coping with high functioning anxiety

Coping with High-Functioning Anxiety

High-functioning anxiety isn’t technically a medical term, and isn’t listed along with anxiety disorders like agoraphobia or generalized anxiety disorder in mental health diagnostic manuals. However, it is how many of us have come to describe a mental health issue that involves symptoms of anxiety paired with the ability to still function at a high level.

In other words, someone may go about their life – both at home and at work – accomplishing all that needs to be done, while suffering silently from extreme stress and feelings of inadequacy and anxiousness. In fact, it’s common that individuals suffering from high-functioning anxiety go above and beyond what is required, often exceeding expectations, and don’t always share their true feelings or divulge their anxiety symptoms.

Symptoms frequently reported by people with high-functioning anxiety include:

  • Racing thoughts and overthinking: people with high-functioning anxiety struggle to calm their minds and can feel overwhelmed by a decision-making process. There can be a lot of “worst case scenario” thinking.
  • A feeling of doom: a wave of dread may be accompanied by tightening in the chest or an inability to catch one’s breath. An increased heart rate and heart rhythm disturbances are signs that stress hormones are affecting the body’s ability to regulate cardiovascular functions. Whether it’s worry about the future or an upcoming test, a variety of stressors can weigh heavily on someone with high-functioning anxiety.
  • A need for frequent reassurance: high-functioning anxiety may cause individuals to check on others, or double check that things are locked and turned off, sometimes bordering on compulsive behavior. (There can also be repetitive and nervous behaviors like counting stairs or cracking knuckles).
  • Difficulty sleeping: insomnia or other sleep disturbances can afflict those with high-functioning anxiety or other anxiety disorders.
  • Limiting one’s social life and activities: those who have high-functioning anxiety may prefer to stay in their comfort zone because they feel additional pressure in social situations. While there is a tendency to be a people pleaser, the high-functioning anxiety makes it difficult to relax and enjoy the moment. 
  • Numbing oneself through substances: those with high-functioning anxiety or other anxiety disorders frequently turn to alcohol or other drugs to dial down the intensity of their experience.
  • Exhaustion: the symptoms of high functioning anxiety include a variety of physical and emotional manifestations. Whether it’s muscle soreness or mental duress (often it’s both), people with high-functioning anxiety feel it everywhere, and report being exhausted both physically and mentally.

Several symptoms of high-functioning anxiety may not be on this list, and not everyone with high-functioning anxiety will have every symptom that is. Some symptoms overlap with substance use disorders or other issues, so a person will need to consult a mental health professional to receive a diagnosis and get treatment.

If some of the symptoms or scenarios in the list above sounds like you, or a member of your family, it may be useful to continue reading, and reach out for help. Also, it’s important to know that you’re not alone. Anxiety disorders affect around 40 million adults in the United States, and are the most common mental illness in the country. If you have an anxiety disorder you may want to get treatment from a  professional and get the added support that is so often needed.

Individuals with high-functioning anxiety sometimes resist reaching out for help, as do many people suffering from mental health struggles. This can be for a number of reasons, including the feeling that they should be able to find a solution on their own, don’t want to cause concern for a loved one, or have misconceptions about therapy. [link to 7 Myths blog post] However, seeking support from a therapist could be critical to your health – both mental and physical. 

Below I’ll share just a few ideas and insights about coping skills and treatment approaches for people with high-functioning anxiety. Of course, reading through a list of ideas is not a replacement for therapy or mental health treatment, but it can be a place to start. Please know that you can always reach out to me with any questions.

See Related: 7 Myths About Therapy

1. Name it and Tame it

With high-functioning anxiety, you may sometimes feel overwhelmed by a flood of emotions, even if it’s not outwardly apparent to others. This might manifest in a physical way, such as a tightening in your chest or shortness of breath. Your response to such symptoms may be to bite your nails or scream in your car or self-medicate with substance use.

