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Symptoms of High-Functioning Anxiety You Should Know About


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Do you obsess over trivial details, always think of the worst-case scenario and appear confident on the outside but struggle with a fear of failure internally? If you tick some of these boxes, you could be showing signs of high-functioning anxiety.

Some of these markers were highlighted in a recent TikTok video about "things you don't realize you're doing because of high-functioning anxiety" shared by Sarah Chernick (@therapywithsarah on TikTok and @therapy_withsarah on Instagram), a California-based licensed marriage and family therapist specializing in anxiety and trauma. The video has had over 749,000 views since it was shared in December 2023.

High-functioning anxiety refers to those who are "high-performing and functioning exceptionally well" in their daily lives, but "on the inside are struggling with anxiety," Tatiana Garcia, a licensed professional counselor (LPC) in New Jersey, told Newsweek. Garcia specializes in helping those who struggle with high-functioning anxiety.

She noted that "because the consequence of this hardworking behavior and attention to detail is often rewarded, high-functioning anxiety is often hidden in plain sight."

Woman appearing anxious on sofa.
Stock image of a woman appearing pensive. Those struggling with high-functioning anxiety may "outwardly appear successful and in control but internally experience persistent worry and distress," said a psychologist. iStock / Getty Images Plus

Carrie Covell, a licensed clinical social worker and psychotherapist based in California, told Newsweek that it's important to note that "high-functioning anxiety is not a diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)," the diagnostic manual for mental health professionals.

She warned that while the behaviors listed in the aforementioned viral video can "certainly be present" in someone diagnosed with an anxiety disorder, "none of these behaviors alone are indicative of an anxiety disorder."

Garcia said that although high-functioning anxiety isn't an official mental health diagnosis, "I do believe it is under-recognized because individuals with high-functioning anxiety tend to put a lot of pressure on themselves and have difficulty asking for help, so it can be hard to acknowledge that they are struggling when so much of their identity is attached to their performance and productivity."

Affecting 40 million adults aged 18 and over in the U.S, anxiety disorders are the most common illness in the country, according to the Anxiety & Depression Association of America, an American nonprofit.

The COVID-19 pandemic brought mental health concerns, such as anxiety as well as depression, which often occurs alongside anxiety, to the forefront.

According to the U.S. Centers for Disease Control and Prevention (CDC), the portion of adults reporting recent symptoms of an anxiety or a depressive disorder increased from 36.4 percent to 41.5 percent between August 2020 and February 2021.

Woman appearing sad at cafe.
Stock image of a woman appearing upset."High-functioning anxiety is often hidden in plain sight," a licensed professional counselor told Newsweek. iStock / Getty Images Plus

What Is High-Functioning Anxiety?

Erika Bach, a licensed clinical psychologist based in New York City, who specializes in trauma, relationships, anxiety and depression, told Newsweek: "High-functioning anxiety refers to individuals who outwardly appear successful and in control but internally experience persistent worry and distress."

"Despite the outward competence, those with high-functioning anxiety often go to great lengths to conceal their inner struggles," added Bach.

Garcia further explained that for these individuals, "anxiety is often propelling them forward" into taking action through achievement, overworking and busyness, rather than holding them back in avoidance.

The condition is often not recognized by those struggling with it until it has a more "significant negative impact" on a person's mental health, work and/or relationships, she added.

Signs of High-Functioning Anxiety

Below are some key indicators of high-functioning anxiety, as outlined by Bach and Garcia:

  • Excessive worry
  • Worrying about the worst-case scenario
  • Overthinking
  • Perfectionism
  • Physical manifestations (such as tension headaches, muscle tension, digestive problems)
  • Having difficulty relaxing
  • Appearing calm and hardworking externally
  • Having a strong fear of failure internally
  • Overworking
  • Putting excessive pressure on yourself
  • Having difficulty saying "no."
  • Feeling overwhelmed as a result of all of the above

Less Obvious Markers of High-Functioning Anxiety

Here are some signs of high-functioning anxiety that may not be obvious and can go unnoticed, according to Garcia.

Excessively Planning by Writing To-Do Lists

This can entail constantly checking your calendar or "procrastinating through planning," which are all "ways to cope with the fear of uncertainty and lack of control that comes with anxiety," Garcia explained.

Having a Rigid Routine or Schedule

Individuals struggling with high-functioning anxiety may set up a rigid routine because they feel that things need to go a certain way and when they don't, they can be thrown off track.

"That can be because of a fear of the unknown, and the mental rehearsing that takes place to give them some sense of control. Rigidity can result in frustration and irritability," said Garcia.

Constant Self-Comparison

While appearing confident externally, those with high-functioning anxiety tend to compare themselves to others often. They may feel the need to measure up to certain standards because of their high expectations. "This persistent comparison can lead to a lot of self-doubt and worry that they aren't doing 'enough,'" Garcia said.

Hand writing to-do list in a notebook.
Stock image of a person writing a to-do list.The act of "excessively planning by writing to-do lists" is among the less obvious signs of high-functioning anxiety. iStock / Getty Images Plus

How To Treat High-Functioning Anxiety

It's important for those who find it hard to navigate anxiety to "know that you are not alone, and that there are numerous mental health resources available to help," Bach said.

Acknowledge Its Presence

The first step in treating anxiety is recognizing and acknowledging its presence. Awareness can allow you to "notice where anxiety shows up and what it is urging us to do."

Anxiety is based in fear and "drives us forward with a sense of urgency and sometimes panic." Bach noted that "while some amount of anxiety can be helpful in aiding us with energy to achieve tasks, an overwhelming amount can paralyze us or chronically keep our bodies in fight-or-flight, which is harmful to us both physically and mentally."

Being aware of the presence of this anxiety, which is "a biological function that is meant to keep us safe," helps you to accept it and still choose behaviors that are aligned with your values, as opposed to ones based out of fear, she explained.

Challenge Its Assumptions

You can also challenge the assumptions that anxiety jumps to, replacing them with more balanced perspectives, Bach noted.

Mindfulness techniques such as meditation help us to notice, acknowledge and let anxious thoughts go. Incorporating relaxation techniques, like deep breathing or progressive muscle relaxation, can also provide "a tangible sense of calm," the psychologist said.

Seek Professional Help

Licensed clinical social worker Covell advised: "Anyone concerned about whether they meet criteria for one of many recognized anxiety disorders should be thoroughly evaluated by a licensed mental health care provider.

Treatment for any anxiety disorder should be planned and administered by a licensed mental health care provider and treatment plans will vary depending on the individual and their diagnosis, she said.

Do you have a health-related question or dilemma to share? Let us know via [email protected]. We can ask experts for advice, and your story could be featured on Newsweek.

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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

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