Let me tell you about my typical client. She is the ultimate responder; she answers every email within the hour, remembers all the birthdays, organizes all the meetings, and still makes it to the gym. To outsiders, she appears to have it all together, to be highly successful. But on the inside, she is slowly falling apart.
In my clinical experience, more than half of women with anxiety experience High-Functioning Anxiety. It is a disorder that many people are unfamiliar with, and yes, it is real even though it is not a formally recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. If you are one of these women, then it can be hidden from the people around you as well as from yourself because you continue to complete all of your various tasks.
In this article, I will attempt to describe what high-functioning anxiety looks like, why it can be so difficult to recognize, and how support can be found to heal from it.
What is high-functioning anxiety?
What they can’t see is that anxiety is governing so much of her behavior. And when she goes to see a clinician for help, they might initially mistake high-functioning anxiety for generalized anxiety disorder, social anxiety, or another anxiety-related disorder and start treating her accordingly. But only after they “get” that all of this drive and these tremendous strengths are masquerading aspects of her personality that protect her from completely falling apart, but they do not protect her from anxiety.
Another common way to misperceive the high-functioning anxious woman is to mistake her high-achieving nature and a strict attention to detail for a high-powered personality. You may have earned the label of a “perfectionist” or a “go-getter” in your place of business or within your social circle. Again, it is true that you are extremely driven and very detail-oriented, but that in itself does not define who you are. It could be the work of your high-functioning anxiety. A survival mechanism you learned early on during childhood.
Is it just stress, or is it anxiety?
Everyone is stressed sometimes. The main difference between stress and anxiety is that stress has a specific cause and usually subsides after the event that caused it has passed. For example, a woman may feel stressed while she is preparing for her big meeting at work, but once she has finished her presentation and her boss has congratulated her on a job well done, she will feel relieved that the stressful situation has passed. However, the high-functioning anxious woman may only experience a brief feeling of relief after a big achievement before another worry occupies her mind.
Signs of high-functioning anxiety in women
Again, each woman will present with her own unique version of these traits; yet the patterns below are common amongst women suffering from high-functioning anxiety:
- You over-prepare for everything. The work you do exceeds what is required in any situation. Even when your work is good enough, the relief is short-lived.
- Instead of being able to fully relax and enjoy your time off, you get gripped by guilt and enter “planning mode” again.
- Constantly re-running conversations (whether in person or text). Dwelling on a particular phrase or tone used in a message, wondering if you came across wrongly in a meeting or presentation.
- You have trouble saying no to requests. Even though something may be outside of your interests or beyond your energy, you worry about the potential consequences of saying no. As a result, you find yourself agreeing to things that you don’t really want to do and packing your schedule with activities that are not of value to you.
- Things don’t feel like they land for you even when you reach your goals. At first, reaching your goals feels good, but then quickly the goalpost gets moved and you’re off to reach the next goal.
- Physical symptoms such as a tight jaw or tension in your shoulders, as well as stomach problems, headaches, and a racing mind at night are also symptoms of high-functioning anxiety.
- You are a go-to person, and others rely on you. You have difficulty asking for help and feel extreme guilt when someone tries to assist you.
No, recognizing the symptoms of high-functioning anxiety does not mean that you are somehow defective. These are just signs that your nervous system is working hard to manage stress and to keep you safe. Acknowledging the patterns is half the battle. Recognizing that these are normal behaviors that were originally designed to protect you but no longer serve you is the first step to start to change them.
Why high-functioning anxiety stays hidden
You may be surprised to find out that many women who suffer from high-functioning anxiety are not met with concern about their health and well-being from others. Often, bosses, friends, and family even admire a woman’s ability to function under high stress and manage many responsibilities, without even realizing the toll it takes on her body and mind. Furthermore, many women are socialized from a young age to be good, helpful, and low maintenance. The only way that some women have learned to receive approval is by being good, helpful, and low maintenance, and if they are not, they fear that something terrible will happen to them.
On the surface, it appears to be great, honorable, and desirable. However, there is dread hidden behind this high-functioning anxiety. Most women with this pattern report being exhausted, having a short temper, feeling estranged from their loved ones, and feeling that they are working hard to keep up a charade and are not really living their lives.
But on top of their career and professionalism, many women are also dealing with an invisible load to manage their household, family, and relationships. Managing to remember everything, anticipating others’ needs, keeping the peace- this extra layer can keep the woman’s anxiety switch constantly turned on.
How it affects relationships and everyday life
High-functioning anxiety typically follows a person and is evident outside of work in all of their relationships. Even if a woman appears to function well at work, her relationships with her partner, children, family, and friends can reveal an anxious and worried person. Sometimes her anxiety is so obvious that even she does not realize how it affects those around her. Her loved ones feel her distance and do not understand what is going on with her.
Perfectionism, people-pleasing, and burnout
- Perfectionism: Often, individuals with high-functioning anxiety set up impossible standards for themselves and then criticize themselves for not meeting them.
- People-pleasing: High-functioning anxiety can also cause individuals to spend way too much time worrying about how other people perceive them. This can lead to chronic fatigue, a feeling of being overwhelmed, and burnout.
You do not have to give up ambition in order to have peace in your life. The support you need to better function will actually help you to keep functioning and to thrive as well.
