What Is High-Functioning Anxiety? Signs, Causes, and Coping

High-functioning anxiety is a descriptive term (not an official diagnosis) that refers to anxiety in which a person appears outwardly successful, organized, and accomplished, but is internally struggling with intense worry, fear, and stress. It can affect anyone, but it’s often thought to be especially common among women. 

To cope with high-functioning anxiety, setting boundaries, challenging unhelpful thought patterns, using relaxation techniques, and seeking therapy can all be helpful. 

What is high-functioning anxiety?

There’s not one single, universal way that anxiety shows up for everyone. 

Anxiety can exist on a spectrum, and the exact symptoms of anxiety, ways they manifest, and settings where they pop up can vary.

High-functioning anxiety isn’t an official diagnosis, as it’s not recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard classification of mental disorders used by mental health professionals in the U.S.

However, that doesn’t mean that high-functioning anxiety is any less real. Experiencing high-functioning anxiety can be very challenging, frustrating, and distressing. But there are also real ways to cope. 

Signs of high-functioning anxiety

Now, what does “high-functioning” look like in terms of anxiety, specifically? 

There are several physical and behavioral signs that can be common in individuals with high-functioning anxiety. 

Some of the common physical signs of high-functioning anxiety can include:

• Headaches or migraines
• Sleep problems 
• Shortness of breath
• Upset stomach or other digestive issues 
• Rapid heart rate
• Muscle tension 
• Persistent fatigue

Meanwhile, some of the common behavioral signs of high-functioning anxiety can include:

• Intense fear of failure 
• Difficulty relaxing 
• Racing thoughts
• Constant worrying 
• Frequent catastrophizing (imagining the worst-case scenario) and “what-if” thinking
• Procrastination (often driven by perfectionism) 
• Frequent self-doubt 

In someone who is high-functioning and high-achieving, anxiety might look like excelling at work or school and frequently exceeding others’ expectations. But coming home and feeling completely exhausted, replaying every moment of the day in their head, and lying in bed for hours unable to fall asleep as they worry about how they’re going to do it all again tomorrow. 

High-functioning anxiety vs. other types of anxiety

Again, high-functioning anxiety is not an official diagnosis, so how exactly does it differ from clinically recognized, diagnosable anxiety disorders? 

Generally speaking, a core difference between high-functioning anxiety and clinical anxiety disorders lies in their impact on daily functioning: a key requirement for the diagnosis of an anxiety disorder is typically that the symptoms interfere with daily functioning. Meanwhile, a key feature of high-functioning anxiety is in its name: high functioning. 

In other words, for someone with a clinical anxiety disorder, the symptoms they experience typically cause noticeable disruptions to their functioning at work, in relationships, or in other important areas of life. Meanwhile, someone with high-functioning anxiety may experience similar symptoms, but they still maintain their daily responsibilities and appear outwardly successful. 

However, doing so can take a significant toll on their mental health and well-being. As Sreela Roy-Greene, PhD, LMHC, and Sr. Manager of Clinical Operations at BetterHelp explains, “The internal anxiety that this person feels is so overwhelming that the person feels the ‘need’ to be productive in order to manage their feelings. Functioning becomes the coping mechanism and it takes a toll on the individual.”

While high-functioning anxiety is not an official diagnosis, it is still anxiety, and in some cases, it may overlap with a clinical anxiety disorder, though this is not always the case.

Clinical anxiety disorders can come in various forms. The types of anxiety disorders include: 

• Generalized anxiety disorder
• Social anxiety disorder
• Panic disorder
• Specific phobias 
• Separation anxiety disorder
• Selective mutism

If you are experiencing any symptoms of anxiety that are causing you distress, know that help is available, no matter what category your symptoms may fall into.

Why high-functioning anxiety may be more common in women

Anxiety in any form can affect people of any gender, background, and age, but high-functioning anxiety is often thought to be especially common in women. 

While there’s limited research on the prevalence of high-functioning anxiety in particular, extensive research has shown that women experience considerably higher rates of anxiety disorders compared to men. 

In fact, a study of more than 20,000 individuals in the United States found higher rates of diagnosis for nearly all anxiety disorders among women.

Other research has shown that women tend to experience higher rates of “internalizing disorders” (which are characterized by directing distress inward), while men tend to experience higher rates of “externalizing disorders” (which are characterized by directing distress outward). 

As for why they’re so common, recent research has suggested that the prevalence of anxiety disorders in women may be due to a combination of biological factors (such as hormonal fluctuations) and psychosocial factors (such as gender roles and unique stressors). 

Taken together, all of this can paint a pretty striking picture of potential high-functioning anxiety: 

• Women often experience unique stressors such as higher rates of sexual assault. 
• Women tend to direct their distress inward.
• Due to traditional gender norms, many women are socialized to prioritize others’ feelings and well-being over their own, which can lead to burnout and suppressing their personal needs.
• Women are expected to manage the brunt of caregiving in families, and in most cases, do this alongside full-time employment. This leads to compounded stress for women having to show up in both places with high expectations from society. 

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How to deal with high-functioning anxiety

If you are experiencing high-functioning anxiety, there are a number of ways to cope. Different approaches may work better for different people, but some of the strategies you can try include: 

• Setting boundaries: Many people with high-functioning anxiety find themselves juggling more responsibilities than they can reasonably handle. To combat this, it can help to learn how to say “no” when you are at capacity, set reasonable timelines, and take steps to avoid over-extending yourself.
• Challenging unhelpful thoughts: Perfectionism can be a common feature of high-functioning anxiety, but this can often lead to procrastination or burnout. It can be helpful to challenge the thought patterns that try to tell you that you need to produce flawless work or that anything less than perfect is failure. 
• Adopting relaxation techniques: Incorporating practices such as breathing exercises, meditation, and mindfulness can help you reduce stress and find calm. 
• Seeking support through therapy: You don’t have to cope with anxiety on your own; a therapist can offer professional insight into how to treat high-functioning anxiety and any other mental health concerns you may be having. 

For many people with high-functioning anxiety, trying to juggle the many different demands and responsibilities on their plate can leave them with little time for something like therapy. This is where online therapy can be particularly helpful: research shows that online therapy can be an effective form of treatment for anxiety, so if online therapy works better for your lifestyle than in-person treatment, you can still get the help you need. 

With a platform like BetterHelp, you can connect with a therapist at a time that works for you, without having to commute to an office. BetterHelp also accepts insurance through many major insurance plans. Insurance availability and coverage may vary by state, plan, provider network, and therapist availability. 

In some cases of more severe anxiety or other serious mental health concerns, exploring additional treatment options such as medication may also be useful. If you think you may benefit from psychiatric support, note that BetterHelp offers psychiatry services through UpLift as an additional care option.*

*Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member’s insurance plan. Controlled substances are not prescribed. Learn more on our psychiatry page.