But before you start to cycle through this unhelpful pattern, try to pause. Even if you just step away from the situation for a second to acknowledge your emotional state, it can be a start.

claim your anxiety by stating what is happening

Stop and say (to yourself, or a therapist, or a friend), “ I’m feeling sick with worry” or “I’m so overwhelmed.” Calling out what is happening, acknowledging and naming it, is one way to reclaim some agency. It takes the power away from the metaphorical mean, scary monster when you say, “I see you.

Step into the light and let me take a closer look.” Even though we don’t have 100% control over any given situation, knowing what we’re working with is one way to regain the reins and steer ourselves in the right direction. 

When you deny or shove your anxious feelings down deeper inside, you can do yourself a disservice. It might actually lead to what I refer to as an “emotional explosion” later on.

Try taking an internal inventory and assessment to see what needs attention. Feel your feelings and know that they don’t have to have the final say, then take a moment deciding how you’ll address it. Of course, it may help if you have some tools to help you, so keep reading for ideas, or reach out for help.

2. Fear is your Friend

Okay, so maybe “friend” isn’t the right word. Fear and worry are more like annoying relatives that keep showing up uninvited, but the point is that they will always be a part of your life. That’s horrible, you might be saying to yourself, isn’t there a way to get rid of them?

Well, with relatives you always have the option of moving to a remote location or not answering the door, I suppose, but fear is a natural emotional response that has actually helped humans survive. The goal is not to do away with these feelings, but to find better ways to manage them.

Unlike machines, we humans don’t have a switch to shut these things down. However, there might be something to that familiar refrain from the I.T. department, “Have you tried turning it off and on again?” Maybe we’re more like computers than we like to admit. We can also benefit from an occasional reboot, refresh, or restart. 

So when you take a moment to pause (as recommended in #1 above), it’s not to shut down or deny your feelings, or even to try and “fix” everything. Instead, it’s about managing those emotions with a new narrative, and understanding that this may be a chronic problem that requires adaptive coping skills.

Bill Hader, the Actor, Comedian, Producer (and so forth) of SNL fame, has shared some thoughts around this idea of greeting your fear, and how it’s served him well when dealing with his own anxiety (and considering all those titles and awards he’s received, it seems likely it’s high-functioning anxiety). In this clip that was part of an anti-stigma campaign he says opens up about his own anxiety and what he would tell his younger self. If his words are helpful, you might want to check out the entire interview. 

3. Know Thyself (and Thy Triggers)

Perhaps you already have a sense of what sets you off panic mode, or you notice how anxiety symptoms appear before certain events. This can actually help you work on a plan of action.

If you have high-functioning anxiety you may already have a mental list of situations that cause you additional stress. You might even have it written down and color-coded. People with high-functioning anxiety tend to be very organized, detail-oriented, as well as punctual people who plan ahead.

keep a stress and trigger journal to help manage anxiety

If you haven’t made a mental note of these scenarios, then try making a list. This way you can be prepared with a combination of actions and responses that serve you better than your initial impulses. In a world of worry, there’s still a path you can clear to forge ahead. A therapist can often help you on this recovery journey, and you can also find practices and tactics that work well for you.

knowing triggers could help you manage symptoms of high functioning anxiety

If you know you have a presentation coming up, be sure to set aside time to take a walk, meditate, or call a friend who makes you laugh. For people with anxiety disorders it’s important to be proactive and plan for mental health breaks. For years people have taken coffee breaks and cigarette breaks, so shouldn’t we all be doing the same for moments like this?

Whether it’s taking slow breaths or a walk around the block, do something that you know helps calm your nerves and gets your frenetic thinking to fizzle out. There’s no time like the present to plan for the future, so pencil in those much-deserved breaks and do what works for you.

4. Body & Mind

Anxiety is a common response to stressful situations. When it becomes intrusive in your life and impinges on your ability to relax and find joy for extended periods of time, then you may be suffering from an anxiety disorder. Of course, a trained mental health professional would have to assess you individually to ascertain that and make a diagnosis.

However any time we humans worry, whether it’s in response to a clear and present danger or our thoughts are racing with a million worst case scenarios for no apparent reason, our mind and body are working in tandem. If someone has tried to tell you, “it’s just in your head,” they may have thought they were being helpful, but aside from the fact that your head is indeed part of your body, it’s usually not helpful to dismiss what’s going on in your mind.

