Whenever anxiety disorders cross your mind, you tend to think about someone you know who is always nervous, excessively worried, or restless. What if that person always appears confident, organized, and outgoing on the outside? Does this mean they can’t have anxiety? Not at all! Although they may not show the obvious signs of depression, these people may have high-functioning anxiety, an anxiety condition that can’t be easily diagnosable

This article will define high-function anxiety, its symptoms, causes, treatment, and when to seek help.

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What is High-functioning Anxiety?

High-functioning anxiety is a type of anxiety that affects people that seem to have it all together in their everyday life.

In other words, these people perfectly execute their duties whether at their job or back at home with their families or with friends; it doesn’t matter. In fact, these are the people you’re more likely to admire and look up to. However, deep down, they could be filled with intense worry, dread, and unease.

Sasha Hamdani, M.D., a psychiatrist at the Psychiatry Associates of Kansas City, Kansas, describes a person experiencing high-functioning anxiety as fully functional and successful in everyday tasks. “Even though these individuals struggle with anxious feelings and thoughts, they can still perform at their workplaces, handle their finances well, balance their home life and maintain relationships,” adds Sasha, M.D

Generally, a person suffering from high-function anxiety may appear organized and well-accomplished from the outside. Still, they could be undergoing stress, have obsessive thoughts on the inside, or experience worry.

Due to its subtle symptoms, high-functioning anxiety can be difficult to diagnose. It’s also not considered an anxiety disorder since it is not listed under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides diagnostic criteria for mental disorders.

Signs and Symptoms of High-Functioning Anxiety

As mentioned in the above section, the signs and symptoms of high-functioning anxiety can be subtle, making it difficult to recognize. However, the common signs and symptoms of high-functioning anxiety are as follows;

1. Overthinking

Overthinking is among the most signs and symptoms of high-functioning anxiety. It is characterized by excessive rumination and worries about life events to the extent that it is out of proportion with the actual likelihood of the events occurring.

Moreover, people with this type of anxiety are often stuck in a cycle of persistent and negative thoughts that can be hard to break. These individuals may feel overwhelmed when faced with even the most straightforward decision, as they tend to analyze every possible outcome in great detail.

Overthinking can also lead to poor decision-making, as it can be hard to distinguish between logical thought and irrational worry. This explains why most people with high-functioning anxiety make decisions based on fear instead of facts. As a result of their delusional beliefs, they are more likely to engage in impulsive behaviors to try to find a solution to their anxieties.

2. Perfectionism

People suffering from high-function anxiety always strive to be perfect in every aspect of their lives. They tend to be extremely hard on themselves and put unrealistic expectations on themselves to achieve perfection. This can lead to stress, frustration, and even depression.

Moreover, whenever they are confronted with a challenge, they tend to be overly perfectionists in trying to find solutions. As a result of the fear of making mistakes, they tend to become overly concerned with details and be reluctant to take risks.

In the long run, this will lead to procrastination, difficulty making decisions, and difficulty completing the task. Ultimately, this leads to feeling burnt out while still having a mountain to climb on the task.

3. Need for control

High-function anxiety people may tend to feel an intense need to control their environment and the people in it. This is often due to the fear of the unknown and the fear of being overwhelmed. Ultimately, this leads them to exhibit behaviors such as the need to plan every detail of their lives and struggle when things do not go as planned.

They may also manifest behaviors such as being overly critical of themselves or others, rigid thinking and struggling to be flexible or adaptive to change. Other notable signs include micromanaging and the inability to delegate tasks.

The need for control can also be seen in relationships since people with high-functioning anxiety may try to control the behavior of their partners or friends to create a sense of security. They may also try to manage their emotions by suppressing them to justify their emotions or feelings.

Physical symptoms of High-function anxiety

Physical signs of high-functioning anxiety include the following;

4. Restlessness or feeling on edge

Feeling on edge or restlessness can manifest as a general sense of unease, agitation, pacing, or fidgeting. Additionally, this symptom can make it difficult for individuals with high-functioning anxiety to relax and may affect their ability to perform daily tasks.

5. Fatigue or exhaustion

Fatigue or exhaustion is another common physical symptom of high-functioning anxiety. It includes feeling drained, having sleep difficulties, or not getting enough rest.

Typically, high-functioning anxiety causes an increase in stress hormones such as adrenaline and Cortisol, making it difficult to relax and fall asleep. Furthermore, constant worry and stress can lead to physical and emotional exhaustion.

6. Muscle tension or headaches

Research has shown that high-function anxiety can cause muscle tension due to the “fight or flight” response, where the body prepares for a perceived threat by tightening muscles. This tension frequently leads to pain in the shoulders, neck, or back, headaches, as well as other physical discomforts. Correspondingly, these symptoms can be intensified by stress and can lead to chronic pain if left untreated.

7. Digestive issues

Digestive issues such as stomach cramps, nausea, diarrhea, or constipation have also been linked to high-functioning anxiety. Anxiety usually causes changes in the body’s digestive system by releasing stress hormones, such as cortisol, that research has proven can affect the muscles in the gut and intestinal lining.

As a result of the effect of the hormones, you may experience symptoms such as bloating, stomach pain, gas, and bowel problems. Additionally, constant worry and stress can affect a person’s appetite, leading to weight changes.

Causes of High-Functioning Anxiety

While there is no single cause of this condition, researchers have found that a combination of genetic, environmental factors, and personality traits can play a role.

Family history of anxiety disorders

Studies have shown that anxiety disorders tend to run in families and that individuals with a family history of anxiety disorders have a higher risk of developing one themselves.

