Are you a perfectionist? Always seem to be busy? Do you find it hard to say ‘no’? Then you may be living with high functioning anxiety. Psychologist Stanislava Puač Jovanović explains how the overachievers and overthinkers of this world can learn techniques to manage this chronic state of anxiety.


High functioning anxiety is not an official diagnosis. It is a term popularly used to describe a state of chronic anxiety that often goes undiagnosed – and unnoticed. However, that does not mean that it is not a real thing. It is, and it can negatively affect your physical health and mental well-being.


The hallmark of high functioning anxiety is the fighting mode of those affected. They are many of the overachievers, overdoers, overthinkers of the world. They are people who are white-knuckling their way through anxiety every day of their lives. 


In this article, we will look into what characterises people who describe themselves as having high functioning anxiety and how to deal with it.


What is high functioning anxiety?

A quote fit to start our discussion on what high functioning anxiety is, is one by Alain de Botton, a contemporary British philosopher:


“The largest part of what we call ‘personality’ is determined by how we’ve opted to defend ourselves against anxiety and sadness.”


High functioning anxiety is not recognised as an official diagnosis in the current revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). People who are using the term define it, generally, as being anxious but pushing through the feeling by staying busy and productive. In other words, it means hiding anxiety behind being an overachiever in various areas of life. 


Diagnostic categories are known to change, For example, homosexuality was once considered a disorder. Other categories were amended, deleted, added, adapted, recategorised, amended again. Such changes to mental disorders’ official classifications follow new findings, observations from psychotherapy practice, and political and societal changes. Anxiety spectrum disorders, in specific, underwent substantial modifications between the DSM-IV and DSM-V. 


Being over-busy is a sign of high functioning anxiety shutterstock/Drazen Zigic


Therefore, high functioning anxiety can be considered a real issue, even though it might not be categorised as a separate disorder at the moment. In other words, it may appear in one of the following revisions of psychiatric manuals. The experience of being anxious, hiding it, and functioning on high (top, over-the-top) performance levels is real – and psychiatry might look into that in some of the future changes to the classifications. 


High functioning anxiety statistics 

So, how many people have high functioning anxiety? That is incredibly difficult to estimate. The first problem is that it is not a diagnosis of which institutions keep track of, as already explained. 


Secondly, anxiety in itself is severely underdiagnosed – and we can assume that people with high functioning anxiety are particularly unlikely to seek help for it. Indeed, one study determined that, in adolescents, only one-third of those affected by anxiety sought any form of professional help. 


According to another study, the lifetime prevalence of anxiety disorders is approximately 30 per cent. Regardless, they remain underdiagnosed, misdiagnosed and improperly treated.


“The hallmark of high functioning anxiety is the fighting mode of those affected. They are many of the overachievers, overdoers, overthinkers of the world.”


Anxiety is far more prevalent in high-income countries, and it disproportionally affects women. 

Considering these statistics, it becomes clear why there is so much talk about high functioning anxiety lately. The pressure of living in the modern-day Western world with ever-mounting roles and obligations results in heightened anxiety. People, however, often do not seek treatment or receive adequate help. Some keep muscling their way through the demands, the pace of life and the non-stop urge to keep going forward. 


Symptoms of high functioning anxiety

As there is no official category in psychiatric manuals, we must rely on other sources to determine how high functioning anxiety looks like in real life. According to the South African College of Applied Psychology, these are the five main symptoms:


1. Staying busy all the time

People with high functioning anxiety are keeping themselves busy at all times. This behaviour goes beyond productivity and working on one’s goals. They have an emotional need to keep themselves occupied. Relaxation and doing nothing at all feels threatening and uncomfortable.


2. Being a perfectionist

Those who know them describe people with high functioning anxiety as highly determined, ambitious, and intent on always getting things done. In other words, everything you imagine under a Type A personality. This is not surprising, given the type’s association with anxiety.


3. Poor sleep

Same as with generalised anxiety disorder, people with high functioning anxiety often have sleep disturbances. They can have difficulties falling or staying asleep. On the other hand, when they manage to get a bit of shut-eye, it is a fidgety sleep that brings little rest.


Excessive working in overachievers can lead to poor sleep


4. Inability to say “No”

Because of their need to be liked and acknowledged, those living with a high functioning form of anxiety are often unable to decline a request. They profoundly fear disappointing others.


5. Numbing behaviour

Some people affected by high functioning anxiety try to numb the apprehension they feel. It can be a slightly more adaptive option, like exercise. However, often it is the straightforward unhealthy choice, such as excessive use of alcohol, psychoactive substances or overeating. 


