What is High Functioning Anxiety?

What is High Functioning Anxiety?

What is High Functioning Anxiety

Table of Contents

Anxiety disorders like high functioning anxiety are a major part of life for many Americans. Anxiety disorders are the most common mental illness in the United States.1 About 40 million adult Americans experience anxiety disorders each year.1

According to research studies that looked at anxiety in American adults:2

High Functioning Anxiety and Substance Use Disorders

We all feel a bit anxious at times. As humans, when we worry or anticipate the outcomes of important situations, it’s only natural to feel somewhat anxious. But when someone experiences prolonged feelings of anxiety that rarely subside, an anxiety disorder like high functioning anxiety may be present.

Substance use disorders can come from prolonged anxiety. Some people may look to relieve anxiety by taking drugs or drinking alcohol. On the other hand, certain drugs can cause anxiety or increase anxiety in a person.

When an individual has both an anxiety disorder and a substance abuse disorder, it’s called a dual diagnosis or co-occurring disorder.

What is High Functioning Anxiety?

As with other mental health disorders, anxiety disorders are on a spectrum. There is the low end, where anxiety and worry are experienced for 6 months or more, all the way up to agoraphobia, where the person is so paralyzed by anxiety that normal functioning is not possible. High functioning anxiety, as the name implies, is when a person with an anxiety disorder can still function reasonably well.

Research has found that among Americans with any anxiety disorder:2

About 23% experienced serious impairment
About 34% had moderate impairment
Most people with anxiety disorder (43.5%) experienced mild impairment

High Functioning Anxiety Symptoms

People with high functioning anxiety use their anxiety to move themselves forward, rather than being paralyzed by it. On the outside, people with high functioning anxiety seem “put together”, but on the inside they experience turbulent emotions.

Outwardly, the person is a Type A personality who may seem calm and successful. Their work is impeccable and they are always ready to help co-workers. Their appearance is usually immaculate. Socially, they have lots of friends.

Inwardly, they are struggling with a constant stream of anxiety. It could be nervous energy, fear of disappointing others, or being afraid of failure that is driving them to success. When ill or needing a break, they are often fearful of calling in sick. They think no one would ever believe something was wrong, because they always seem “fine”.

If this sounds like you or someone you know, here are some more signs of struggling with high functioning anxiety.

Signs of High Functioning Anxiety

Overall, you may be suffering from an anxiety disorder if your anxiety symptoms are:

Interfering with your productivity

Negatively impacting your overall quality of life

Interfering with your relationships

Making you feel you are “just surviving” instead of thriving

The signs of high functioning anxiety run the gamut from positive to negative.

The Positive Signs

Success at work

Outwardly calm

Plans ahead for all scenarios

Outgoing personality (happy, tells jokes, smiles, laughs)

On time or early for appointments

Organized (a list maker or keeps detailed calendars)



High achiever


Neat and tidy




The Negative Signs

Being a "people pleaser" (afraid of driving people away, or of letting others down)

Talks a lot (nervous chatter)

Nervous habits (knuckle cracking, playing with hair)

Needs to do repetitive things (counting, tapping)

Overthinking situations

Need for reassurance (asking same questions multiple times)

Procrastination followed by long periods of cramming work

Avoiding eye contact

Dwell on the negative (thinking about many "what if" scenarios)

Can't say "No"

A constantly overloaded schedule

Very busy all the time

Insomnia (can't fall asleep or wakes too early)

Racing thoughts

Others think that the person is unemotional

Can't enjoy the moment because expecting the worst

Feels intimidated by the future

Compares themselves to others but thinks they fall short of expectations every time

Mentally tired

Physical fatigue

Loyal to a fault

Potential for alcohol or drug abuse as an unhealthy way to cope

What Anxiety Feels Like

Anxiety is a feeling of dread, fear, and uneasiness. You may feel restless, tense, or sweaty, and have a racing heartbeat.

Anxious Person: Feeling anxiety may just be a normal reaction to stress. For example, you have an assignment deadline or a hard decision to make, so you may feel anxious. This anxiety can help you cope as well as give you a push to focus on the issue.

High Anxiety: For people with high anxiety, the fear, dread, and uneasiness are not temporary, but rather they are constant and can be overwhelming.

High Functioning Anxiety Treatment

If you are diagnosed with an anxiety disorder, there are several ways to get effective treatment.

Anxiety disorders can be treated with:3

Medications such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)

Alternative therapies such as meditation or mindfulness training

Many people with anxiety find that using a combination of treatments is the best way to help them manage their symptoms.

CBT in Anxiety Treatment

CBT strives to create positive thoughts and emotions to counteract negative ones. Behavioral aspects of CBT involve exploring emotions to discover how to fight the factors that create anxiety.4

One example is exploring why clients think the worst in most situations. They are encouraged to quickly think about what the worst outcome could be and then to dial it back or leave it behind. This exposure to anxiety teaches how to tolerate fears, which allows the freedom to think less often and less intensely about concerns and worries.

Overall, CBT helps:

Evaluate situations more objectively to avoid generalizations or overblown dangers

Become aware of negative thought patterns

See positive alternative to the overestimation of risks

Mindfulness in Anxiety Treatment

The goal of the cognitive treatment is to support the ability to step back from automatic thoughts and to disconnect from the worries that come from those thoughts. This mindfulness practice eventually becomes a habit that alleviates anxiety.

Treating a Dual Diagnosis in Rehab

If you or a loved one is struggling with anxiety as well as alcohol or drug abuse, this condition is called a dual diagnosis. Alcohol or drugs may temporarily alleviate the distress of high functioning anxiety, but in the end, these substances only intensify anxiety symptoms.

Dual diagnosis is a common condition in individuals who have alcohol or drug struggles. Research shows that the lifetime frequency for someone with a mental health disorder is:5

Since each disorder can aggravate the course of the other, both must be treated at the same time for the best chance for a good outcome.

Seek Treatment to Avoid the Emergency Room

It’s important to seek treatment for a dual diagnosis to avoid mental and physical harm or complications. A research report found that, in 2007, about 1 in 8 hospital emergency room visits made by adult Americans were due to a mental health and/or substance abuse problem.6 The most common reasons were:6

Mood disorder (42.7%)
Anxiety disorder (26.1%)
Alcohol-related problem (22.9%)
Drug-related disorder (17.6%)

Find Help for High Functioning Anxiety & SUDs

Non-emergency, substance abuse treatment facilities are equipped to handle the challenges of co-occurring disorders, such as anxiety and substance use. Treatment centers can help you or a loved one experience the benefits of recovery in a comfortable and safe environment.

Fight Fear and Isolation

When you feel fearful and isolated due to anxiety, it’s more difficult to reach out for help. Alcohol or drugs add more complications to the mix. But there is hope for recovery with the right help.

There are two sides to living with high functioning anxiety. You may fear to let go of something that feels like an integral part of your personality. It’s important to keep in mind that you don’t have to hold onto your anxiety to meet your goals and be successful.

Focus on Your Positive Traits

It’s healthier and less taxing to focus on your positive traits through the habits developed in therapy. Do your best to let go of tensions and the internal battles your anxiety causes. Success doesn’t have to come from struggles. Open yourself up to your true feelings. Share your feelings with others so you and your world are more authentic.

Talk to a Health Professional

If you’ve never been diagnosed with an anxiety disorder, but you can relate to the signs of anxiety, talk to your doctor who can give you a referral for an assessment by a mental health professional.

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