A Guide To Managing “High-Functioning Anxiety”

Medically reviewed by Majesty Purvis, LCMHC
Updated June 27, 2024by BetterHelp Editorial Team

Many people don’t realize that the term "anxiety" isn’t a catch-all. There are many kinds of anxiety with symptoms that vary from person to person. But the different kinds of anxiety disorders have some common anxiety symptoms, as well. These may include extreme and constant worry, fear, helplessness, and more. 

High-functioning anxiety disorder features many of these common symptoms that can affect an individual’s mental health, but the primary difference is in how they manifest. Some people with high-functioning anxiety disorder may not even realize they have a form of anxiety until they’ve been experiencing symptoms for an extended time. When left unaddressed, those symptoms could worsen, and the anxiety could progress into something more serious. 

Therefore, it’s important for people who suspect they may have high-functioning anxiety to speak to a therapist right away so they can work on a treatment plan and get the symptoms under control before they get worse. 

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Anxiety is treatable and manageable with guidance
Symptoms of high-functioning anxiety
One of the most recognizable symptoms of most anxiety conditions is the "anxiety attack" or "panic attack." During an anxiety attack, the individual's heart rate increases (sometimes making them think they are having a heart attack), and their breathing may become fast and shallow. They may feel chest tightness or even chest pain. The individual may think they are going to throw up or pass out—and they may do so. Anxiety attacks can also include racing thoughts and unusual sensations, such as the sense that you are losing your mind or that your life is outside of your control.

Individuals with high-functioning anxiety may not experience anxiety attacks in this way. The kinds of anxiety attacks experienced by people with high-functioning anxiety have been called "silent anxiety attacks." Anxiety attacks of this kind may not include physical symptoms like shortness of breath but do include emotional symptoms like a sense of a loss of control.

In some cases, people with high-functioning anxiety disorder don't get the same kind of anxiety attacks that can typify other kinds of anxiety disorders. In other cases, people with high-functioning anxiety disorder may simply be better at masking the symptoms or avoiding things that trigger their attacks. They may perform well at work, meet deadlines, be comfortable in social settings (unlike with social anxiety disorder), be highly organized and detail-oriented, and have a good work-life balance. Some people with high-functioning anxiety may even outperform people who don’t experience anxiety. 

One of the common traits of people experiencing high-functioning anxiety disorder involves crafting their lives around avoiding the things that make them uncomfortable or living a life characterized by several nervous habits.

Another common element of anxiety disorders is fear. In most anxiety conditions, this may prevent the individual from doing things or pursuing opportunities. However, in a person with high-functioning anxiety, this fear can drive them to always work or always work harder. As a result, they may experience success in their professional lives but don't have time or energy left over to address their true feelings, maintain healthy relationships, or take care of their own emotional or physical health.

Who can get high-functioning anxiety disorders?

Anybody can have a high-functioning anxiety disorder. As with other emotional and mental disorders like depression, an anxiety disorder can be the result of chemical imbalances, stressful life events, family history, or a combination of these.

People with high-functioning anxiety disorder can be very high-achieving, successful people, but the fact that they are usually diagnosed as adults sometimes makes it difficult to determine which came first: the anxiety or the success. Some adults are successful because the anxiety drives them to achieve, and others develop anxiety because they drive themselves to achieve. 

Regardless of which came first, most cases of high-functioning anxiety disorder are theorized to be a result of life circumstances combined with a family history or biological predisposition to anxiety.

How is a high-functioning anxiety disorder diagnosed?

As mentioned above, high-functioning anxiety is often diagnosed in older adults, whereas most anxiety disorders are diagnosed in teens or young adults. This is largely because high-functioning anxiety lacks many of the most recognizable symptoms of other anxiety disorders, although it has much of the same diagnostic criteria. As a result, high-functioning anxiety is often diagnosed when the individual sees a therapist or counselor about another seemingly unrelated issue, like relationship counseling.

Further, because people with high-functioning anxiety are often perfectionists and insist on specific routines, they may seek a diagnosis for a better-known disorder like obsessive-compulsive disorder. Their attempts to avoid things that trigger their anxiety may also make some of their symptoms look like symptoms of mood disorders like depression. Many people with depression also have anxiety, so being diagnosed with another disorder may lead to the discovery of an individual's high-functioning anxiety.