Myths about high-functioning anxiety
Myth: High-functioning individuals with anxiety are anxious but able to function. Therefore, they are not anxious at all. Therefore, they do not need to seek help for anxiety. In reality, high-functioning individuals with anxiety are often very anxious but able to function well in order to hide their anxiety. Thus, functioning and thriving are not the same.
Many women mistakenly believe that their level of anxiety is a characteristic that cannot be changed. This anxiety is learned behavior and can be “unlearned.” It takes time and support, but it is possible to break the cycle of a life controlled by high-functioning anxiety.
Myth: Therapy is for when things fall apart. Waiting for a breakdown means waiting to feel worse before you feel better. Beginning your life-changing work while you are still successful and holding together just makes the work faster and gentler.
When it might be more than anxiety
It is also possible that high-functioning anxiety is mixed with another medical condition such as ADHD, clinical depression, a past trauma, sleep problems, and even a medical illness such as thyroid disease. It would be wise to have a thorough evaluation and potentially find out if another medical condition exists that is contributing to one’s feelings of anxiety and/or worry.
A thorough evaluation by a psychiatrist, which can include testing to identify the root causes of your symptoms and potentially even med review, is sometimes necessary to rule out other conditions such as ADHD, depression, unresolved trauma, sleep disorder, or thyroid disease that can present with identical symptoms of high-functioning anxiety and actually be masked by it.
What actually helps with high-functioning anxiety
Therapy for high-functioning anxiety tends to be most effective when a combination of approaches is used. Of course, this all begins with therapy. In sessions with me, we explore the origin of your high standards and what you think will happen if you fail to meet them. We examine how you cope with anxiety and explore ways to help you tolerate things that make you uncomfortable on a temporary basis. CBT (cognitive behavioral therapy) and ACT (acceptance and commitment therapy) are two very effective approaches to anxiety and are often combined with strategies for the physical symptoms of anxiety and learning to set healthy boundaries.
I have teamed up with the psychiatrist Dr. Reddy for this reason: we both specialize in high-functioning women. Dr. Reddy evaluates, treats, and prescribes, including for ADHD as needed, while at Psychotherapy for Young Women, my team and I do the specialized therapy work to help women unlearn their current core beliefs that run to perform in order to live and to develop a good relationship with themselves that does not have to rely on constant achievement. It is very effective work when done by both parties.
You might be interested to know how the first few sessions of therapy work. Essentially, we are trying to get to know you and all that is going on for you. We explore how things have come to be as they are and how you would like things to be instead. We then work from there to build up a plan of work that would be suitable for you to work at your own pace, completing sessions which are aimed at slowing you down, exploring your struggles in more depth, looking at new ways of thinking and/or behaving, and practicing them within the sessions.
For some women, it is important to include a particular brand of medication in their treatment plan as it helps lower their normal anxiety level so that they can more easily learn to use new ways of coping in session. Usually, a physician who also knows about a woman’s history of treatment for anxiety is best to determine whether or not certain medications would be helpful.
Small things you can try this week
- Start to notice the pattern in yourself of preparing over and over, rehearsing conversations, etc. Each time this happens quietly in your head, say “that is the anxiety.” Try to distance yourself a bit from your worries.
- Try doing one thing that is good enough. Send the email with one less edit. Listen to a song with an unsyncopated rhythm. Change out of formal clothing as soon as possible at the end of the workday.
- Schedule “rest time” like you would any other meeting! Write it in your calendar and treat it as you would any other appointment.
- Say a slower yes. Use “let me check, and I will get back to you” instead of automatically agreeing to something.
- Give your worries some space. Set aside 10 minutes and write down all of your worries and then close the notebook and put it away.
- These are all places to start, but the root of high-functioning anxiety is deep and takes time and support to work through.
Common questions about high-functioning anxiety
1. Is high-functioning anxiety a real diagnosis?
While often used to describe this form of anxiety, “high-functioning anxiety” is not an actual medical diagnosis and can often be associated with recognized anxiety disorders such as Generalized Anxiety, Panic Disorder, Social Anxiety, etc. That being said, a trained, licensed clinician can attempt to determine if one is suffering from an Anxiety Disorder and treat them accordingly.
2. Can I have anxiety if I am successful?
Yes, it is common for high-achieving women and men to experience anxiety. Being high-functioning does not mean that everything is fine and it is not costing you anything. In fact, the reverse is true for many high-functioning, over-achieving individuals.
3. Does high-functioning anxiety go away?
Anxiety is treatable. Many women discover that with support, they can manage their anxiety while retaining all of the qualities that make them so driven and the things that they love about themselves.
A closing thought
Even if you are functioning well and reaching your goals and aspirations, you can deserve support for anxiety. High anxiety affects so many women who are doing well in life and are able to maintain their health, relationships, jobs, and overall lifestyle and quality of life. Understanding how your high functioning is connected to your suffering is a good place to start to work through your issues.
And if in crisis or feeling unsafe at any time, please call or text 988 in the US.
About the author
Claudia Giolitti-Wright, LMFT, founder and clinical director of Psychotherapy for Young Women, a boutique psychotherapy practice for Gen Z and Millennial women in NYC. More about Psychotherapy for Young Women here.