Potential positives

From one point of view, one that considers objective achievements, high functioning anxiety might come with benefits. The “trademark” of people affected by it is their high productivity. It is also one of the reasons why many are reluctant to seek professional help.


If you think that you have high functioning anxiety, you are probably happy with its outcomes, even though it burdens you emotionally and physically. You might be outgoing, passionate, active and helpful. You are probably everyone’s first pick for any team. 


“People with high functioning anxiety are keeping themselves busy at all times. This behaviour goes beyond productivity and working on one’s goals.”

You are punctual, detail-oriented, highly efficient and effective. Being perfectly organised and orderly is your middle name. 


On the outside, arguably, one might be pleased about managing to cope with anxiety by overachieving. After all, one of the reasons it is not considered a disorder is that it does not affect the person’s functioning.


Potential negatives

At the same time, albeit high functioning, it still is anxiety. In addition to the emotional toll, there are also outcomes of pushing yourself too hard. 


As a result of never taking a time-out, you are highly vulnerable to burnout. Obligations tend to hoard because you cannot say “no” when someone asks you to complete a task. You could also be comparing yourself to others and feeling dissatisfied with yourself all the time. Even though you might be highly sociable, inside, you probably feel insecure and tense.


Because you have a hard time relaxing, you might be unable to enjoy the moment. You rarely take a vacation and relish in the benefits of obligation-free retreats. 


Unhealthy habits, such as working beyond optimal limits, could get the best of you. Poor sleep quality adds to exhaustion. Proneness to excessive use of alcohol or other harmful substances to numb the anxiety further strains you. 


Dealing with high functioning anxiety

The first thing we should emphasize is: you are not going to lose your efficiency or become less successful if you address your anxiety. Some people might be reluctant to make changes because they, understandably so, like being high-fliers. 


However, healing from anxiety will not rob you out of your organisation skills. It will merely make you feel less stressed and your life more balanced, healthier. 


Anxiety troubles different people differently. So, you should try what works best for you. We give you four possible ways to deal with your high functioning anxiety:


1. Get professional help

As with any mental health disturbance, the best thing you can do is seek professional help. Anxiety can be overwhelming, even the high functioning type. Anxiety disorders should be treated with psychotherapy, pharmacotherapy, or a combination of both. Cognitive-behavioural therapy is most often used, but other forms could also work for you. 


2. Meditate and learn to be mindful

A recent study reviewed 25 further studies on the effects of mindfulness meditation on anxiety among college students. The findings determined that such a form of mental practice has ample positive effects. In the clinical population, that is, among people diagnosed with anxiety, mindfulness-based interventions were also very effective.

RELATED: Mindfulness vs meditation – understanding the difference


3. Be your own therapist

You are an expert on your state. So, use this knowledge and design a toolbox specifically for your needs. For example, if you worry too much, you can designate some time- and place-specific worry time. Findings revealed that, although counter-intuitive, a half-hour of intentional worry, when it follows certain principles, lowers anxiety levels. 


Consider trying self-hypnosis for anxiety. According to a recent study, hypnosis audios trained the brain to exert better physical and emotional control over one’s experiences. Maybe try and work on cognitive restructuring a technique in which you track, analyse and alter your habitual way of thinking about events and experiences. 


4. Reach out

Studies show that social support is one of the most powerful ways to reduce anxiety. Open up to someone who cares about you and tell them how you have been feeling. It might come as a surprise to them. 


However, it is important to have people who know everything about you and encourage you when you slip. It could do wonders for your need to power through your days and maintain a superhuman persona. Being your vulnerable and insecure self in a safe environment will help you tap into a more relaxed state of existence. 


Defend yourself against anxiety in a healthier way

Although we are exposed to the pathologisation of anxiety in media and expert literature, some philosophers consider it an inherent part of being human. From that perspective, what we are left with is a choice. It is the choice of how we will view and deal with high functioning anxiety. 


We invite you to redesign your pick. Opt to defend yourself from the feeling in a more balanced way, with lots of self-love and self-care.
Main image: shutterstock/Roman Samborskyi | The fine art of being: learn, practise, share

 Are you a member? Sign up for free to enjoy:

■ our happiness magazine with practical life tips
■ sharing and supporting others in our happiness forum
■ developing with free online classes in our Academy

Coaching | Letting go | Authenticity



Written by Stanislava Puač Jovanović

bert.jpgStanislava Puač Jovanović has a master’s degree in psychology and works as a freelance writer and researcher in this area. Her primary focus is on questions relating to mental health, stress-management, self-development and well-being.




Join the conversation

You are posting as a guest. If you have an account, sign in now to post with your account.

Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

There are no comments to display.

Similar articles