High Functioning Anxiety

For those suffering from anxiety, even day-to-day tasks in their routine can be difficult. Activities and responsibilities that others seem to deal with smoothly can feel daunting and intimidating.

Anxiety is one of the most prevalent disorders in the US. According to the Anxiety and Depression Association of America, almost 1 in 5 (18.1%) people suffer from some form of anxiety disorder.[1] Unfortunately, only 30-40% of people suffering are receiving treatment.[2] Furthermore, this percentage only accounts for those with a diagnosis, which means that many more are struggling with no diagnosis and are receiving no treatment.

On the moderate-to-severe end of the spectrum, anxiety disorders can be so debilitating that the sufferer feels too withdrawn to leave home or socialize. This social withdrawal has a further negative impact on a person’s mental well-being, as a lack of social connection can evoke feelings of loneliness and depression, which can in turn feed one’s anxiety. It is a vicious cycle.


What is High Functioning Anxiety?

Though anxiety disorders can be debilitating, some individuals manage to remain social, even appearing confident and outgoing. This type of anxiety is known as “high functioning anxiety,” and often goes unnoticed by others. However, beneath the surface, the high functioning individual is dealing with inner emotional turmoil, doubt, confusion, and  low self-esteem. Instances of anxious behavior like nail biting, head scratching, playing with one’s hands or fingers, or playing with or fixing one’s hair may seem like a quirky personality trait or funny habit, but they are really focus points to distract sufferers of high functioning anxiety from anxious feelings and thoughts.

Causes of Anxiety

According to the National Institute of Mental Health, the causal factors in the onset or development of anxiety that are general to the wide range of potential anxiety disorders include[3]:

  • Behavioral inhibition, or shyness, in childhood
  • A genetic history of anxiety (the presence of an anxiety-related disorder in a biological relative)
  • Exposure to traumatic or stressful environments, events, or circumstances in childhood or adulthood

Characteristics of High Functioning Anxiety

Due to their seemingly outgoing and productive behavior, people with high functioning anxiety may.  appear calm and collected, be willing to engage, and seem ready to take action. The following characteristics of high functioning anxiety are even considered to be positive in work and social settings:

  • Good organizational skills
  • Punctuality
  • Helpfulness
  • Passion for the profession
  • Loyalty
  • Proactiveness
  • Outgoing personality
  • Attention to details
  • Motivation to reach goals

What many people misunderstand is that the driver for these seemingly positive traits isn’t always positive for the individual, who may exhibit these traits to compensate for their fears.

The helpful, people-pleasing nature of a high functioning anxious person may be driven by a fear of letting people down or pushing them away.

Their outgoing, talkative personality may stem from a compulsive need to talk in order to deal with nervousness or offset a fear of silence.

Attention to detail may result from a tendency to overthink, which is a highly stressful experience. External difficulties can be dealt with temporarily by removing yourself from or changing the present situation. However, overthinking takes place within the mind and can be much harder to escape.

A strong drive towards achieving goals could well be a means of warding off feelings of invalidation, whereby one’s sense of self-worth may be dependent on achieving those goals.

Punctuality may stem from a phobia of being late, which would cause a significant spike in anxiety levels.

By contrast, characteristics of high functioning anxiety sufferers that are often perceived negatively include:

  • Obsessive compulsions, like counting or touching something repeatedly, rocking back and forth, etc.
  • Rumination
  • Catastrophic thinking (imagining the worst case scenario)
  • An inability to say “no” to new responsibilities or tasks (related to people-pleasing)
  • Insomnia
  • An inability to fully relax in the moment

Those with high functioning anxiety may come to identify with or depend on their condition and use it to fuel their productivity. As a result, they may be unwilling or reluctant to talk about their issues, as it could change the image that they believe others have of them.

While anxiety can be a motivator to get things done, it may also keep people within their comfort zones and limit their potential to live a full life.

Challenges in Healing

Carmen Trebbe Priebe, PhD, a sports psychologist at the University of Iowa, spoke to the team at www.health.com in 2018 about the prevalence of high functioning anxiety and how anxiety is viewed by society. Anxiety can, at times, be “very motivating [and] very facilitating,” says Priebe. “It makes people work hard, so it can seem as if they’re functioning well.” However, this isn’t always the case. Priebe goes on to explain that, although a person may seem to be functioning well, “they’re not [always] disclosing everything that’s happening.[4]

Herein lies the challenge for addressing and treating high functioning anxiety: while a plethora of anxiety-related disorders – Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Panic Disorder, Social Anxiety Disorder, and Post Traumatic Stress Disorder (PTSD) – are listed in the Diagnostics and Statistics Manual (DSM-V), “high functioning anxiety” is not.

In order to be clinically diagnosed with an anxiety disorder, or more specifically, Generalized Anxiety Disorder (GAD) – which most closely relates to high functioning anxiety – an individual must meet the following criteria for diagnosis outlined in the DSM-V[5]:

  • Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
  • Difficulty controlling the worry.
  • The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months):
  1. Restlessness or feeling keyed up or on edge
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep).
  • The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
  • The disturbance is not attributable to the physiological effects of a substance (e.g., abuse of a drug, a medication) or another medical condition (e.g., hyperthyroidism).

Those suffering from High Functioning Anxiety don’t always meet the criteria outlined above and  may find it difficult to get an official diagnosis. However, anxiety in any form can cause significant and damaging stress to the individual, which can lead to a multitude of other adverse physical and mental health conditions, so treatment should be sought regardless of a diagnosis.

For more information on how we can help with any anxiety disorder, call 800-335-0316 or email info@heatherhayes.com today.


[1] Adaa.org. 2018. Facts & Statistics | Anxiety And Depression Association Of America, ADAA. [online] Available at: <https://adaa.org/about-adaa/press-room/facts-statistics#:~:text=Anxiety%20disorders%20are%20the%20most,of%20those%20suffering%20receive%20treatment.> [Accessed 3 June 2020].

[2] ibid

[3] Nimh.nih.gov. 2018. NIMH » Anxiety Disorders. [online] Available at: <https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml> [Accessed 3 June 2020]

[4] Gardner, A., 2018. What Is High-Functioning Anxiety–And Could You Have It?. [online] Health.com. Available at: https://www.health.com/condition/anxiety/high-functioning-anxiety-disorder-symptoms [Accessed 3 June 2020].

[5] Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.15, DSM-IV to DSM-5 Generalized Anxiety Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/ [Accessed 3 June 2020]

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