This can be due to the existence of inherited genetic variations in genes that regulate the levels of neurotransmitters such as serotonin, GABA, and dopamine in the brain, which are known to play a role in regulating mood and anxiety.

Exposure to traumatic life events

Traumatic life events such as physical or emotional abuse, neglect, the death of a loved one, or a severe accident can contribute to the development of high-function anxiety. This is because such occurrences can cause emotional and psychological reactions, such as fear, guilt, shame, and anger.

Trauma can also change how the brain functions by affecting how a person processes and responds to stress and various emotions. Notably, this can lead to long-term changes in brain chemistry, which may contribute to the development of high-function anxiety.

Certain physical health conditions

Various health conditions can also contribute to the development of high-function anxiety. These may include:

  • Thyroid conditions: An overactive or underactive thyroid can affect the levels of hormones in the body, leading to symptoms such as fatigue, irritability, and nervousness.
  • Heart disease: The physical symptoms of heart disease, such as chest pain and shortness of breath, can cause anxiety and fear about the possibility of having a heart attack.
  • Chronic pain: Chronic pain can cause helplessness, hopelessness, and depression, leading to anxiety.
  • Respiratory conditions: Conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD) can cause shortness of breath, which are potential stimulators to panic and anxiety.

Substance or alcohol abuse

Abuse of substances such as alcohol, marijuana, cocaine, and amphetamines can cause changes in brain chemistry. This can ultimately lead to high-function anxiety symptoms.

Moreover, the withdrawal symptoms that occur when an individual stops using these substances can also cause feelings of high-function anxiety, mood swings, and overall well-being.

Personal traits

Personal traits such as shyness or nervousness from childhood contribute to developing high-function anxiety. Generally, children who are naturally shy or nervous are more likely to develop anxiety as they grow older. This results from them experiencing a hard time adjusting to new situations or meeting new people, which positively contributes to feelings of anxiety.

Additionally, shy or nervous children are prone to negative social interactions or bullying, which can contribute to the development of anxiety.

Treatment of High-Functioning Anxiety

Treatment for high-functioning anxiety includes a combination of medication, lifestyle changes, and therapies. Notably, the most effective treatment plan will depend on the individual and the specific symptoms they are experiencing.


Research has shown therapy sessions as among the best treatments for several medical conditions, including high-function anxiety. Some of the therapies to include in the treatment plan for high-function anxiety include;

  • Cognitive Behavioral Therapy (CBT): CBT is beneficial for identifying and changing negative thought patterns and behaviors that contribute to anxiety.
  • Exposure therapy: Exposure therapy involves gradually exposing individuals to what they are afraid of in a controlled and safe environment to help them learn how to manage their fear and anxiety.
  • Mindfulness-based therapies: These therapies teach individuals to focus on the present moment and accept their thoughts and feelings without judgment, which can help reduce anxiety.


Medications can effectively reduce symptoms of anxiety and depression, enabling those with high-functioning anxiety to manage their emotions efficiently.

The most commonly prescribed medications for anxiety are antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs usually work by increasing the levels of serotonin and norepinephrine in the brain, which are effective in reducing the symptoms of anxiety and depression.

Additionally, sedatives, such as benzodiazepines, are effective in reducing anxiety symptoms such as a racing heart and sweating.

Lifestyle changes

Several lifestyle changes are significant for the effective treatment of high-function anxiety. They include;

  • Get adequate sleep: Getting enough sleep is essential for overall health and well-being. When you are anxious, falling asleep or staying asleep is difficult. As such, establishing a regular sleeping routine and avoiding stimulants such as caffeine close to bedtime is essential for quality sleep leading to effective management of high-function anxiety.
  • Exercise regularly: Physical activity stimulates the release of hormones such as endorphins, which are beneficial in reducing anxiety symptoms. In fact, a short walk is a helpful way to free up your mind and reduce anxiety.
  • Eat a healthy diet: Eating a balanced diet full of fruits, vegetables, and healthy fats is an excellent way to provide the body with the nutrients it needs to function optimally. Moreover, these foods contain essential vitamins such as Vitamin C and minerals such as fatty acids and Magnesium that are good for reducing stress and anxiety.

Alternatively, avoiding consuming processed foods and sugars is also beneficial in managing anxiety.

  • Practice relaxation techniques: Relaxation techniques such as deep breathing, mindfulness meditation, and journaling can be beneficial in managing anxiety. Notably, within your daily activities, ensure you schedule time for self-care.

When to Ask for Help

Generally, if you are experiencing high-functioning anxiety, asking for help can be the best thing to do.

Also, it is crucial to recognize the signs and symptoms of high-functioning anxiety and be aware of simple ways to manage it yourself.

These ways can include talking to a friend or a close family member or seeking professional help. Never hesitate to reach out and get the necessary assistance whenever you feel overwhelmed. It can make a big difference in your life and those around you.

Related Articles:

  1. What is Anxiety
  2. Emotional Numbness: Why Is It Bad For Your Health?
  3. Atypical Anorexia: Causes, Systems, and Treatment Options
  4. What Is Negative Stress and Positive Stress

Final thoughts

Anxiety can come in different forms. High-functioning anxiety is one of those that often go unnoticed and affects more people than is accounted for.

It’s characterized by internalized stress, anxiousness, worry, and overwhelm that don’t affect daily life and interactions.

Some symptoms to help you identify if you or someone you know has high-functioning anxiety includes perfectionism, the need for control, and overthinking.

This condition can, however, be easily managed with a combination of lifestyle changes, therapies, and medication.

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