What Is High-Functioning Anxiety? Symptoms, Causes And Treatment

High-functioning anxiety is not a diagnosis, as it’s not an anxiety disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides diagnostic criteria for mental disorders. Therefore, you won’t find a lot of information or research on it. Instead, high-functioning anxiety typically refers to someone who experiences anxiety while still managing daily life quite well.

Generally, a person with high-functioning anxiety may appear put together and well- accomplished on the outside, yet experience worry, stress or have obsessive thoughts on the inside.

“A person with high-functioning anxiety is fully functional and usually successful,” says Sasha Hamdani, M.D., a psychiatrist at the Psychiatry Associates of Kansas City, Kansas. “They’ll perform well at their job, handle all of their finances, balance their home life, maintain relationships, but they’re still struggling with anxious feelings and thoughts.”

Since it’s not an official diagnosis, research on high-functioning anxiety and how it affects people is limited. People with high-functioning anxiety may present less obvious signs and symptoms, and some experts say the signs and symptoms often most closely align with those of generalized anxiety disorder (GAD).

Symptoms associated with GAD include:

• Excessive anxiety or worry on most days for at least six months
• Restlessness
• Difficulty concentrating
• Being easily fatigued
• Irritability
• Muscle tension
• Sleep problems

When it comes to high-functioning anxiety, some of these symptoms are more apparent than others, according to Dr. Hamdani, who says she’s more likely to notice or hear from patients reporting persistent feelings of being on edge, muscle tension, headache from clenching of the jaw, hunched shoulders and irritability.

“Patients will say they have a hard time falling asleep or staying asleep or just not having restful sleep,” says Dr. Hamdani. “Irritability is also common with high-functioning anxiety. For example, if you’re really busy and anxious, you could also be really snappy.”

High-functioning anxiety has both positive and negative characteristics, so while some of the positive qualities may appear great (such as being able to handle daily tasks well), it’s not to discount the inner struggle the person may be experiencing. It can be for those very reasons that someone doesn’t seek help or endures anxiety in silence.

“These positive characteristics can mask the negative characteristics, which makes it harder to treat,” says Dr. Hamdani. “It also makes others seem like you’re doing so well, that how could there be anything wrong?”

Researchers believe that the causes of anxiety generally rely on genetic and environmental factors. Some of the causes may include:

• Family history of anxiety disorders
• Exposure to negative or stressful life events
• Certain physical health conditions like thyroid issues
• Substance or alcohol abuse
• Shyness or nervousness traits from childhood

People who might be especially susceptible to high-functioning anxiety, in particular, can include “individuals who have achieved success in a small amount of time, for example, physicians who’ve taken on a lot of cases, lawyers who’ve become partners at their firm or someone who has received many promotions,” says Dr. Hamdani.

These risk factors can vary. If you have experienced one of them, it doesn’t necessarily mean you have an anxiety disorder. If you feel you may, reach out to your doctor.

There are many types of anxiety disorders, and they can all present differently. Here are some of the most common types, according to the National Alliance of Mental Health:

• Generalized Anxiety Disorder (GAD): As noted above, GAD symptoms can include constant worrying about everyday life. The worry isn’t linked to a certain event, but rather tends to be more chronic. Someone with GAD may have difficulty finishing tasks or struggle to concentrate, and their worrying tends to exhaust them.
• Panic disorders: These disorders often consist of panic attacks and the sudden onset of terror without any forewarning. Sometimes, panic attacks can cause chest pain, heart palpitations, shortness of breath and dizziness, leading some to think they’re experiencing a heart attack.
• Social anxiety disorder: This disorder takes place in social settings and causes anxiety when having to contribute to discussions or partake in conversations. It’s driven by the worry of saying the wrong thing, not knowing what to say or being humiliated.
• Phobias: Phobias are considered an anxiety disorder because someone with a phobia tends to have strong reactions of fear or discomfort. Phobias can include places, objects or events. Depending on what it is and how strong of a reaction it causes, many avoid any potential triggers to avoid having a panic attack.

High-Functioning Anxiety and Depression

Anxiety and depressive disorders have a critical relationship and can coexist during the same time. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study found 53% of patients with major depression also had significant anxiety and were considered to have anxious depression^[1]Kalin, N. The Critical Relationship Between Anxiety and Depression. American Journal of Psychiatry. 2020;177(5):365-367. .

