Quick Summary:
High-functioning anxiety describes people who appear successful but feel constant worry inside. Though not an official diagnosis, it shares symptoms with generalized anxiety and often stems from perfectionism. Left untreated, it can lead to burnout or depression, but CBT, self-compassion, and sometimes medication can help. This interview with MindGlow Health therapist Dr. Justin Garcia-Grace shares the difference between “regular anxiety” and “high-functioning anxiety” and how to get help if you need it.
Clinically Reviewed by Dr. Justin Garcia-Grace, DNP, APRN, PMHNP-BC
Dr. Justin Garcia-Grace
DNP, APRN, PMHNP-BC
Can you be high functioning while still suffering from anxiety? Believe it or not, it’s more common than you think. To understand the difference between “regular” or “general” anxiety and “high-functioning” anxiety, we sat down with Dr. Justin Garcia-Grace, a mental health provider with MindGlow Health.
What’s the difference between general anxiety and high-functioning anxiety? How are both treated?
Generalized anxiety disorder (GAD) is a clinical diagnosis where people worry too much in a way that interferes with daily life and functioning (Stein & Sareen, 2021). High-functioning anxiety isn’t an official diagnosis but refers to those who seem to do well on the outside, like holding good jobs or finishing school, while feeling tense or worried on the inside (Saris et al., 2017). Cognitive-behavioral therapy (CBT) helps both: it teaches practical skills to manage overthinking, perfectionism, and stress.
When did people start talking about high-functioning anxiety?
High-functioning anxiety isn’t an official diagnosis, but the term has become more common over the past decade. It started showing up in blogs, social media, and mental health conversations as a way to describe people who seem outwardly successful but struggle internally with constant worry. More recently, researchers have begun to study this pattern, especially in people with perfectionistic traits or high-pressure lifestyles.
What are some common signs of high‑functioning anxiety?
People with high-functioning anxiety often appear organized, dependable, and hardworking, but inside, they may worry constantly, struggle with sleep, feel restless, or be very hard on themselves. These signs often overlap and reflect inner stress even when things look normal outside.
Can it be harmful to describe someone with anxiety as “high-functioning”?
Yes. Saying someone is “high-functioning” can make others believe their anxiety isn’t serious. That can stop people from seeking help, especially since perfectionistic individuals may avoid asking for support, fearing judgment (de Lijster et al., 2018).
How can friends or providers support someone who looks OK but feels anxious inside?
Start with kindness and listening. Promote self-compassion and realistic goals rather than perfection. CBT that targets stubborn perfectionistic beliefs and patterns of worry works well. Strategies like journaling, mindfulness, and rest also help regulate stress.
Can high‑functioning anxiety lead to more serious problems like burnout or depression?
Yes. Even if someone appears to be managing well, carrying long-term anxiety on the inside can take a toll. Over time, that hidden stress can lead to serious issues like emotional exhaustion, burnout, trouble sleeping, muscle tension, and eventually depression (Smith et al., 2017). People with high-functioning anxiety often push through without rest, which increases the risk of mental and physical health problems if the anxiety goes untreated.
What should family or clinicians look for to identify high‑functioning anxiety?
Look beyond appearance: a person may meet deadlines and seem capable, but may also mention poor sleep, internal pressure, or being overly self-critical. Those are some red flags that they may benefit from support (de Lijster et al., 2018).
Is high‑functioning anxiety linked to perfectionism or certain traits?
Definitely. Research shows that when people set very high standards for themselves and judge their performance harshly, a pattern called maladaptive perfectionism, they often experience higher levels of anxiety, stress, and lower life satisfaction. The same study also found that self-compassion, especially when combined with strong family support, can help reduce anxiety in people with perfectionistic traits (Smith et al., 2017).
Can medication help with high-functioning anxiety?
Yes, medication can be helpful for some people. Even if someone seems to be doing well on the outside, their inner anxiety can still cause distress or exhaustion. In these cases, mental health providers may prescribe medications like selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat anxiety. Medication is often most effective when combined with therapy, especially approaches like cognitive-behavioral therapy (CBT) (Saris et al., 2017). The right plan depends on the person, and treatment should always be personalized with help from a mental health provider.
Get more information about high-functioning anxiety and learn how MindGlow Health can help support you or someone you know who may be suffering in silence.
