I have had moments when my anxiety peaks and makes it hard for me to tend to my responsibilities or spend time with the people I love. I remember one panic attack when I was scheduled to take my kid out for a bike ride. My stomach was in knots the whole time, I felt sick to my stomach, and was anywhere but present while pumping my legs on the bike. But most of the time, my anxiety is undetected by others. In fact, people assume that I have it all together and that I have it all figured out. They’ve shared this with me once they’ve gotten to know me and I’ve been vulnerable about my inner world, and I’m always shocked. But my anxiety, my “high-functioning anxiety,” has both pushed me to seem totally together while at the same time making me want to crawl out of my skin.
Recently, I hosted an event with three other mental health providers. The event was free to those who attended, and our aim was simple: to better support each other. Those of us in this field carry a lot and often pretend like we are a-okay, and the hope of the Provider Wellness Collective is to challenge that norm. To create a safe space for vulnerability and to allow us all to learn to lean on each other. While the events are free, we have received some sponsorship for them, which made us want to make them both more enticing, while also working within a budget because we cannot afford all the things we would want to include. Our last event was held at a church, the most affordable space to rent out. We had no idea that the church had no working AC until we got there, on a sweltering day. What I wanted most was for people to come, feel supported, and to be glad that they took time out of their lives to join us. What I worried was that everyone was going to overheat and question their life choices. I turned to someone who was standing near me, looking uncomfortable, and apologized for the heat (not something that I had any control over, clearly) and he asked what happened and if we didn’t know that there wasn’t AC… and I wanted to disappear into the floor.
Some people left early, some people stuck around, and at the very end of the event, many people approached us to thank us for the event, to tell us that they found it moving, and to express their hopes of attending similar events in the future. They loved the food and the desserts (I had chosen the restaurants), they liked the exercise (I had suggested one that allowed us to share anonymously with a ritual involved), and they… What else happened? I kept ruminating on the one attendee who was seemingly unhappy. When I gathered with the other organizers, everyone was patting themselves on the back, but I wanted to know what they thought of the one person who seemed clearly put off by the experience. Why? Because of my high-functioning anxiety.
What Is High-Functioning Anxiety? And What is it Not?
Panic attacks can be unbearable, but they’re not the only symptoms of anxiety, and often the others can be harder to identify. While we may understand anxiety that is debilitating and that makes it hard to function, there is also high-functioning anxiety. High-functioning anxiety, which isn’t a formal diagnosis, is how some people nonetheless experience anxiety.
Per the DSM-5, Generalized Anxiety Disorder (GAD) requires that symptoms cause clinically significant distress or impairment, not necessarily both. This is the detail that makes high-functioning anxiety possible: a person can meet full criteria for GAD while still managing their responsibilities, so long as the internal distress is significant enough. Someone in this position may even be overfunctioning, all while internally second-guessing every choice and carrying the weight of the world.
What are the symptoms of GAD, that those with high-functioning anxiety may be experiencing? Per the DSM-5, someone who meets the criteria of GAD has excessive, hard-to-control worry about multiple areas of life, including work, health, relationships, and finances. These worries occur more days than not for at least six months, and for adults, a person also experiences three of the following six symptoms: restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Additionally, the person finds it hard to control the worry. The key distinction for this diagnosis is that it can cause distress or impair functioning, but it doesn’t necessarily need to do both. And that’s where we can understand high-functioning anxiety: a person who is experiencing internal distress due to their symptoms, but to the world, they are functioning as usual.
Even though it’s not a formal diagnosis, it is a label many identify with once they learn about it, because it speaks to their experience of functioning (and sometimes over-functioning) while often feeling physical discomfort and a brain working extra hard in the background.
How Do I Know if What I’m Experiencing is High-Functioning Anxiety?
High-functioning anxiety can be hard to spot and understand, since it can be perceived as responsibility and diligence. Often, someone with high-functioning anxiety has achievements and success, and this can make it difficult to look under the surface to see the suffering of the individual. Internally, it can look like overthinking and replaying conversations or decisions, worrying about letting people down, struggling to say no and taking on too much, seeking reassurance, and physical symptoms like muscle tension, headaches, clenched jaws, and difficulty sleeping.
Because “high-functioning anxiety” isn’t a formal diagnosis, research specifically on the term is limited. Instead, much of what we know about this experience comes from research on related features of anxiety, including worry, reassurance seeking, avoidance, perfectionism, and intolerance of uncertainty. Another challenge is that, for people who may identify with high-functioning anxiety, or who experience significant internal distress while continuing to function, their distress may be difficult for others to see. From the outside, the person may seem fine, or even seemingly thriving. In fact, the Anxiety and Depression Association of America has written about that gap directly, noting that people who look like they’re “managing” or “coping,” even succeeding, can still be struggling with significant internal distress.