“High-functioning anxiety tends to become problematic when it bleeds into depression,” says Dr. Hamdani. “That’s when most patients will start to seek help—when they’re having trouble getting out of bed, difficulty sleeping, losing interest in doing things they enjoyed doing or thoughts of life not being worthwhile.”

The two conditions can go hand-in-hand, as high-functioning anxiety can lead to depression, but depression can also lead to high-functioning anxiety, so looking at their impact on each other and then treating accordingly is important, according to Dr. Hamdani.

If you feel like you could be suffering from depression symptoms, reach out to your doctor—there are a number of effective treatments out there that can provide relief.

To receive a diagnosis for an anxiety disorder, a doctor may conduct a physical examination or lab tests to rule out other conditions that cause symptoms that may be confused with anxiety, such as heart disease or high blood pressure. If no underlying health concerns are found, a doctor may then conduct an interview or refer an individual to a mental health professional for psychological evaluation.

During psychological evaluations, a mental health care provider may diagnose an individual with an anxiety disorder based on criteria from the DSM-5, including:

• Excessive anxiety and worry for more days than not about events or activities such as work or school performance for at least six months.
• Difficulty controlling feelings of worry, with symptoms such as increased heart rate, fatigue, sleep disturbances, trembling or shaking, nausea, dizziness, muscle tension or aches, restlessness, difficulty concentrating or irritability.
• Symptoms cause significant distress or impairment in social settings, at work or in other areas of functioning.
• Recurrent panic attacks followed by at least one month of fear of having another panic attack, worry about the implications or consequences of panic attacks (such as having a heart attack or loss of control) or changes in behaviors related to panic attacks.
• Fear of social or performance situations during which an individual is exposed to new people or to possible scrutiny from others.
• Exposure to feared situations leads to a panic attack.
• An individual avoids social situations or endures them with distress.
• Symptoms cannot be attributed to a medication or substance.

Because individuals with high-functioning anxiety may be more successful in controlling or hiding their symptoms, it is important to be honest with a mental health care provider about symptoms and concerns. This can ensure that an individual who suspects they are experiencing the symptoms of high-functioning anxiety receives an accurate diagnosis.

Fortunately, there are many ways an individual can cope with high-functioning anxiety. Some coping methods include:

• Use stress management techniques, such as exercising, getting plenty of sleep and eating healthy meals.
• Practice meditation or mindfulness, a type of meditation that involves focusing on what’s happening in the present moment and accepting one’s thoughts and feelings without judgment.
• Avoid consuming caffeine, which can worsen symptoms.
• Attend support groups, either in-person or online, to share with others who experience similar symptoms and learn effective coping techniques.

High-functioning anxiety can be treated the same way that other anxiety disorders are treated, including therapy, prescription medications or a combination of the two.

Talk therapy can be an effective way for some people to manage symptoms. Speaking to a therapist or counselor can help you understand your anxiety and teach you techniques to better manage your symptoms. Cognitive behavioral therapy (CBT) is a common form of psychological treatment used to change thinking patterns with the goal of better understanding one’s behavior and recognizing one’s distortions.

“For patients with high-functioning anxiety, therapy and techniques like cognitive behavioral therapy can be extremely beneficial,” says Dr. Hamdani.

Prescription medications that treat anxiety disorders are also available and include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants. Other medications like benzodiazepines, buspirone and beta-blockers can also be used to treat anxiety.

If you think you may need treatment, speak to your doctor about which treatment method might be best for you.

Online therapy platforms connect you with licensed providers, which can include psychiatrists, psychologists, licensed marriage and family therapists, licensed clinical social workers and licensed professional counselors. Discover our top picks and the best online therapy to fit your needs and preferences.

Online Therapy for High-Functioning Anxiety

Research suggests that online therapy for anxiety is as effective as in-person therapy. In fact, a 2021 meta analysis in Depression and Anxiety reports that internet-delivered talk therapy was effective in treating symptoms of GAD^[2]Eilert N, Enrique A, Wogan R, et al. The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis. Depress Anxiety. 2021;38(2):196-219. .

Additionally, a meta analysis in Journal of Anxiety Disorders found that online therapy—particularly the kind of therapy that utilizes cognitive behavioral therapy—is an effective and acceptable form of treatment for individuals who experience anxiety and depressive disorders^[3]Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord. 2018;55:70-78. .

Online therapy may be a worthy alternative to in-person therapy for individuals who live in rural areas or lack access to mental health care resources in their community. Internet-delivered therapies may also be an attractive option for individuals who prefer to receive treatment from the comfort and convenience of their own home.