High Functioning Anxiety vs. Anxiety Disorders Explained:

Anxiety is one of the most common mental health challenges, but not all anxiety disorders are the same. While some people might visibly struggle with severe anxiety symptoms, others manage to function in everyday life - often without anyone knowing that they're dealing with a constant internal struggle. One such form of anxiety is high functioning anxiety, which can be difficult to spot but still significantly impact your life.

In this blog I’ll explain what high functioning anxiety is, how it differs from other anxiety disorders, and why therapy for anxiety is one of the most effective ways to manage it. We’ll explore a few examples and practical insights that can help you better understand how therapy for anxiety can lead to healing and improved quality of life - even without a “traditional” anxiety diagnosis.

What is High Functioning Anxiety?

High functioning anxiety is not an official diagnosis, but it’s a term used to describe people who experience intense anxiety but are able to maintain outward appearances of normalcy and, just like the name suggests, are generally high functioning. Those with high functioning anxiety tend to keep up with their daily responsibilities, excel at work or school, and appear calm and collected to others, which can mask the anxiety beneath the surface. I like to explain it using an image of ducks on a lake: the appear calm on the surface, but their feet peddling wildly under the water. A lot of people with high functioning anxiety usually have lives that look good on paper, but inside they are struggling. Despite an appearance of outward success, the constant mental strain is draining, and can lead to increased feelings of anxiety, burnout and relationship issues.

People with high functioning anxiety are often high-achievers, perfectionists, highly organized, and often take on a lot of responsibility. They tend to struggle with people-pleasing, self-doubt, excessive worry, overthinking, and the fear of making mistakes. While they may seem confident and like they have it all together on the outside, they are often overwhelmed internally by their constant need to meet high standards, even if they are the ones setting such standards for themselves.

Key Differences Between High Functioning Anxiety and Other Anxiety Disorders

When we think about anxiety disorders we usually think of more visible or ‘obvious’ symptoms like panic attacks, phobias, or total social withdrawal, which is different than ‘social anxiety’. Social anxiety is a term that is over used in society when people feel uncomfortable or nervous in social situations, but that isn’t the same as a true social anxiety disorder, which we’ll get into a little bit later. High functioning anxiety is also different, but just as real. Let’s get into the differences between high functioning anxiety and other (diagnosable) anxiety disorders.

Visible Symptoms vs. Hidden Struggles

People with high functioning anxiety often appear to be in control. They are typically on time, organized, and accomplish a lot, but inside they are often anxious, overthinking every decision, and overwhelmed with stress. They might worry obsessively about the smallest of mistakes and feel a constant need to perform well. For example, let’s say you are a real estate agent who excels at your job. You have a high caseload, make good money and regularly receive accolades for your work. On the surface, you seem confident, put-together, and in control. However, at night, you lie awake for hours replaying every conversation and decision from her day, fearing that you may have made an error that will cost you a client or a sale.

In contrast, other anxiety disorders like generalized anxiety disorder (GAD) or social anxiety disorder usually manifest in more visible ways. People with GAD might experience physical symptoms like trembling, sweating, or fatigue, and their worries might become uncontrollable and pervasive to the point where they cannot function normally at work which likely gets noticed by colleagues and supervisors. Those with social anxiety may avoid social situations altogether, which is far more visible to others. 

Another example of generalized anxiety disorder as described in the DSM (an acronym for the diagnostic manual used by mental health professionals) is a constant, nagging sense of dread about everyday events, such as meetings at work or even running errands. It can look like struggling to get through the day without feeling overwhelmed, and can cause individuals with GAD to avoid social or professional engagements. This anxiety is often apparent to others as those who struggle with it express their worries and frequently cancel plans.

Productivity vs. Impairment

A hallmark of high functioning anxiety is being able to maintain a high level of productivity. Despite the overwhelming feelings of worry, individuals with high functioning anxiety often work harder, trying to avoid failure or disappointing others. I usually describe this to clients as trying to ‘outperform their feelings’, or in this case, anxiety. Additionally, people who struggle with high functioning anxiety often feel like they are never doing enough and often sacrifice sleep or social time to keep up with their responsibilities. Unfortunately this drive to overachieve usually comes at the cost of personal health, relationships, and mental health.

In disorders like panic disorder or phobias, productivity and day-to-day functioning are often impaired by the overwhelming or debilitating symptoms. For example, someone with a medical phobia might avoid seeking medical care even when they are feeling unwell due to their significant fear of medical procedures, hospitals, etc. In other situations phobias and avoidance of them can limit someone’s ability to function in certain situations, even if they are important for work events or relationships. For example, a moderate to severe phobia of flying can cause someone to miss important work events or family vacations because being on an airplane, or even the thought of it, can trigger a panic attack. In order to avoid the panic attacks the person avoids flying and then work performance and/or personal relationships are affected. At this point the person is not fully functioning and the anxiety is causing an impairment in normal functioning.

Coping Mechanisms: Overworking vs. Avoidance

People with high functioning anxiety often cope by overworking or staying excessively busy. This can serve as a way to distract from their anxiety or provide a sense of control. They might become perfectionists at work, home, or in their relationships, trying to create order and predictability, and avoid uncertainty. They might cope by constantly organizing everything around them - schedules, how the home is decorated or cleaned, kid’s extracurricular or school activities, and work projects. When things are predictable and it feels like if everything is under control, then anxiety is manageable, if it’s even felt at all. But when things inevitably don't go as planned, anxiety and stress usually ramp up.