When Is It Anxiety, and When Is It Just Who I Am?
One of the tricky things about high-functioning anxiety is that it can be difficult to separate anxiety from your genuine personality. Maybe you really are conscientious and you genuinely care about doing a good job, being thoughtful toward others, or keeping things organized. None of those things are inherently a problem.
The question is what happens underneath those behaviors. Am I doing this because it reflects what matters to me, or because I am afraid of what might happen if I don’t? Can I make a mistake without spending the rest of the day replaying it? Can I leave something unfinished and still allow myself to truly rest, without the incessant rumination?
The behavior can look exactly the same from the outside. The difference is what is happening internally. Two people can both be highly organized, dependable, and successful, while one is doing these things from a place of choice and the other is doing them because their anxiety tells them they have to.
Why Is It So Hard to Just Stop?
There is a reason these patterns can be so difficult to change: anxiety often rewards us for listening to it. If I am worried something will go wrong, I might check it one more time. If I am afraid someone is upset with me, I might send a text to make sure we are okay. If I worry an event will not go well, I might spend hours preparing for every possible problem. When nothing goes wrong, I feel relief. Research comparing adults with generalized anxiety disorder to healthy participants found that those with GAD engage in significantly more checking, avoidance, and reassurance-seeking as ways of trying to control worry. That relief can make the pattern especially sticky. I checked, and everything was okay. I asked for reassurance, and they said we were fine. I overprepared, and nothing went wrong. My brain learns: Good thing I did those things. The next time anxiety shows up, I may feel even more compelled to check, prepare, or seek reassurance again.
Research on social anxiety provides another example of how safety behaviors and intense self-focus can sometimes work against us, increasing the felt intensity of anxiety rather than resolving it. In an experimental study with adolescents, participants who used safety behaviors and focused on themselves during conversations didn’t just feel more anxious. They were also rated by outside observers as looking more anxious and coming across less favorably than when they dropped those same behaviors. The very strategies meant to protect us from being judged can end up producing the reaction we were trying to avoid.
This is one reason that changing anxiety is not simply a matter of telling yourself to relax. Sometimes the work involves learning to tolerate uncertainty, imperfection, disappointment, or someone else’s discomfort without immediately doing something to make the feeling go away. And there can be another layer to this experience: sometimes the people around us begin to depend on the very behaviors that are exhausting us. If you are always the person who remembers, plans, anticipates, checks in, solves the problem, smooths things over, or makes sure everyone else is okay, people may understandably start to rely on you. From the outside, it can look like you are simply very good at handling things. And you probably are, but this can create a difficult and vicious cycle. Anxiety can lead us to overfunction. Our overfunctioning makes us dependable, and our dependability gives other people more reason to lean on us. Over time, this can become part of our identity: I am the capable one. I am the dependable one. The more capable we appear, the more people may expect us to be. And sometimes the person everyone describes as “the one who can handle anything” is quietly wondering how much longer they can keep handling it. It can be exhausting.
When High-Functioning Anxiety Becomes the Coping Strategy
Left unaddressed, high-functioning behavior can contribute to exhaustion and burnout. Sometimes it is the dramatic kind that forces you to stop. More often, it is slower and somewhat insidious: the kind that gradually sucks the life out of your everyday routines and robs you of the joy that makes life feel worth living. A meta-analysis of over 40 studies found that the perfectionistic worry about disappointing others or falling short, distinct from simply holding high personal standards, has a meaningful relationship with psychological distress and burnout. It isn’t caring about the outcome that wears people down. Sometimes, it’s the fear underneath the caring.
And sometimes the very things that make someone look like they are coping are the things keeping the anxiety going. Being responsible isn’t a problem. Caring deeply isn’t a problem. Wanting to do a good job isn’t a problem. But when doing a good job becomes a way to prevent criticism, when saying yes becomes a way to avoid disappointing someone, or when anticipating every possible problem becomes the only way you can feel prepared, anxiety can start to disguise itself as competence.
This is also why high-functioning anxiety doesn’t exist in a vacuum. Coping strategies can help us regulate our nervous systems, but they cannot single-handedly change a workplace, relationship, or family system that continually rewards us for overfunctioning. If the people around you have learned that you’re the one who holds everything together, no breathing exercise is going to change that dynamic on its own. Sometimes the work is recognizing the pattern, naming it out loud, and beginning to ask what would happen if you stopped carrying quite so much.
