Most people admire friends and coworkers who are confident, organized and consistently meet their deadlines. What they may not know is that this level of organization can be a symptom of high-functioning anxiety disorder.

High-functioning anxiety is characterized by someone who strives to keep their life in order while coping with hidden anxiety. Symptoms can include nausea, crying jags and intense anxiety in private, all while appearing calm to others.

Some people with high-functioning anxiety don’t realize they have it.

“They often don’t recognize the internal anxiety,”  said Evie Breedlove, adult psychiatric-mental health nurse practitioner. Breedlove see patients in the Optum Behavioral Care program with WellMed / Optum FL, in Florida.

While not an official DSM V diagnosis, high-functioning anxiety is a recognized condition that behavioral health care providers see often. It affects people of all ages, including older adults. Learning about high-functioning anxiety  can help you understand and recognize it in yourself, or loved-ones and friends, and that’s the first step to managing it.

A common symptom of high-functioning anxiety is excessive worry. Some people experience disaster scenarios such as a loved one dying, a bad car accident or an environmental disaster. One patient described it as feeling like their thoughts were a runaway train.  And even though people with high-functioning anxiety are usually meticulous about work, many fear failing at their job or getting fired.

Other symptoms may include:  

• Overthinking: Replaying conversations or events over in their mind and second guessing what was said or the choices they made.
• Perfectionism: Setting very high standards and feeling upset if they’re not met.
• Procrastination: Putting off tasks because they’re afraid the result won’t be perfect.
• Restlessness: Feeling tense and unable to relax.
• Physical symptoms: Experiencing tense muscles, headaches, trouble sleeping, a fast heartbeat or stomach cramps.

Those with the condition may feel a certain level of anxiety, from mild to severe, most of the time, but continue to cope until something happens to tip the scale. It may be a sick child, elderly parents who need more help, or upcoming special occasions such as the holidays.

“It’s usually something that changes their schedule and makes additional demands on them,” Breedlove said. “Or it may be a case of not being able to say no when asked to do extra.”

Holidays can be especially stressful because of the extra pressure of pleasing everyone.

 “Since they outwardly appear to be able to handle it all, their extended family expects more of them, so they cook, they decorate, and they plan the family festivities,” Breedlove said. “They tend to have high expectations for themselves, and they expect things to be perfect.”

When the person reaches a breaking point, they may shut down for a while and can’t participate.

Breedlove often sees older adults who coped with the condition their whole lives and were successful but become depressed after they retire because they are no longer working and functioning as they were.

“To top it off, because they have the need to be in control, they often don’t seek get treatment, and their loved ones and friends don’t realize they have anxiety,” Breedlove said.

If you think you might have high-functioning anxiety, it’s important to talk to your doctor.

Symptoms that may require a doctor’s help include:

• Anxiety that interferes with daily life such as work and relationships.
• Stress that is more difficult to manage.
• Headaches, fatigue, or sleep issues with no known cause.
• Using unhealthy ways to cope, such as drinking too much alcohol, working too much or avoiding other people.

Treatments

With the right treatment, high-functioning anxiety is manageable. It’s important to take care of both your body and mind. Treatment options include:

• Cognitive-behavioral therapy (CBT) helps you spot and change negative thoughts. It also helps you learn better coping skills.
• Medication: Your doctor might prescribe antidepressants or anti-anxiety medicine to help with your symptoms.
• Lifestyle changes: Regular exercise, mindfulness, and getting enough sleep can help with anxiety.
• Stress management: Take care of yourself and set realistic goals. This can lower the pressure you put on yourself.
• Deep Breathing Exercises: This is something you can do at any time to help calm your body.

These treatments can help you take control of your anxiety so you can live a more balanced and happy life.

Strategies to help manage high-functioning anxiety:

• Build a support system. Talk to friends and family. Join a support group. Find people who understand your struggle. Sharing your feelings can make the anxiety feel less heavy and help you feel less alone.
• Practice mindfulness. Try meditation, deep breathing, or yoga. These can help calm your mind and reduce anxiety.
• Set boundaries. Learn to say no when you’re feeling overwhelmed. Focus on doing what makes you feel good and healthy.
• Focus on the present. High-functioning anxiety often makes you worry about the future. Mindfulness can help you stay focused on what’s happening right now.
• Seek professional help. A therapist can support you and suggest ways to manage your anxiety.

Remember, it’s okay to ask for help.

Taking care of yourself with high-functioning anxiety

High-functioning anxiety can be hard to spot. It hides behind a façade of success and capability, but it’s important to recognize the symptoms and get the help you need. By understanding this condition and managing it, you can feel better.

Discussing your mental health with your doctor is a big part of staying healthy. WellMed has resources for mental and behavioral health as well as physical health. Don’t wait until your anxiety feels too big to handle. Getting help early can stop it from getting worse and affecting your health.

To read more WellMed health advice articles, visit agehealthynow.com. To see WellMed patient success stories, see agehealthystories.com.

References

1. Behind the mask: Managing high-functioning anxiety. (2023, July 11). Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/managing-high-functioning-anxiety#
2. Signs you have high-functioning anxiety. (2022, May 16). Cleveland Clinic Health Essentials. https://health.clevelandclinic.org/what-is-high-functioning-anxiety
3. What is mindfulness? (2020, July 8). Mindful. https://www.mindful.org/what-is-mindfulness/
4. How Box Breathing Can Help You Destress. (2021, August 17). Cleveland Clinic Health Essentials. https://health.clevelandclinic.org/box-breathing-benefits