Unmasking High Functioning Anxiety: Symptoms, Causes, and Treatments

Personality Profile: High-Functioning Anxiety

High-functioning anxiety wears many different faces. Some might be outgoing and the life of the party—the type of person who seems to know everyone and never has a hard time making new friends. Others are the pinnacle of career success: always early, always submitting the best work, and never turning away a challenge. Others still are the ones who always look put together, with the perfect Instagram feed, the perfect diet and workout schedule, and the perfect plan for their life.

But behind all that are layers of fear and anxiety. 

People with high-functioning anxiety push themselves harder than what is healthy out of fear of what will happen if they slow down, take a break, or do less. 

For some, this fear is social. They might think, “People will be disappointed. They had such high expectations of me and I let them down. They’ll be mad. They will think I’m not cut out for this.” 

For others, the fear is a result of catastrophizing, a cognitive distortion common in many mental health issues that causes people to spiral to the worst possible outcome, blowing the problem out of proportion. Such as, “If I fail, I’ll lose my job, and then I’ll be bankrupt and forced to sell my house.” or “If I mess up, they’ll hate me, break up with me, and I’ll be alone for the rest of my life.”

 Other personality traits that may contribute to high-functioning anxiety include: 

• Perfectionist 
• People-Pleaser
• Type-A Personality 
• Highly Sensitive Person

Adults who struggle with high-functioning anxiety have often been high-achievers since they were children. They learn to associate over-achieving with praise and acceptance and become fearful that if their successes stopped, so would their acceptance. 

If you relate to this description, it’s worth reaching out to a mental health professional. Although it can feel like you don’t need therapy because of your external success, high-functioning anxiety can result in burnout, depression, or other mental health issues. It’s okay to admit you’re struggling; you deserve the best, and freedom from anxiety is possible.

High-Functioning Anxiety and Comorbidities

A “comorbidity” is a mental health disorder that occurs alongside another mental health issue. For example, anxiety and depression often go hand-in-hand; many people who have anxiety end up forming depression, and vice versa. This is likely due to the overlapping genetic and environmental factors between mental health issues. There has also been evidence that suggests some mental health issues make people more susceptible to other mental health issues. Anxiety is one of those issues. 

High-functioning anxiety is exhausting. Not only are you fighting anxiety all day long, you’re also trying to convince everyone around you that you are not fighting anxiety. This often leaves people vulnerable to other mental health issues. Some of these comorbidities of high-functioning anxiety include: 

• High-functioning anxiety and Depression: It is common to experience anxiety and depression at the same time. This is partly because they share many of the same risk factors, but also because it is easy to become depressed when you are anxious all the time. If you have high-functioning anxiety, you know how exhausting it can be. You feel trapped inside your own mind and walls of perfection. You feel like no one knows the real you because you only show them the perfect side.
• High-functioning anxiety and ADHD: People with ADHD, especially undiagnosed ADHD, often develop high-functioning anxiety as a way to mask their ADHD symptoms. They become hyper-aware of and anxious about fitting in, succeeding, and appearing “normal” in a way that society deems appropriate, and these behaviors result in anxiety. 
• High-functioning anxiety and Eating Disorders: Eating disorders have a high rate of comorbidity with anxiety. This is often because people with anxiety have a desperate need to control things. Everything in their head feels out of control, and it feels safer to control everything in the outside world. Perfectionism, over-preparing, and disordered eating can arise from this need. Controlling your food intake can have a soothing effect on anxiety, but this is not a sustainable coping mechanism. 

Comorbidities are difficult to address on your own. If you think you might be struggling with more than one mental health issue, we strongly recommend reaching out to a mental health professional. 

Talk to us

Symptoms of High-Functioning Anxiety

Because of the successful outer life many people with high-functioning anxiety lead, it can be difficult to recognize the symptoms of high-functioning anxiety. Many people with this issue practice “masking” to hide their symptoms. Mental health masking is commonly used by people with mental health issues or neurodivergence in order to fit in or not let on how much they’re struggling. A mask hides emotions, behaviors, and struggles. 

