What is High-Functioning Anxiety?
You may have heard the phrase “high-functioning anxiety” floating around on Instagram, or on a podcast, or maybe even in a conversation with friends. Despite not being a clinical diagnosis, it’s a term that resonates for many people, especially women who look like they’re excelling but secretly feel a steady hum of general “not okay-ness” in the background.
If this is you, you may look capable, driven, and reliable from the outside. People know they can count on you. What they don’t see are the constant overthinking, the tossing and turning in bed, and the exhaustion of keeping up. This is why people use the phrase “high-functioning anxiety” - it gives language to the experience of living with persistent anxiety while still keeping everything afloat.
Let’s talk about what it actually is, what it looks like day to day, why it gets unnoticed, myths that surround it, and how therapy can help.
So, What Is High-Functioning Anxiety?
While it’s not a diagnosis you’ll find in the DSM (the diagnostic manual most therapists use), it’s becoming a widely used way of describing a certain experience of anxiety. High-functioning anxiety describes the experience of having the classic symptoms of anxiety while also maintaining jobs, relationships, and responsibilities. Folks with high-functioning anxiety are “functioning” in the sense that their lives look put together, or even look successful.
Importantly, the “high-functioning” part can be deceptive - it might make it seem less serious or more manageable, while in reality, these individuals are often experiencing high levels of anxiety while pushing themselves harder and harder to keep up appearances.
Common Signs of High-Functioning Anxiety
High-functioning anxiety often shows up in subtle ways that don’t raise alarms to others, and often not even to yourself.
Cognitive and Emotional Signs
Overthinking conversations, interactions, decisions, etc. (e.g., “Did I sound too harsh in that text?” / “Should I have added more exclamation points so they know I’m not mad?”)
Playing out every possible scenario before making a move
Repetitive worry about letting others down or disappointing them
Procrastinating not out of laziness, but because of wanting things to be perfect
Difficulty celebrating wins and achievements
Physical Signs
Difficulty falling asleep or staying asleep
Jaw clenching, headaches, muscle tension
Digestive issues related to stress
Restlessness and difficulty relaxing until exhausted
Behavioral Signs
Automatically saying yes, even when your plate is full
Overpreparing for small tasks (e.g., “I’ll make three versions, just in case)
Double and triple-checking work, to-do lists, etc
These signs can be easy to miss, both due to not looking like a full freeze, “can’t get out of bed” level of anxiety, as well as their pervasiveness - people with high-functioning anxiety have often experienced it for a long time, with symptoms slowly getting worse or more intense.
Why High-Functioning Anxiety is Hard to Recognize
One of the most frustrating, and often confusing, parts of high-functioning anxiety is how invisible it can be. From the outside, you might be praised for being organized, ambitious, or dependable, while on the inside you’re living in a constant state of tension, wondering if this is normal.
Three reasons high-functioning anxiety often goes unnoticed:
If you live in a culture that prioritizes productivity, then hustling, multitasking, and “pushing-through” are often glorified. Overworking is seen as a sign of passion, rather than anxiety or chronic stress. You’re praised for “going above and beyond,” even when it costs you sleep, weekends, and your own sanity.
Many people downplay their own anxiety. If you’re performing well, it can feel easier to convince yourself it’s not “serious enough” to ask for help or tell others. You may think, “other people have it worse, I shouldn’t complain.”
The toll on the individual is more internal, while the success is external, so others don’t see the cost. Others see the degree, the promotion, or how you show up reliably, not the toll it takes on your body, sleep, and self-worth.
Because of this, high-functioning anxiety can be incredibly isolating, which leads people to not reach out for help even more. You may feel at your wits end while also feeling hesitant to call it anxiety because it doesn’t match the stereotypes you’ve seen on TV.
Myths About High-Functioning Anxiety
Let’s talk about a few myths about high-functioning anxiety.
Myth: If you’re functioning, it’s not that serious.
False. Functioning on the outside can often look very different internally. Just because you can’t see the progression of symptoms on the outside doesn’t mean it’s not happening. Many people with high-functioning anxiety are holding it together internally while feeling one step away from unraveling.
Myth: It’s just stress. Everyone feels this way.
False. Stress comes and goes. Anxiety lingers and shows up even when there isn’t a clear stressor. It may worsen during stressful times, but it colors daily life regardless.
Myth: Anxiety helps you be successful.
While anxiety can fuel productivity in the short term, chronic anxiety is not sustainable and leads to burnout and health issues. Short-term anxiety is not a problem, but high-functioning anxiety is often chronic and can slowly chip away at your well-being.
Myth: Therapy is only for people who can’t cope.
Just because you’re coping doesn’t mean you’re “fine.” Therapy isn’t about coping, it’s about finding healthier, more sustainable ways forward that align with what matters to you, not just escaping anxiety.
The Impact of High-Functioning Anxiety Over Time
Whether high-functioning or not, anxiety can wear you down over time. This might look like slowly feeling more disconnected from what matters to you and feeling more and more loneliness and isolation. It often leads to burnout, both at work and in relationships, which continues to erode your joy and self-worth.
Physically, over time chronic anxiety is linked to headaches, digestive problems, and more. These impacts often actually increase stress and anxiety, leading to a self-perpetuating cycle.
High-functioning anxiety also has a substantial strain on relationships. People with high-functioning anxiety often struggle with hyperindependence, difficulty trusting others, or people-pleasing that leads them feeling resentful or isolated.
Maybe you’ve noticed yourself snapping at your partner for small things, or canceling plans with friends because you’re too drained to socialize. Or maybe you secretly fantasize about getting sick just so you’d have a valid reason to rest.
It’s not that high-functioning anxiety means you’re doomed to these impacts, but if left unaddressed, “pushing through” every day tends to spiral into these bigger problems down the road.
How Therapy Helps with High-Functioning Anxiety
The good news is that therapy is incredibly effective for high-functioning anxiety. It can support you in:
Slowing down and learning to pause
Working with the body to recognize and regulate the physical signs of anxiety
Separating self-worth from achievement by untangling your identity from your performance
Creating coping strategies that work for you, rather than over-preparing and numbing out
Building self-trust so that you can stop spiraling over decisions and seeking reassurance
Providing a safe space to process without performing
Therapy isn’t about removing your ambition or drive. It’s about helping you move forward in ways that align with your values, rather than always trying to escape anxiety.
Moving Forward with Less Pressure
High-functioning anxiety is real. If you’ve recognized yourself in these descriptions, you’re not alone, and naming what you’re going through is a powerful step.
You don’t have to wait until you’re falling apart to get help - therapy can help you find a sense of steadiness and clarity, even while you continue to pursue your goals.
If this resonates, learn more about Therapy for Perfectionism & Anxiety in High-Achieving Women and how support can make a difference.