High-functioning anxiety may also be initially noticed by a primary care provider because chronic stress, like that experienced by those with anxiety disorders, can lead to physical symptoms that may turn up in a routine checkup. These include high blood pressure, heart problems, sustained muscle tension, poor immune system, digestive problems, muscle pain, weight loss or weight gain, and other symptoms that can lead to an official diagnosis and treatment.

As information becomes more readily available and the stigma associated with mental and emotional disorders dissipates, more and more people are seeking out diagnoses for their anxiety conditions and other mental illnesses rather than waiting for someone else to discover these conditions.

How can you treat high-functioning anxiety disorders?

Once high-functioning anxiety disorder is diagnosed, it is treated in the same way that other anxiety disorders are treated. Depending on the preferences and circumstances of the individual, treatment may consist of just prescription medications, just talk therapy or some combination of the two. Its severity will help determine the best way to treat anxiety.

Medications (such as selective serotonin reuptake inhibitors and/or beta-blockers) on their own can help ease the symptoms of individuals with high-functioning anxiety. However, anxiety medication may also make talk therapy treatment more helpful. As a result, the combination of talk therapy and medication may last for months or even years, but the treatment can eventually come to an end. Talk therapy or medication often lasts for the life of the patient.

Consequently, many people with anxiety disorders are wary of beginning medication. They fear that medication will change their personality, cause them to turn to other substances, or negatively impact their relationships with others. In the case of high-functioning anxiety, many people also fear that medication will "dull" them or take away their drive and ability to succeed.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

While this is not often the case, people with these concerns can choose to only go through cognitive behavioral therapy if they wish. Many research studies demonstrate that therapy is successful in treating significant anxiety without medication.
Therapy for high-functioning anxiety

The main goal of therapy in the case of people with high-functioning anxiety disorder is to help them stay calm and manage symptoms. This involves recognizing when their thoughts are "spiraling" and getting them back on track with the help of coping strategies.

People with high-functioning anxiety disorder often worry about the future, including things that they can't change or even realistically anticipate. They also tend to ruminate on past mistakes and harbor a deep fear of repeating them. Talking with a therapist can help these people learn how to identify these kinds of unhelpful thought patterns and realign them with something healthier. 

Many people with high-functioning anxiety also have irrational fears about how others perceive them. A counselor can help them determine when these fears are founded and can also help them determine how important these things really are to their daily lives.

Mindfulness practices are becoming increasingly popular in therapies for people with high-functioning anxiety. Practicing mindfulness is about learning to understand your thoughts and feelings as they relate to the present moment. Incorporating mindfulness into cognitive therapy helps psychologists give their patients with anxiety the tools that they need to keep themselves grounded in their own thoughts and feelings at the moment rather than worrying about what other people think or what may happen in the future.

Even though cognitive therapy is effective in treating anxiety disorders, not everyone living with the symptoms seeks therapy. There are many possible reasons for this, but most are related to issues of scheduling, availability, and stigma associated with seeking help from a mental health professional. 

People with high-functioning anxiety may have a unique set of challenges that act as barriers to treatment. For instance, because they are often hyperfocused on achievement, many people with this type of anxiety tend to load their work schedules to the point where they don’t have much time to do anything else. This makes it difficult to find the time to attend sessions, particularly if a rush-hour commute is involved. 

Online therapy for high-functioning anxiety

Online therapy can be an effective solution to these kinds of barriers to treatment. With online therapy, you can speak to a mental health professional at any time that fits your schedule. You can interface with them anywhere via phone, text, online chat, and video chat.

If you notice signs of high-functioning anxiety, you might consider reaching out to a therapist using an online platform such as BetterHelp. By connecting individuals with hundreds of professional licensed therapists and counselors over the internet, BetterHelp likely offers a therapy option that fits your needs, schedule, and lifestyle. 

Anxiety is treatable and manageable with guidance


Anxiety disorders of any kind can be debilitating to a person’s health and well-being, but high-functioning anxiety poses a unique threat. If a person doesn’t realize they are experiencing symptoms of anxiety or if they believe these symptoms are “normal,” they may not get help until the disorder progresses to something that is more difficult to treat. 

If you experience excessive anxiety and it seems to be interfering with your daily life, it may help to speak to a therapist. You don’t have to have anxiety related to any specific stressful situation or trigger to receive treatment. A therapist may be able to provide insight into what you’re experiencing and help you cope with symptoms more effectively. Take the first step toward getting professional help with anxiety by reaching out to BetterHelp.

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