Every person’s mask will look different, but people with high-functioning anxiety often appear on the outside as: 

• Overachievers 
• Detail Oriented
• Sociable and well-liked
• Physically put together
• Hard workers
• People Pleasers

They may also exhibit behaviors such as:

• Over planning
• Always punctual 
• Rarely calls out sick or uses PTO
• Always willing to do an extra task, stay late, or lend a helping hand 

However, behind that mask, they’re struggling deeply. They might experience symptoms of high-functioning anxiety such as: 

• Fear of failure 
• Imposter Syndrome
• Looping or racing thoughts
• Fear of criticism or disappointing others
• Feelings of impending doom 
• Chronic stress
• Agreeing with others externally even if you disagree internally
• Feeling tired no matter how much rest you get
• Overanalyzing social situations 
• Desire for reassurance
• Inability to say “No”, resulting in an overburdened schedule
• Feeling like no one knows the real you
• Unhealthy coping mechanisms, like substance abuse, eating disorders, hair or skin picking, or binging TV or social media to find a sense of numbness or peace

 In addition, people with high-functioning anxiety may experience physical symptoms such as: 

• Insomnia 
• Nausea 
• Body aches
• Headaches 
• Muscle tension
• Racing heart

If you relate to these symptoms of high-functioning anxiety, therapy can help. Anxiety is highly treatable, although most people will never seek help. Don’t wait to find relief. If you recognize yourself in some of these symptoms, Lifebulb’s anxiety counselors can help.

How Do I Treat High-Functioning Anxiety?

The good news is that high-functioning anxiety is highly treatable. It is treated in the same way as other anxiety disorders: with therapy, medication, or a combination of both. Many people also find success in treating high-functioning anxiety at home with healthy coping mechanisms and a strong support system.

Therapy

High-functioning anxiety can be treated with a variety of counseling approaches. Some of these include:

• Cognitive Behavioral Therapy: Cognitive Behavioral Therapy (or CBT) can address the cognitive distortions common with high-functioning anxiety. Your therapist will help you identify untrue, negative thoughts such as “My productivity defines my worth” or “If I don’t do this perfectly, I might as well not do it at all”. From there, they will help you understand where these thoughts come from, how to dismantle them, and how to reframe them into something positive and true, such as: “My productivity is just one aspect of who I am.” 
• Acceptance and Commitment Therapy: Acceptance and Commitment Therapy, or ACT, works by accepting your emotions and thoughts, realigning with your values, and then taking action steps with those values in mind. With high-functioning anxiety, it can be easy to try and brute-force your way through negative emotions. ACT teaches us the mindfulness technique of slowing down, acknowledging that your current emotional state exists but does not have to impact your behaviors, and then moving on rationally from there. 
• Exposure Therapy: Exposure therapy is used to treat many different anxiety disorders. It is the process of slowly confronting a situation or thought that scares you and using relaxation and mindfulness techniques to calm your body and mind. Over time, this technique teaches your body that the feared stimuli (for example: failure, letting others down, or not knowing the right answer) isn’t a dangerous situation. Your fight or flight response will not be activated and you are able to think more rationally.

Coping with High-Functioning Anxiety

While professional therapy can be incredibly helpful for those struggling with high-functioning anxiety, it’s not the only thing you can do. Having healthy coping mechanisms can help ease the stress and help build healthy habits in the long term. Some coping mechanisms you can start implementing today include:

• Make sure your physical needs are met first: You can’t do the heavy emotional and cognitive lifting (changing your thoughts and emotional patterns) without having a strong physical base. This means prioritizing eating healthy, exercising, and strong sleep hygiene. 
• Limit substances like alcohol or caffeine: This may be hard, but by cutting down on these external substances, you can get to the root of your issues. Caffeine and alcohol often exacerbate the symptoms of anxiety, such as heart palpitations, chest pain, racing thoughts, etc.
• Keep track of your looping thoughts: Keep a journal or notes app on your phone with you wherever you go. When you notice a negative thought, write it down. For example, if a friend texts you asking to hang out and you recognize a spike of anxiety, take a moment to observe your thoughts. Are you exhausted and don’t want to go, but are worried they might take offense? Are you worried something is wrong and that’s why they want to talk to you? You don't have to take action on these notices yet, just observe. 
• Find healthy replacement behaviors: Many people with high-functioning anxiety find coping mechanisms that help with the constant anxiety like picking at their skin, chewing their nails, or clenching their jaw. These behaviors are unhealthy and can cause skin or tissue damage. Find other ways to destress and make time to practice them when you feel your anxiety rising. For example, try a breathing exercise, take a walk, or journal your thoughts. 
• Surround yourself with people who get you: It can be scary to open up and let others behind your mask. But the benefits of having people who understand and care about you are immense. Find just a few people who you trust and tell them about your struggles. You might be surprised just how caring they may be. 

If your symptoms get worse, reach out to a mental health professional. As beneficial as at-home coping mechanisms are, high-functioning anxiety can lead to more disruptive anxiety disorders. It is always better to receive professional treatment early, so don’t wait to contact a licensed therapist and get the help you need today. You deserve to live the happiest, healthiest life possible, and therapy can help you get there. 

To learn more about Lifebulbs anxiety therapy services, reach out to our team or request a session today. 

Find Your Therapist