High-functioning anxiety is not some sort of character defect to be fixed. It’s more akin to false alarms going off in your brain as synapses misfire and tell your body to prepare for the worst. There’s not always a way to shut down those alarms, but you can acknowledge when it’s happening and learn more adaptive ways to process your perception of it, and choose how to respond. People with anxiety frequently benefit from physical activity and relaxation techniques as part of their treatment.

People with high functioning anxiety, or any type of anxiety for that matter, may have a maladaptive stress response that promotes inflammation, damaging arteries and potentially leading to complications with the heart. If the thoughts that come with high-functioning anxiety cause you physical unease, then it’s important to address the situation with both cognitive and physical responses. In other words, the mind and body are connected in a continual feedback loop, so it’s good to approach mental health issues holistically.

5. Just Breathe

No wonder everyone from Eddie Vedder to Faith Hill has written songs about breathing. It’s pretty essential for our survival and one way we can have an impact on the inner workings of our body. Certain breathing techniques can help slow your heart rate and reduce tension. Awareness of the breath can be part of meditation, yoga, and other activities that act as a kind of reset during or after a stressful situation.

Since muscle tightness and other physical signs of stress are symptoms of high-functioning anxiety, it makes sense that moving your body would be part of the remedy. Maintaining awareness of your breathing is important and has been found to make a difference in the lives of many folks with high-functioning anxiety. There is a lot of information out there about breathing techniques, and some of it is specifically for people with anxiety disorders.

move your body and take deep breaths to help cope with anxiety

Start somewhere and make small changes. You don’t have to become a yogi and adopt an entirely new lifestyle to draw upon wisdom from an array of traditions (though you can if you like). Pick one day a week to try a new breathing exercise. There are several where you can even stay in your seat and get right back to work. If you choose to do therapy, I have several techniques that have helped clients in the past.

An anxiety disorder doesn’t define you as a person or mean that you are destined to always feel like you do right now. You may have a chronic condition, but with therapy you can learn to manage the symptoms and perhaps even identify assets amidst your unique tendencies. It’s important to note that empathy and loyalty are also traits observed in those with high-functioning anxiety.

Some people with high-functioning anxiety may actually fear that they will lose their ability to be “high-functioning” in life, if they let their guard down and put their overachieving overactive mind on pause or take a break. From my experience, clients with anxiety experience relief and clarity through self-reflection and incorporating new practices in their life. They are able to focus on what they really value.  Life is more than accumulating accomplishments, though work is indeed important. If you begin to prioritize yourself and allow yourself to focus on your mental health, it’s likely that all areas of life – family, work, friends – will all benefit.

When you are feeling stressed and your mind is running a mile a minute, it may be hard to hear that there is hope.  Your personal suffering doesn’t have to remain private. Feel free to reach out with questions or schedule a session.

therapy can work well for many people suffering from high functioning anxiety

Keep Reading: 7 Must Reads for Adoptees and Their Parents


Becca Leitman’s lens and therapeutic approach are rooted in Attachment Therapy. I believe there is great importance in developing healthy, emotionally-fulfilling connections with yourself and those closest to you. I am currently conducting all sessions online via Telehealth. I am able to work with clients from anywhere in New York, or across the country. Just know that treatment with me is a safe and confidential space, wherever it is. Let’s talk. Follow me on Facebook, Instagram, Twitter, Pinterest , Psychology Today and LinkedIn for mental health guidance, stress and anxiety tips, therapy resources and more.

Becca Leitman

Becca Leitman

I’m a Licensed Independent Clinical Social Worker (LICSW), and have worked with children, adults, and families for over ten years. I earned my Master of Social Work from New York University and received a Bachelor of Photojournalism from Boston University. Additionally, I was trained in Art and Dance Therapy at Pratt Institute in Brooklyn, New York, and earned a Post Graduate Certificate in Attachment Focused Trauma Therapy.

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