Some people with anxiety may define themselves as high functioning and may do well at work, for example, or excel at sports or other aspects of their lives. Despite this, people living with this type of anxiety can face many challenges.

People with high functioning anxiety experience many typical symptoms of anxiety, such as excessive worry and fear, overthinking, and poor sleep. Effective treatment is available for all types of anxiety.

This article provides an overview of high functioning anxiety, its symptoms, and the potential treatment options.

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Doctors do not recognize high functioning anxiety as a distinct anxiety condition, and there is a distinct lack of research in the area. However, some people with anxiety symptoms describe themselves as being high functioning. By this, they typically mean that they manage to function well in their day-to-day lives.

The medical community knows that anxiety disorders exist on a spectrum and affect people in different ways. While some people may experience moderate or severe symptoms, others may experience mild distress or impairment.

It is possible that the people who consider themselves as high functioning experience mild impairment. Or, they may have subclinical anxiety — a situation where people do not meet the diagnostic criteria for anxiety but still have anxiety symptoms. Subclinical anxiety symptoms may be:

  • mild
  • atypical
  • hidden
  • brief but recurrent

Some people with high functioning anxiety may be good at hiding their symptoms from others and appear calm and confident. The anxiety may even drive them on to achieve rather than holding them back.

On the inside, however, they may feel scared or worried or have obsessive thoughts. They may overthink and be unable to relax. The anxiety symptoms may affect their sleep or appetite.

All anxiety symptoms can have significant and long-term impacts on a person’s health and relationships.

Learn more about causes of anxiety here.

Due to the lack of research in the area, medical professionals may not know what causes high functioning anxiety. However, it may be one way that anxiety disorders present in some people.

While experts do not fully understand the causes of anxiety disorders, they most likely occur due to a combination of factors, such as:

  • Genetics: People with a family history of anxiety disorders or other mental health conditions are more likely than others to develop anxiety.
  • Personality: Childhood traits of shyness or nervousness in new situations, for example, increase the risk of having an anxiety disorder.
  • Exposure to stress: Experiencing stress or trauma at any point can trigger anxiety.
  • Other health issues: Underlying physical health concerns, such as a thyroid disorder or heart problems can trigger or worsen anxiety symptoms. Having another mental health disorder is also a risk factor for an anxiety disorder.
  • Drug or alcohol use: Misuse of drugs or alcohol can trigger anxiety, as can withdrawal from these substances.

Learn more about alcohol use and anxiety here.

Without enough research, medical professionals cannot say how high functioning anxiety presents and how it affects people who experience it.

Anecdotal reports, however, suggest that people with high functioning anxiety may have fewer obvious symptoms that affect their ability to function. While they may have many of the classic symptoms of anxiety, these may occur on the milder end of the spectrum.

Possible signs and symptoms may include:

  • worry, fear, and anxiety
  • irritability and frustration
  • an inability to relax
  • a need for perfectionism
  • overachieving
  • fear of failure or judgment
  • a desire to keep busy all the time
  • overthinking and overanalyzing
  • anticipatory anxiety (anxiety before events)
  • elevated heart rate and faster breathing
  • sleep problems
  • changes in appetite
  • digestive issues

Learn more about recognizing anxiety here.

However, there may be a potential link between high functioning anxiety and depression. The National Alliance for Mental Illness (NAMI) indicates that 60% of people with anxiety will also have symptoms of depression.

Furthermore, if people do not seek treatment for chronic anxiety and stress, they may be at an increased risk of depression. Only 36.9% of those with an anxiety disorder receive treatment.

People with high functioning anxiety may be less likely than others to seek treatment. Research indicates that people often only seek help when they struggle to cope with their symptoms. Those with high functioning anxiety often manage very well in some areas of their lives.

Also, individuals may only seek help when they recognize their symptoms as being a problem. Individuals with high functioning anxiety may view some anxiety symptoms, such as perfectionism, as positive traits that help them progress and achieve.

However, chronic anxiety may adversely impact their self-esteem and mental health in other ways, contributing to depression.

Learn more about perfectionism and mental health here.

Doctors cannot diagnose high functioning anxiety because it is not a recognized disorder. However, it may be a level on the spectrum of anxiety and one way that a recognized anxiety disorder presents in some people.

To diagnose a recognized anxiety disorder, such as generalized anxiety disorder or social anxiety disorder, a doctor may first perform a physical check to see if an underlying medical condition is causing anxiety symptoms.

If the doctor does not find an underlying cause, the person may need to see a mental health professional for diagnosis and treatment.

Doctors may find it challenging to diagnose an anxiety disorder in people with high functioning anxiety. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one of the criteria for anxiety disorder diagnosis is distress or impairment in important areas of functioning.

In people with high functioning anxiety, this impairment is not always obvious. It may be affecting their quality of life in subtle ways. It is essential that people provide their doctor with a complete picture of their life and feelings.

The primary treatments for anxiety disorders are psychotherapy and medications. Many people require a combination of the two to feel better.

Psychotherapy

Psychotherapy, or talk therapy, can help people to manage the symptoms of anxiety. Some types of therapy may be more effective than others for anxiety.

Cognitive behavioral therapy (CBT), for example, is generally an effective treatment for anxiety disorders. CBT helps people reduce their anxious thoughts and gradually confront situations or objects that trigger their anxiety.

A therapist can also teach people techniques to manage their anxiety symptoms, such as deep breathing, meditation, or progressive muscle relaxation.

Many forms of therapy may benefit those with high functioning anxiety.

Learn more about therapy here.

Medication

Several medications can treat anxiety. These include:

Finding the correct medication and dosage to control their symptoms may take some trial and error as not all medications work for everyone.

Learn more about anxiety medications here.

Individuals should contact their doctor if:

  • they experience regular symptoms of anxiety that causes distress
  • they cannot control the anxiety symptoms
  • anxiety affects their relationships, health, or self-esteem
  • they use alcohol or drugs to manage their symptoms
  • they develop symptoms of other mental health issues, such as depression

Anxiety is highly treatable. The earlier a person seeks help, the better the outcome.

Learn more about mental health professionals here.

Doctors and other medical professionals do not recognize high functioning anxiety as a specific condition. Instead, anxiety exists on a spectrum and, for some people, it may present as high functioning. This means that other people may not notice any anxiety symptoms.

However, a person living with high functioning anxiety can face significant challenges, but treatment can help those with high functioning anxiety manage their symptoms and feel better.

Individuals who think they have anxiety should speak with their doctor about their treatment options.