What it’s like to have high-functioning anxiety

Busy and in control. High-achieving and perfectionistic. Driven by details and order in a desperate attempt to calm racing thoughts, worry, and the fear that invades every ounce of the mind and body. An over-thinker with a tendency to perseverate, dwell, and stew on everything.

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As much as those who experience these symptoms would like to be able to turn them off or put them on pause, they can’t. Most days, their thoughts turn into worries, and their worries, in turn, consume their thoughts. This creates a constant state of “what if?” But this isolated turmoil is often hidden by smiles and laughs, success and achievements, and a decent dose of extroversion. Ironically, this nervous energy is what keeps them moving forward. These persistent feelings are always there, pushing them to do more, achieve more, succeed more, and be better. This is the face of “high-functioning” anxiety.

Identifying with “high-functioning” anxiety

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million American adults age 18 or older, or 18 percent of the population. While not an official diagnosis, the term “high-functioning” as it relates to an anxiety disorder—especially generalized anxiety disorder (GAD)—is something many people who struggle with anxiety identify with. “As therapists, we talk about a lot of people even with diagnosed anxiety disorders as ‘high-functioning,’ and many of them are,” says Lynne Siqueland, Ph.D. of the Children's and Adult Center for OCD and Anxiety. “They are doing really well in their jobs, in relationships and raising kids, despite having significant anxiety.”

What causes high-functioning anxiety?

The roots of high-functioning anxiety are complex, shaped by a mix of biology, personality, and environment. For some, genetics plays a role, as research shows anxiety can run in families and increase the likelihood of developing an anxiety disorder. Early upbringing also matters. Individuals raised in households where perfection was expected or mistakes were met with harsh criticism may internalize patterns of perfectionism and negative thought cycles that fuel anxious tendencies.

Personality traits can further intensify the internal struggle. People who are highly conscientious or strive for perfection often set unrealistically high standards for themselves. These self-imposed pressures, combined with a heightened need for control and constant worry, create fertile ground for persistent anxious feelings.

Environmental stressors add another layer. A stressful situation at work, difficulty in relationships, or even long-term exposure to high levels of stress can exacerbate mental health challenges. Chronic strain may contribute to physical symptoms such as muscle tension, fatigue, or headaches, further impacting daily activities. Without effective coping strategies, these influences may reinforce the cycle of fear, failure, and the ongoing battle with high-functioning anxiety.

Identifying signs and symptoms of anxiety

Research shows that people with an anxiety disorder perceive the world in a fundamentally different way. People with GAD experience excessive anxiety and worry, often expecting the worst even when there is no apparent reason for concern. There is constant mental exhaustion weighing heavily on those struggling with anxiety because their mind never stops going. These intense feelings of worry require a lot of energy to battle the thoughts of what could go wrong, has gone wrong, or may go wrong in the far future.

This continuous loop of stress and overthinking thoughts of “worst case scenario” is often exacerbated by the fact that non-anxious people see this way of thinking as irrational, illogical, emotional, and crazy. Anxiety is not easily explicable, at least not to those who don’t experience it. While a person with high-functioning anxiety can appear as though in control and actively engaged in the daily tasks of life, underneath this confident exterior, it is a fight to make it through the day. “Much of anxiety is internal-uncontrolled worry or social evaluation, and no one would know unless the person has a lot of physical symptoms of avoidance,” says Siqueland. “Many people with mild to severe anxiety will do the essential tasks but limit other experiences or opportunities, and this is what sometimes leads them to treatment.”

Are there any benefits or drawbacks of high-functioning anxiety?

Living with high-functioning anxiety can feel like a double-edged sword. On one hand, the constant drive to manage worry and avoid failure can lead to admirable strengths. Many people with this form of anxiety disorder thrive in their careers because their heightened awareness fosters strong coping strategies like organization, careful planning, and attention to detail. These traits often translate into success at work or in daily activities, as well as a high level of motivation to push through challenges.

However, the drawbacks are just as real. The same persistent feelings that fuel achievement can also result in perfectionism, chronic stress, and an inability to fully relax. Over time, this cycle may cause fatigue, muscle tension, headaches, and difficulty sleeping — common physical symptoms linked to prolonged anxious feelings. Left unchecked, the need for constant control may lead to burnout and strained relationships.

Managing and treating anxiety

Anxiety can be managed and treated, but not cured. This is the reality people with anxiety live with every single day. There are a variety of treatment options that are effective in treating anxiety disorders, including cognitive behavioral therapy, coping strategies, medication, and alternative therapies such as meditation, acupuncture, mindfulness, and yoga. And there is increasingly compelling evidence making its way to the masses about the effectiveness of mindfulness and meditation to help manage anxiety. In fact, meditation and mindfulness can be a great resource on their own or in combination with other treatments. Learning effective ways to reduce anxiety and discovering what works best for each individual to manage their symptoms. 

“The goal of meditation practice is to be aware, observe and notice thoughts, feelings, and body states without becoming reactive or fused with them (believing them to be true states of the person or the world),” explains Siqueland. “It takes practice but it gives the person both pause and freedom to make choices that are more effective.” New technology has made meditation and mindfulness more accessible, and even mental health practitioners are finding ways to incorporate these “handheld” treatment options into their plans. “I have used Headspace with quite a number of my adult and teen clients and have even been using it myself,” says Siqueland. “The animations really help to describe concepts in an engaging way.” If people have reservations about adding one more thing to a busy schedule, Siqueland advises clients to begin with 10 minutes a day. A smaller commitment can help to make mindfulness a lifestyle change that can be incorporated into daily life.

_Sources:

_{1. Anxiety and Depression Association of America. (2025, August 21). Facts & statistics. https://adaa.org/understanding-anxiety/facts-statistics. Accessed on September 30, 2025.}

_{2. Children’s and Adult Center for OCD & Anxiety. (2025). Home. https://childrenscenterocdandanxiety.com/. Accessed on September 30, 2025.}

_{3. Koskinen, M.K., Hovatta, I. (2023). Genetic insights into the neurobiology of anxiety. Trends in Neurosciences, Volume 46, Issue 4, Pages 318-331, ISSN 0166-2236, https://doi.org/10.1016/j.tins.2023.01.007. Accessed on September 30, 2025.}

_{4. Laufer, O., Israeli, D., & Paz, R. (2016). Behavioral and neural mechanisms of overgeneralization in anxiety. Current Biology, 26(6), 713–722. https://doi.org/10.1016/j.cub.2016.01.023. Accessed on September 30, 2025.}