Would it surprise you to know that some successful individuals—such as students who always ace their tests, employees who exceed performance expectations, or business people who run very profitable companies—experience high levels of anxiety?  That they feel insecure, constantly fear falling behind their peers, and cannot stop worrying about what other people think of them?  Or that they get panic attacks, experience chronic muscle tension, and have sleep difficulties?

But this is true.  These individuals have what is called “high-functioning anxiety.” In this article, we explore what high-functioning anxiety looks like and when and how it should be treated.

High functioning anxiety and psychological disorders

People with high-functioning anxiety are often described in positive terms: As hardworking, productive, high-achievers, and perfectionists.  They appear calm, collected, and always on top of things.  Indeed, they look like they have it all.

However, that is not the whole truth.

On the inside, individuals with high-functioning anxiety tend to feel tense, restless, and irritable.  They overthink things, are terribly afraid of failure, find it difficult to delegate tasks and get furious when events do not go as planned.

But do these symptoms, you might wonder, indicate an anxiety disorder?  Not necessarily.

In fact, high-functioning anxiety is not a mental health diagnosis—for example, it is not in the DSM-5, the diagnostic manual of the American Psychiatric Association.  Why?

Partly because a key criterion for the diagnosis of anxiety disorders is functional impairment (i.e. limitations in daily life).  Even though many individuals with high-functioning anxiety show symptoms of psychological disorders (e.g., obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder), most can function well, at least at work or at school, which means their symptoms may not meet the criteria for a diagnosis of a psychological disorder.

Helping those with high-functioning anxiety

Before discussing treatment, let us be clear: Not all anxiety is bad.  While too much anxiety or anxiety over things we cannot control (e.g., another person’s mood, organizational changes in the workplace) is unhelpful, the right amount of anxiety could be beneficial.  For instance, research suggests that for motivated, emotionally intelligent, or skilled employees, anxiety can improve performance.

But if anxiety causes distress or functional impairment, then a disorder may be present.  And some high-functioning anxious people do experience distress or impairment, particularly in non-work domains.  For example, many have a limited social life.  As psychologist Lawrence Needleman notes, “success driven by anxiety can be at the expense of functioning well in other areas, like relationships.”

Furthermore, high levels of anxiety could take a toll on one’s health, increasing the risk for emotional burnout (i.e. emotional exhaustion and loss of motivation) and numerous types of physical health problems (e.g., heart disease), and mental illnesses (e.g., substance use disorders).  In these cases, treatment may be recommended.

A variety of treatments, such as cognitive-behavioral therapy (CBT),3 help reduce anxiety.

To illustrate, some effective interventions and techniques for dealing with specific symptoms of high-functioning anxiety are listed below.

  • Psychological symptoms (e.g., perfectionist tendencies): Identifying and challenging cognitive distortions, such as all-or-nothing thinking, filtering out the positive, and making “should” statements.
  • Somatic symptoms (e.g., muscle tension): Breathing techniques, progressive muscle relaxation, and biofeedback.
  • Insomnia: Sleep hygiene, stimulus control therapy, and sleep restriction.
  • Unhealthy coping (e.g., alcohol and drug abuse): Using healthier coping strategies, such as exercise, mindfulness meditation, and problem-solving techniques.

So, if you have high-functioning anxiety, know that effective treatments are available.  And these interventions can reduce your anxiety and help you function more effectively—and not just at work, but also in intimate and social relationships.