High Functioning Anxiety: What Is It and How Can I Navigate It?

Mary-Lauren O’Crowley, MA, NCC, LPC

When you are the first to arrive at work and the last to leave, have never missed a deadline or a meeting, and are always prepared, most people will find it difficult to believe you could actually have an anxiety disorder. Some types of anxiety may not present themselves in the most obvious ways. While anxiety disorders can cause feelings of overwhelm, fear, and panic, they can also lead to overthinking, people-pleasing, and a general inability to slow down.

What Is High Functioning Anxiety?

Strictly speaking, high-functioning anxiety (HFA) is not an official diagnostic category. In the US, for example, it is not recognized as an illness in America’s Diagnostic and Statistical Manual of Mental Disorders–5th Edition (abbreviated the DSM–5), a manual used by mental health practitioners to diagnose clinical illnesses. The phrase “high-functioning anxiety” is used to characterize people with anxiety symptoms that (on the surface) have little effect on their daily lives and their ability to function in personal and professional settings. 

Things are not often what they appear when you have high-functioning anxiety. A person with HFA may appear to have it all together from the outside. These people are likely those who show up first to work and are the last to leave, always dress to impress and take on extra tasks and assignments. People may find that certain behaviors such as overanalyzing, saying “yes” to everything, and striving for perfection actually propel them further in the workforce; however, these very same habits can lead to burnout. For example, when you are feeling under the weather, HFA might lead you to put off calling in sick because you do not want to appear lazy or unmotivated. You may even skip sleep and work all night to get more work done. While everything may appear to be in order from the outside, the internal experience of HFA may feel vastly different. You may find that you struggle with persistent thoughts and fears of failure, have difficulty sleeping, and often feel restless or agitated. 

Signs and Symptoms

HFA may be difficult to identify in most people because the presenting symptoms are often regarded as “normal” behaviors in our culture, making it harder to recognize the threat. Among the many signs of this type of anxiety include: 

• Striving for perfection
• Constant overanalyzing and overthinking
• Fear of failure
• Sleep deprivation (insomnia)
• The inability to say no and the desire to please people
• A habit of dwelling on one’s previous transgressions
• Nervousness (nail-biting, leg shaking, hair twisting, etc.)
• Worry and a lack of ability to convey one’s feelings

Positive Sides of HFA

• Success in the workplace
• A calm demeanor from the outside
• Readiness for any eventuality. 
• Passionate 
• Extroverted persona (happy, laughs, tells jokes, smiles)
• Always arriving on time or ahead of schedule for an appointment
• Organized (for example, keeps elaborate calendars)
• Active
• Accomplished
• Orderly
• Neat and tidy
• Loyal

Negative Symptoms 

• Repetitive worries about “What if…?” are among the most common characteristics of people with high-functioning anxiety (even if they seem to be calm and successful outwardly). Other undesirable effects of this condition are:
• A pattern of procrastination (for fear of starting on something you are not sure you will accomplish perfectly) interspersed with bursts of productivity due to a pressing deadline
• Compulsiveness to measure one’s performance against that of others
• Stress or a fear of the future to the extent that it prevents you from enjoying the present moment.
• Having a fear of the future or persistent anxiety about it
• Tension, agitation, or a struggle to relax
• Increased chance of developing drug addiction problems

High-Functioning Anxiety Treatment

To determine whether you have high-functioning anxiety or anxiety in any form, it is important to see a licensed therapist. Anxiety IS treatable. When it comes to dealing with anxiety, Cognitive Behavioral Therapy (CBT), a kind of psychotherapy that focuses on modifying one’s behavior and thought patterns, is an excellent option. Cognitive-behavioral therapy is an empirically-validated method that can train a person with high functioning anxiety to manage the condition and perform better and healthily in their life. CBT teaches you how to cope with life’s challenges more effectively while also reducing the amount of time you spend in a state of constant fear and anxiety.

It can also be beneficial to practice meditation and mindfulness to mitigate symptoms. HFA sufferers may benefit immensely from the practice of mindfulness, a method that focuses on regulated breathing, being present in the moment, self-compassion, and acceptance. This is an effective way to cut stress and manage parts of your life that may be causing you to feel anxious. Other therapeutic tools for dealing with anxiety and related conditions are:

ACT (Acceptance and Commitment Therapy)

Acceptance and Commitment Therapy is a form of talk therapy that encourages you to calm down, focus on the present, and not judge it. 

DBT (Dialectical Behavioral Therapy)

DBT is a mix of Eastern mindfulness, and cognitive-behavioral therapy (CBT)used to help people accept and modify their thoughts and behaviors.

EMDR (Eye Movement Desensitization and Reprocessing)

A therapist can use bilateral stimulation as a technique to address underlying trauma memories that may drive or accompany your HFA. 

If you or someone you know is struggling with anxiety, high functioning, or otherwise, please reach out to the intake specialists at Symmetry Counseling today!