I know this because I’ve been the one holding it together. And recognizing that the holding itself was costing me something was an important first step. I didn’t need to become less responsible or stop caring about the people around me. I needed to become more honest about why I was doing so much, what I was afraid would happen if I didn’t, and how much energy I was spending trying to make sure everything and everyone was okay.
What Can Help with High-Functioning Anxiety
Understanding where high-functioning anxiety comes from is one piece. Knowing what actually helps is another. Some of what helps involves understanding the patterns underneath it, and some of it is more concrete.
Understand the Role of Uncertainty
A lot of what drives checking, preparing, and reassurance-seeking comes down to one thing: a difficulty tolerating not knowing. If I check one more time, if I ask one more question, if I prepare for one more possible outcome, maybe I can get to a place where I feel sure. But certainty is rarely on offer, and the search for it can become its own kind of exhausting loop.
Researchers call this intolerance of uncertainty, and it’s one of the most consistently studied features of generalized anxiety disorder, showing a strong relationship with worry across dozens of studies. It isn’t simply disliking surprises or preferring to have a plan. Intolerance of uncertainty refers more broadly to difficulty tolerating the possibility that negative events may occur, even when we cannot know whether they will. This pushes a person toward more checking, more preparing, and more reassurance to feel safe. The good news, if you can call it that, is that this isn’t a fixed trait. Studies support that psychological treatments aimed specifically at building tolerance for uncertainty have been shown to meaningfully reduce worry, anxiety, and related symptoms in adults with GAD. It’s a skill that can be practiced.
Practice Self-Compassion Instead of Self-Criticism
A lot of the internal experience of high-functioning anxiety involves a harsh inner voice. Even after something goes well, that voice tends to land on the one thing that could have gone better rather than everything that did. I know this firsthand from the event we planned for other mental health providers. Despite the gratitude from nearly everyone who attended, my mind went straight to the one person who seemed unhappy.
Self-compassion research offers a different place to land. Across a large body of studies, higher self-compassion is consistently and strongly associated with lower levels of anxiety, depression, and stress. This isn’t about lowering your standards or caring less. It’s about changing the internal tone that follows a mistake or an unfinished task, from alarm to something closer to what you’d offer a friend in the same situation. That shift in tone doesn’t happen automatically, but with effort and consistency, it can become more natural and accessible.
Experiment With Choosing Differently
Trying something different in small, low-stakes ways can be where a lot of this work starts. That can include noticing the urge to check, prepare, or ask for reassurance before you act, and seeing what happens if you wait five or ten minutes first. Leaving one small task imperfect on purpose, then paying attention to what actually happens as a result, rather than what your anxiety predicted would happen. Practice naming the fear underneath the behavior. Instead of “I need to check this again,” try “I’m afraid something bad will happen if I don’t check,” and notice whether that fear is actually likely. When you do catch yourself spiraling after a mistake, try responding to yourself the way you’d respond to someone you care about, rather than waiting until the moment has already passed to be kind to yourself.
None of these steps require becoming a different person. They’re small experiments in tolerating the discomfort that comes right before you’d normally check, prepare, or take on one more thing. For some people, especially when anxiety is severe, these experiments can be easier and more effective with the support of a therapist.
Consider Therapy
Therapy can be a space to explore both the anxiety itself and the patterns that have taught you to carry so much. Cognitive behavioral therapy, or CBT, is one well-supported approach for generalized anxiety. Studies support how CBT can help people notice the thoughts, behaviors, and patterns that keep anxiety going, like over-preparing, checking, avoiding, or seeking reassurance, and practice responding in new ways.
Depending on someone’s history, needs, and symptoms, therapy may also include attention to the body, trauma-informed care, relaxation skills, or other evidence-based approaches. The goal is not to become less caring, less responsible, or less capable. It is to have more choice: to be able to rest, set limits, make mistakes, and tolerate uncertainty without feeling like everything will fall apart.
The goal isn’t to stop functioning. It’s to discover that you are allowed to function without constantly fearing what will happen if you don’t. If you are reading this and any of it sounds familiar, we hope you know that you don’t have to figure this out alone. Therapy can be a place to explore not only the anxiety itself, but the patterns that taught you to carry so much in the first place. We understand high-functioning anxiety as a lived experience at Take Root Therapy and would be glad to support you in this work. We hope you reach out.