High Functioning Anxiety

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By Milissa Aronson | Anxiety

Posted: January 29, 2024 

Woman spinning multiple plates, trying to balance too much due to overwhelming experience of high functioning anxiety

Think back to how you slept last night. Did you sleep? Did you remain asleep? Wake up at all? What was falling asleep like? How much did your thoughts interfere with your quality of sleep? Did you think about the length of your “To Do” list and everything you must do the next day?  Maybe you were awake thinking about what you said the previous day, wondering if you said the right thing or what someone thought of you? Or something you did- was it good enough? Did you forget something? Perhaps you were so exhausted from going non-stop for the entire day that it seemed like you fell asleep before your head hit the pillow, knowing you wouldn’t even get a whole night’s rest before doing it all over again?

Does any of this sound familiar? Does it seem typical? Some of you may be thinking, “Sure, that’s just life.” Or “Yes, but I’ve always been like that.” Others may be wondering if there is a way out of this pattern- maybe you have even tried to break out of it but can’t sustain it.

Your “To Do” List

Where did it come from? What are the range of responsibilities? How much is self-imposed? Are you often the first to volunteer for a task? Is this because you want to “appear” a certain way? Done out of guilt? Maybe you are “voluntold” for some activities and have difficulty saying “no.” Perhaps you genuinely want to do all of them, but know that doing them with your other responsibilities isn't realistic.

High-Functioning Anxiety

High Functioning Anxiety is not currently a formal diagnosis by itself. Instead, it is a subset of Generalized Anxiety Disorder. Someone with high-functioning anxiety experiences anxiety symptoms but functions well in their relationships and day-to-day life. They may look like they have everything under control. In fact, people struggling with high-functioning anxiety disorder try to overly control situations.

High-functioning anxiety often goes undiagnosed. To an outsider, people experiencing high-functioning anxiety may appear organized, detail-oriented, proactive, hardworking, and overachieving. They may even be praised or rewarded for these qualities! However, internally, they may not be plagued with self-doubt, preoccupied with perfectionism, and have an intense fear of failure. They often have difficulty setting boundaries for themselves, cannot slow down, and feel exhausted!

Common Symptoms of High-Functioning Anxiety

· Overthinking- Individuals with high-functioning anxiety may ruminate over past situations, worry about the future, and fixate on details of something to the point of double, triple, or quadruple-checking or changing them.

· Perfectionism- It is common for someone with high-functioning anxiety to set extremely high standards for themselves and become very critical when they don’t meet those standards.

· Constant Need for Reassurance- People with high-functioning anxiety will seek ongoing reassurance from others or internally (checking or verifying details) to avoid perceived failure.

· Procrastination- It isn’t uncommon for someone with high-functioning anxiety to procrastinate on tasks to avoid failure. Similarly, they may have difficulty focusing on a single task due to being overwhelmed by the volume of tasks on their plate.

· Avoidance- Individuals with high-functioning anxiety can avoid certain situations, particularly social ones or opportunities where they may perceive a likelihood that they will not be successful.

· Excessive Need for Control- In an effort to maintain the appearance of achievement and reduce the experience of anxiety, individuals with high-functioning anxiety experience an extreme need for control.

· Extreme Organization- Similar to the extreme need for control, people with high-functioning anxiety are highly organized and proactive in an attempt to maintain control.

· Overachievers- People with high-functioning anxiety often struggle with self-doubt and focus on achievements as a way to alleviate their self-doubt and ease their worry about the future.

· Difficulty Slowing Down- Individuals with high-functioning anxiety tend to take on a lot. The volume of things on their plate, their overthinking, and their drive to achieve make it difficult for them to slow down.

· Difficulty Setting Boundaries- People with high-functioning anxiety struggle setting boundaries, particularly saying “no” to others, and often take on more than they can reasonably manage.

· Imposter Syndrome- Despite their achievements and evidence of competence, people struggling with high-functioning anxiety tend to doubt their accomplishments and struggle with self-esteem.

Risks of High-Functioning Anxiety

· Burnout- Individuals struggling with high-functioning anxiety experience a continuous sense of internal conflict from pressure imposed to meet their high standards. They will ignore feelings of fatigue and illness to continue to meet those standards.

· Self-Esteem Issues- Individuals coping with high-functioning anxiety often feel as if they fail to meet their high standards and struggle with low self-esteem.  

· Sleep Disturbances- People with high-functioning anxiety have difficulty falling asleep due to replaying their day or focusing on their “Do” list. They often have difficulty quieting their thoughts to relax enough to sleep or return to sleep when awakened in the middle of the night.

· Additional Mental Health Issues – If left untreated, high-functioning anxiety can lead to depression. Eating disorders or substance use issues may also arise as an attempt to self-medicate anxiety.

· Physical Health Impact- People dealing with high-functioning anxiety are generally under chronic stress, which will have detrimental effects on physical health.

Managing High-Functioning Anxiety

Fortunately, there are ways to manage high-functioning anxiety and break out of those habits!

· Practice Asking for Help- Some believe doing everything yourself shows strength. If this sounds like you, ask yourself where you learned that belief. Then, ask which feels demonstrates more strength: being self-aware enough to know that you can’t handle something and being brave enough to ask for help OR suffering silently to do something alone. Try to reframe asking for help as a challenge and start by asking for help with something small.

· Delegate- Is it necessary that you handle everything? Delegating is different from asking for help in that delegating hands the task off to someone who also bears some responsibility. For example, you can delegate some work responsibilities to a subordinate or delegate the daily task of emptying your dishwasher to one of your children.

· Practice Leaving Some Tasks at “Good Enough” instead of “Perfect. For Everything Else, Strive for Excellence, Not Perfection- Perfectionism leads to procrastination, mistakes, and unfinished work. Everything can’t be perfect. This takes practice. It may take A Lot of practice, so start small. Find something small and insignificant and practice leaving it at “good enough.” This will help you prioritize what matters and what requires your focus to strive for excellence.

· Include Downtime in Your Structure- Give yourself unstructured time to slow down each day without focusing on the “next thing.” Try to be present and in the moment (think mindfulness).

· Seek Professional Help- If you have been living with these habits for a while, they may be hard to break. A mental health professional can help you understand how they started and give you more adaptive ways to cope with your feelings.


- Antony, M. M. (2015, April 9). Cognitive-behavioral therapy for perfectionism. Anxiety and Depression Association of America. 

-Benson, E. (2003). The many faces of perfectionism. Monitor on Psychology, 10(34), 18.

-Rasmussen, K. E. & Troilo, J. (2016, June 1). “It has to be perfect!”: The development of perfectionism in the family system. Journal of Family Theory & Review, 2(8), 154-172. doi: 10.1111/jftr.12140

-Mayo Clinic Health System (2023, July 11) Behind the mask: Managing high-functioning anxiety