High-Functioning Anxiety: Symptoms, Causes, And Treatment

Everyone feels a bit anxious at times. Anticipating or worrying about the outcome of a particular situation is a natural feeling. However, if these feelings stay with you for a long time and significantly impact your life, it could mean that you have an anxiety disorder.

Some people can have ongoing anxiety without it negatively impacting their day-to-day functioning – this is known as high-functioning anxiety.

Mental health professionals do not currently recognize high-functioning anxiety as an official anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) guidelines state that anxiety must disrupt or impair life activities to qualify as an anxiety disorder.

This does not mean that high-functioning anxiety is just a mild form of anxiety. Often, the symptoms of high-functioning anxiety present as qualities that are viewed positively in society, such as being excessively driven, goal-oriented, or active.

Unlike classic anxiety disorders that tend to leave people feeling stuck, people with high-functioning anxiety often feel propelled forward by their symptoms.

Read on to learn more about high-functioning anxiety, including its symptoms, diagnosis, and treatment.

What is high-functioning anxiety?

High-functioning anxiety is a persistent feeling of worry, stress, or general anxiety that can negatively affect your emotional health but does not significantly interrupt your day-to-day life.

It's not an official medical diagnosis, and most people who experience this type of anxiety may excel in many areas of their lives, such as in their career, school, or sports. However, a person with this form of anxiety may look calm and collected on the outside while feeling overwhelmed, fearful, and dealing with obsessive thoughts on the inside.

What is the difference between high-functioning anxiety and general anxiety?

Unlike generalized anxiety disorder, high functioning anxiety is not a recognized anxiety disorder. While the two have many overlapping symptoms, the biggest difference arises in the overall impact of the anxiety on the person’s day-to-day functioning.

Generalized anxiety is characterized by persistent worry and anxiety about everyday events and can often be crippling. People with general anxiety typically feel frozen by their symptoms and find it hard to engage in certain activities and daily tasks. They may also find themselves seeking excessive reassurance to ease their stress.

People with high-functioning anxiety may similarly experience persistent worry and fear, but they feel driven forward by their symptoms. They may carry a constant fear of failure, nervous energy, perfectionism, or obsessive thoughts of achievements that push them to throw themselves into work and hobbies to alleviate the symptoms.

Their desire to minimize their anxious feelings often leads them to work harder and succeed more, but behind the smile is a perpetually worried individual struggling with anxiety.

Signs and symptoms of high-functioning anxiety

• Irritability and frustration

• Fear of letting people down

• Nervous habits (nail biting, picking, biting the inside of the mouth)

• Worry, fear, and anxiety

• Changes in appetite

• Inability to relax

• Perfectionism

• Sleep problems

• Overthinking or overanalyzing

• Fear of failure or judgment

• Digestive issues

• Overachieving

• Difficulty saying no even when overwhelmed

• A desire to always keep busy

• Mental and physical fatigue

• Becoming anxious before events

• Increased heart and breath rates

What causes high-functioning anxiety?

The causes of high-functioning anxiety are not well-known, but experts consider¹ that it could be due to factors such as:

• Personality – Childhood characteristics such as nervousness or shyness in new situations increase the risk of developing anxiety.

• Genetics – If you have a family history of anxiety disorders or other mental health illnesses, you are at a higher risk of developing high-functioning anxiety.

• Exposure to stress – Trauma or stress at any point in life can trigger anxiety.

• Underlying health issues – People with other health issues such as heart problems or thyroid disorders are at higher risk of experiencing high-functioning anxiety.

• Drug or alcohol abuse – Alcohol or drug misuse, along with withdrawal, can trigger anxiety.

Diagnosis

As high-functioning anxiety is not officially recognized as an anxiety disorder, mental health professionals cannot diagnose it. However, high-functioning anxiety may either be seen as a level on the anxiety spectrum or how anxiety disorders present in some people.

When diagnosing anxiety, doctors will often first carry out a physical check to examine whether any underlying medical conditions are contributing to anxiety symptoms. If there is no underlying physical cause, the patient may require diagnosis and treatment from a mental health professional.

It can be difficult to diagnose high-functioning anxiety since the symptoms do not officially meet the criteria for an anxiety disorder. Therefore, it is essential for people with high-functioning anxiety to provide their doctor with a complete picture of their symptoms and areas in which the anxiety they are experiencing affects their well-being.

Treatment

Psychotherapy and medication are the two primary treatments for high-functioning anxiety. Most patients require a combination of the two to support their recovery.

Psychotherapy – Psychotherapy, or talk therapy, helps people manage symptoms of anxiety and the underlying thoughts that worsen them.  Cognitive-behavioral therapy² (CBT) is one type of psychotherapy that is effective in treating anxiety disorders. It helps individuals reduce anxious thoughts, progressively confront triggering objects or situations, and learn meditation, progressive muscle relaxation, or breathing to manage anxiety symptoms.

Medication – Medication to treat anxiety includes antidepressants, antihistamines, and beta-blockers.  You may also be prescribed benzodiazepines for short-term relief, especially if you experience panic attacks.

How many people are diagnosed with high-functioning anxiety?

Since high-functioning anxiety is a non-recognized psychiatric condition, it is unknown just how prevalent it is. However, anxiety disorders overall affect 40 million adults in the U.S.³  Among those with anxiety disorders, only 36.7% receive treatment for their conditions. Patients with high-functioning anxiety are even less likely to seek out treatment.

The lowdown

A person with high-functioning anxiety may face major challenges in understanding and accessing treatment for their symptoms because medical professionals do not consider high-functioning anxiety to be an official anxiety disorder. How high-functioning anxiety presents itself also means that symptoms can go undetected or the person is simply seen as driven or hardworking.  Especially because people close to them may not detect any anxiety symptoms. 

If you are experiencing high-functioning anxiety, it is recommended that you talk to a medical professional to discuss treatment options to help you handle your symptoms and feel better.