You won’t find high-functioning anxiety listed in medical textbooks as it’s not an actual diagnosis, but it’s something many people can relate to. Picture the overfunctioning, accomplished, confident professional who on the outside has it all together, yet is well known to be a control freak and perfectionist. But they may sweat a lot or bite their nails before a meeting while feeling they have to work harder than anyone else. That just may be one. 

Learn more about this anxiety, the signs you can observe and available treatment options.

What Is High-Functioning Anxiety?

A person with high-functioning anxiety is someone who seems able to very effectively manage the professional and personal demands of work and home life, yet feels anxious. Often this is associated with the Type A personality of successful overachievers. But the way they feel inside may tell a different story as they still struggle with anxious feelings and thoughts.

It’s not a recognized disorder as such in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by psychiatrists and mental health professionals to assess and diagnose conditions. 

Over 19 % (40 million) of Americans experience any form of anxiety disorder, according to the National Institute of Mental Health [1]. But high-functioning anxiety is usually a form of Generalized Anxiety Disorder (GAD), a type of  anxiety in the DSM-5 affecting 6.8 million adults or 3.1% of the US population [2]. Typical symptoms include:

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

While someone with GAD may try to remove themselves from anxiety-provoking situations, people with high-functioning anxiety have more of a fight response (instead of flight). They turn up the jets and push themselves to perform more and work harder to regulate the anxiety. But their anxiety often goes unnoticed and undiagnosed. 

However, some may observe that this successful person is irritable and on edge, has a clenched jaw resulting in tension headaches, and walks with hunched shoulders. Imagine a lawyer just made a partner, a doctor with too many cases or a sales executive with a punishing quota. And they endure in silence. Starting to look familiar? 

High-functioning anxiety and depression often co-exist. Often it is symptoms of depression which bring awareness of the anxiety to the fore as the formerly high performing person starts to slip on obligations, has difficulty with sleep and trouble getting out of bed, or worse. 

Now let’s explore some other key signs.

Signs of High-Functioning Anxiety

There are many signs of high-functioning anxiety but let’s focus on ten main ones to look out for.

Personality signs

Overfunctioner/Overthinker

Are you a perfectionist high achiever with an outgoing personality? Are you highly organized and detail-oriented but worry about things to the extreme? Do you have an intense fear of letting people down? Known as a hard worker, you put in long hours, but do you go above and beyond to minimize your fear of an error? 

Are your standards impossibly high and even when met don’t leave you feeling content? Do you feel safe when focusing on details? Do you have habits like fiddling with your hair, biting your nails or cracking your knuckles?

As an overthinker, do you over-analyse situations and often replay conversations going through every detail? Do you wonder what you could have done differently and criticize yourself for any perceived slight issue?

Need for Control and Fear of Criticism

Do you fear things won’t be done right unless you’re hands-on with everything? Does delegating tasks increase your stress or even cause panic? Letting go is out of the question. Do you focus on even the slightest criticism? You’re worried about your character and abilities being under scrutiny. You may have negative self-talk.

Intense Stress

Do you feel acute stress even for routine tasks? This goes beyond normal stress responses. It takes a silent toll on your mental and physical well-being.

Emotional signs

Defensive About Criticism

Are you bothered by or even afraid of criticism? Do you freeze up and shut down defensively when criticized by others? Are you highly self-critical? Are you afraid of seeming inadequate or even foolish to others?

On Edge and Afraid of Losing Control

Do you mostly feel on the verge of losing control? Does this make you feel on edge? Do you sometimes have a sense of impending failure?

Feeling Down

Despite your high performance, do you often feel down or even depressed about things? That you just can’t measure up? That you may be found out for who you really are, even if that doesn’t correspond to reality?

Physical signs

Muscle Tension

Do you have a sore jaw from teeth clenching, tight shoulders, a sore neck or tense back? Can’t unwind? Feel you just can’t relax? Do you have tingling sensations in your toes and fingers? Or do your legs feel rubbery or like jelly sometimes, especially before a presentation or meeting?

Tension Headaches or Migraines

Do you often have headaches or more severe migraines? Not sure what causes these?

Racing Heart Rate and Restlessness

Is your heart often racing? Do you feel adrenaline pumping frequently, speeding you up? Do you sweat a lot for no apparent reason? Do you feel off-balance or light headed? Do you feel you need to do more at the end of your days? Are you mulling over what may have been missed or overlooked in your work?

Sleep disturbances

Have trouble falling asleep? Is your mind always racing with thoughts when you’re trying to fall asleep? Are you always reviewing your to-do list or replaying conversations in your head? Don’t have regular sleeping hours? Frequently wake up with unpleasant dreams? Do you have sleep apnea preventing you from getting deeper prolonged sleep?

Anxiety Treatment Options in Utah

If you have some of these signs of high-performing anxiety there may be a struggle beneath the veil of your success. This anxiety will eventually express itself in various ways. There’s hope, if you can make some changes such as the following [3]:

Personal Lifestyle Changes

• Review some of your choices and adjust by limiting caffeine, nicotine, alcohol or other drugs. 
• Focus on a nutritious balanced diet
• Exercise regularly
• Try mindfulness meditation, yoga or acupuncture
• Take stress breaks to center yourself and review your mental well-being
• When you feel anxiety hitting, use mindfulness techniques to reflect on your thought patterns. Focus on positive thoughts, not self-critical judgment
• Prioritize getting healthy sleep with a regular bedtime and wake up time.
• Do breathwork when you feel anxious
• Do muscle relaxation exercises, even sitting at your desk. Or just get up and tsake a little walk

Therapy and Medication

Anxiety disorders can be effectively treated as we do at Corner Canyon Health Centers in Utah. The primary ways include [3]:

Cognitive Behavioral Therapy: Working with a licensed therapist, you can reframe negative thinking patterns, review your goals and adjust them and learn more positive self-talk among other things. This therapy is typically short-term, 6-18 weeks.

Medication: Antidepressant medication such as selective serotonin reuptake inhibitors can help with anxiety and any associated feelings of depression. Anti-anxiety medication such as benzodiazepines for short-term use due to their addictive potential and beta blockers to assist with performance anxiety can also be helpful.

Holistic Therapy: Many people are seeking multiple methods for improved self-care and healing to complement traditional western medicine. Of these, mindfulness meditation is evidence-backed for its effectiveness and simplicity. Yoga has proven effective as well for helping to breath out anxiety and achieve greater inner balance.

There’s Help In Utah

Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from anxiety, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.

Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.

Sources

[1] National Institute of Mental Health. Any Anxiety Disorder.

[2] Anxiety & Depression Association of America. Anxiety Disorders – Facts & Statistics. 

[3] National Institute of Mental Health. 2024. Anxiety Disorders.