as coping skills when you are feeling overwhelmed. 

Medications

There are a variety of medication options available to treat anxiety, depending on your symptoms. Possible medications include SSRIs, SNRIs, pregabalin and benzodiazepines. When deciding whether a medication may be right for you, speak with your doctor regarding:

  • Frequency, severity and duration of your symptoms
  • Different medications available
  • Potential side effects of medications
  • Interactions between the medication and any current medications you’re taking
  • Plan for dosage and length of treatment
  • Risk of dependence or addiction to the medication

When taking medication for anxiety, it is a good idea to monitor and keep track of your symptoms so that you and your doctor can discuss if the dose and specific medication are right for you. If you decide to stop medication used to treat your anxiety, it is important to do so under the care and direction of your doctor. 

Therapy

Psychotherapy is an effective treatment for anxiety disorders, with cognitive behavioral therapy (CBT) having the highest success rate for patients. Within CBT, a therapist will work with an individual to identify, address and change thought patterns and behaviors that lead to or worsen anxiety.

If you need support in dealing with anxiety, the Nobu app is an excellent resource. This free app provides mental health services, wellness activities, guided lessons and more. For an additional fee, you can even connect with a licensed mental health professional for treatment and additional support. Find the help you’ve been looking for by downloading the Nobu app, available for free on both Apple and Android devices.

Take Control Of Your Mental Health

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About The Editor
About The Editor

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor’s in Communication in 2017 and has been writing professionally ever since.

About The Writer
About The Writer

Taylor Cameron is a Licensed Professional Counselor and mental health copywriter.
Read more.

About The Medical Reviewer
About The Medical Reviewer

Dr. Angela Phillips is a licensed therapist and clinical researcher.

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