A Diminished Quality Of Life
Ernest Hemingway once wrote: “Worry a little bit every day and in a lifetime you will lose a couple of years.”
It is now medically proven that anxiety takes a cumulative toll on life.
And when this anxiety takes on a chronic pattern, it is recognized as High Functioning Anxiety.
Though DSM-5 does not officially state high-functioning anxiety as a separate disorder, it is a widely recognized term used to describe people who experience chronic anxiety while continuing to function at a high level. While other anxiety disorders like panic disorder or generalized anxiety disorder are seen to visibly interfere with daily life, high-functioning anxiety hides behind the veil of enhanced levels of productivity and achievement. The anxiety itself becomes a driving force propelling perfectionism, over-preparation, and constant striving, at the same time, slowly destroying inner peace and emotional well-being.
Signs of High-Functioning Anxiety
The signs of high-functioning anxiety are often mistaken for normal behaviors, making them harder to spot. They may be categorized as emotional, cognitive, behavioral, and physical.
Common cognitive signs include:
- Persistent overthinking,
- Fear of failure,
- Excessive self-criticism, and
- A constant need for reassurance.
Individuals often replay conversations in their head, live in fear of worst-case scenarios, or, at the best of times, experience a sense of uneasiness. They find it difficult to acknowledge that all is well.
Behaviorally, high-functioning anxiety manifests as people-pleasing behaviors. Individuals find it difficult to say no, and often end up bending their boundaries for other people’s gains. They tend to overwork, and relaxation comes accompanied by a sense of guilt. Many individuals seek refuge in work to escape uncomfortable fears and worries. In their effort to be perfect, they may delay tasks not because they are lazy but because they fear that the task has not been done “well enough.”
The physical symptoms of high-functioning anxiety may show up as:
- Muscle tension,
- Headaches,
- Digestive issues,
- Fatigue,
- Sleep disturbances or a racing heart.
Emotionally, high-functioning clients often exhibit irritability, restlessness, or a persistent sense of being “on edge.”
A common struggle for clients with high-functioning anxiety is Impostor Syndrome, where the client is plagued by a persistent feeling of being a fraud despite notable accomplishments. When combined with anxiety, it can doubly burden an individual’s mental well-being. As Sylvia Plath so poignantly said, “The worst enemy to creativity is self-doubt.”
Causes of High-Functioning Anxiety
High-functioning anxiety usually originates from a matrix of biological, psychological, and environmental factors. Clients with the disorder often have a family history of the condition, suggesting that genetics plays a role. Sensitive people or individuals with a highly conscientious temperament may also be more prone to develop the disorder.
Early life experiences leave an impact. Retracing client histories often reveals childhood environments where love or approval was conditional, and often directly correlated with achievement, obedience, or emotional restraint — teaching individuals to equate worth with performance. Children who received praise for success, or those who had to fulfill adult responsibilities too early, may internalize the belief that they must always “do more” to be valued.
Individuals with high-functioning anxiety come with central nervous systems wired to a constant state of alertness — a result of traumatic setbacks such as emotional neglect, unstable caregiving, bullying, or prolonged pressure. The trauma is further compounded in their adulthood by cultural expectations, unhealthy comparisons fueled by social media, and workplace competition.
Ironically, society rewards high-functioning anxiety, making it harder for individuals to admit that their coping mechanisms come at the cost of their mental health.
Also Read: Perfectionism and Mental Health: How to Break the Cycle
How Therapy Helps with High-Functioning Anxiety
Therapy helps individuals with high-functioning anxiety to slow down, introspect, and reconnect with themselves. The first step in therapy is validation — acknowledging that inner distress is present even when life looks “fine” on the outside. This realization in itself can reduce shame and self-judgment.
Cognitive Behavioral Therapy (CBT) uses structured techniques to help clients counter negative thought patterns such as catastrophizing, all-or-nothing thinking, and excessive self-criticism, with positive, balanced, and compassionate viewpoints.
Acceptance and Commitment Therapy (ACT) changes the way the individual views their anxiety with mindfulness skills, objective observation of anxious thoughts, and insights into healthier choices such as rest, reconnection with one’s authentic self, and better identification and regulation of emotions.
Psychodynamic and trauma-focused therapies explore the origins of anxiety, delving deeper into early relational patterns and unresolved emotional traumas. Understanding the root causes of the anxiety can shift the situation from one where the individual blames themselves to one where they respond to their needs with empathy rather than pressure. Trauma work can address the root causes of the anxiety and bring real, lasting relief.
Therapy helps the client to regulate their nervous system through techniques such as grounding exercises, breathwork, and body-based awareness, which help transition the body out of chronic fight-or-flight mode. Over time, individuals learn that productivity does not have to come at the cost of peace.
Looking for a therapist in Upper East Side, New York?
Laura Pearl has years of experience treating high-functioning anxiety clients, helping them lead meaningful lives without the pressures of fears and worries.