In other anxiety disorders, some may use avoidance as a coping mechanism. For example, someone with social anxiety might avoid social gatherings altogether to prevent feelings of embarrassment or self-consciousness. These avoidance behaviors can lead to isolation and further anxiety. It is more than declining a social invitation due to a full schedule, or being exhausted from a week of work or social events. It is usually turning down invitations and gatherings out of intense and debilitating fear of judgement or embarrassment - not just feeling a little self-conscious or nervous that they won’t know anyone there. The problem is that the more social interaction is avoided, the stronger the anxiety and avoidance behavior becomes, leading to increased isolation and disconnection from others. 

Physical Symptoms: Low-Grade vs. Intense

While people with high functioning anxiety often experience physical symptoms of anxiety like headaches, heart pounding, occasional trouble sleeping, nervousness, muscle tension, and GI issues, these symptoms tend to be more subtle and chronic rather than acute. They may feel restless, exhausted, or physically tense without realizing the source of their discomfort. Those with high functioning anxiety tend to attribute these symptoms to stress or working too much, but the underlying cause is actually the constant worry.

In contrast, other anxiety disorders usually involve more pronounced physical symptoms that are immediately noticeable. For example, panic attacks which involve intense physical symptoms like heart palpitations, difficulty breathing, shortness of breath, dizziness, and a real fear that something is physically wrong, which can be debilitating in the moment. Panic attacks can also be frightening, and many people truly feel like they are having a heart attack or that the are going to die. While there are no known instances of someone actually dying from a panic attack alone, but the symptoms are so intense and real that many people end up in the emergency room or at a doctor’s office. Given the intensity of panic attacks, people who struggle with them begin to avoid places or situations that might trigger another attack, which can then limit mobility, interactions and functioning in work and social situations because the anxiety feels unmanageable. As with other types of anxiety, the avoidance then strengthens the anxiety and becomes a reinforcing pattern of avoidance and anxiety.

How Therapy for Anxiety Can Help Manage High Functioning Anxiety

If you struggle with high functioning anxiety, therapy can be a vital part of learning how to cope and manage symptoms. Therapy for anxiety focuses on providing you with strategies and support to deal with anxiety. Here are some specific ways therapy can help with high functioning anxiety:

Cognitive Behavioral Therapy (CBT)

CBT has been highly researched and is one of the most effective therapeutic approaches for managing many different forms of anxiety. Cognitive Behavioral Therapy helps clients identify and challenge negative thought patterns that contribute to anxiety. For someone with high functioning anxiety, CBT can help clients reframe perfectionistic thoughts, reduce self-criticism, and address the excessive need to overachieve. This does not mean that you can’t still be high-achieving, but it can help you find balance where you perform well, just not at the expense of your mental health or relationships.

Mindfulness and Relaxation Techniques

Mindfulness-based approaches, such as meditation or deep breathing exercises, can also help with high functioning anxiety but helping clients ground themselves in the present moment and reduce their constant state of worry. Mindfulness also helps clients recognize and attend to their own needs and emotions, which can then enable them to show up for others in meaningful ways that do not foster resentment. Therapy can teach these techniques and helps clients integrate them into everyday life, providing relief from stress and anxiety.

Developing Healthy Boundaries

People with high functioning anxiety often struggle with setting boundaries, feeling like they need to please others or find themselves constantly taking on more responsibility for fear of disappointing others or letting them down. Therapy can help clients recognize unhealthy patterns of people-pleasing or overloading themselves, and learn how to set boundaries without feeling guilty. Good boundary skills are needed in order to balance doing things for others while also getting your needs met.

Building Coping Strategies for Stress

In therapy, clients can learn to develop healthier coping strategies when stress arises. Instead of overworking or trying to outperform the anxiety (a strategy frequently used by high-achievers and people-pleasers), or getting consumed by anxiety, clients can learn how to pause, assess the situation, and use coping techniques like relaxation or problem-solving to manage anxiety in more constructive ways.

Addressing Underlying Issues

Therapy for anxiety can also help uncover any underlying issues, such as childhood experiences, trauma, or other unresolved concerns that might be contributing to the anxiety. In my experience, there is always something that drives anxiety, it does not exist in a vacuum because something is causing it. By addressing these root causes in therapy, clients can experience long-term healing and learn invaluable skills to reduce and manage anxiety.

Is Therapy for Anxiety the Right Choice for You?

If you’ve been silently struggling with high functioning anxiety, you don’t have to keep white knuckling it. It really doesn’t have to keep being this way - you can experience relief. I know because I’ve found my own relief from high functioning anxiety, and I’ve helped others do it as well. Therapy offers a space to understand your anxiety, build coping skills, and lead a more balanced life.

If you are in Colorado and would like to talk about how therapy can help you with high functioning anxiety I’d be happy to chat with you. You can book a free consultation call with me by clicking here.

DISCLAIMER: This blog is for educational and entertainment purposes only; it is not therapy and is not a replacement for therapy. Reading this website does not constitute a provider-client relationship. Consult your licensed physician or licensed mental health provider regarding advice, questions and support for your mental health. Information found on this website should be used only in conjunction with working with a licensed mental health professional or physician. If you are experiencing a mental health emergency, call 911 or 988. Nothing found on this website is intended to be a substitute for professional or medical advice, diagnosis or treatment. Denver Therapy LLC, authors and contributors to this blog assume no liability for any actions taken or decisions made in reliance upon, or in response to information contained on this website. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.