High-functioning anxiety isn’t a formal diagnosis, you’re not going to find it in the DSM. Despite this, it’s a very apt phrase describing something a lot of people recognize in themselves but oftentimes minimize despite feeling like they are struggling tremendously on the inside: getting everything done, often better than the people around you while feeling very anxious on the inside.

From the outside, it looks like success. You’re prepared, reliable, and on top of things. People come to you when something needs handling. From the inside, it can feel like you’re running a little too fast all the time, and that if you slowed down, something would fall apart.

What high-functioning anxiety looks like

Because it doesn’t stop you from functioning, it rarely looks like what people picture when they think of anxiety. There’s no panic in the hallway, no avoiding work. If anything, you do more.

Some of the signs I most often hear about include:

• Over-preparing for things that don’t need it, and feeling uneasy if you can’t
• Finding it hard to delegate, because it’s easier to do it yourself than to worry about whether someone else will
• Replaying conversations and emails afterward, checking for anything that landed wrong
• Trouble resting. Time off feels restless or faintly guilty
• A knot in your stomach on Sunday evenings (aka “Sunday Scaries”)
• A tight jaw, shallow breathing, or trouble sleeping that you’ve come to think of as normal
• Needing to be the one who has it together, in almost every setting

None of these by themselves mean much. It’s the pattern, and how long it’s been going on, that matters.

Why it’s so easy to miss

The biggest reason is that it works, at least for a while. The anxiety keeps you prepared and careful, and those qualities get rewarded. Promotions, good reviews, a reputation as the person who can be counted on. It’s hard to see something as a problem when it keeps being praised.

It’s also easy to miss because it doesn’t match the story people have about themselves. Many of the people I work with are the ones others lean on: the physician colleagues call when something’s gone wrong, the partner at the firm, the sibling who handles things when a parent gets sick. Struggling doesn’t fit that picture, so it tends to stay private, sometimes even from themselves.

And there’s a particular kind of isolation that comes with it. When you’re the capable one, people don’t often ask how you’re doing. Usually you don’t give them much reason to.

“But the anxiety is what makes me good at my job”

The worry I most often hear when people start thinking about changing any of this is, “Being anxious has been part of how I got to be so successful, what’s going to happen if I let it go?”

The reality for most people is that they got where they are through smarts, judgment, and care. The anxiety has been riding along with those qualities, and it’s gotten a lot of credit it didn’t earn. When it quiets down, people usually don’t lose their edge. They lose the exhaustion that came with it, and they often make better decisions, because they aren’t making them under constant pressure.

That’s not something anyone takes on faith. It’s something you find out by trying small changes and seeing what happens.

Where it comes from

For many people, the roots go back a long way. Sometimes it’s a household where love or approval seemed to depend on performance. Sometimes it’s being the responsible kid in a family that needed one. Sometimes it’s a temperament that has always noticed what could go wrong.

Knowing where it started doesn’t fix it on its own, but it often changes how people feel about it. It’s easier to be patient with a pattern once you understand it was a sensible answer to something, even if it’s outlived its usefulness.

What helps

A few things tend to make a real difference.

Start noticing the difference between preparation and reassurance. Preparation improves the outcome. Reassurance just calms you down for a little while, like reading the email a fifth time before sending it. When you catch yourself doing something for reassurance, try doing it one less time and see what happens. Usually nothing does. This can be easier said than done – checking and rechecking can become almost like an addiction so if you try this (or any of the ideas in this section) expect to have a bit of a spike in your anxiety. The goal here is to teach your body that doing less doesn’t lead to the catastrophic outcome it may anticipate.

Try small experiments with doing less. Hand off one task you’d normally keep. Send something when it’s good, instead of when it’s perfect. Leave on time one day a week. Pay attention to what actually happens, as opposed to what the anxiety predicted.

Let rest be rest. Many people with high-functioning anxiety only let themselves stop once everything is done, which, of course, it never is. Realizing and accepting that you will probably never get fully caught up and that a little time for yourself here or there is not going to cause you to slide further down the hill. Time off that you don’t have to earn is one of the harder habits to build, and one of the more important ones.

Pay attention to your body. Anxiety that you’ve gotten used to in your thoughts often still shows up physically: in sleep, in your stomach, in the tension you carry around. If sleep is where it hits hardest, my post Why Can’t I Sleep? goes into that. And if the anxiety tends to show up as thoughts that loop, How to Stop Overthinking may be useful.

When it’s worth talking to someone

The National Institute of Mental Health describes generalized anxiety disorder as excessive worry most days for at least six months, along with things like restlessness, fatigue, trouble concentrating, and poor sleep. Plenty of people with high-functioning anxiety meet that description and have never thought of it that way, because they’re still getting everything done.

You don’t need a diagnosis to benefit from help, though. If you’re tired of running this way, or you’re starting to notice what it’s costing you in your health, relationships, or simple enjoyment of your life, that’s reason enough.

A lot of my work in individual therapy in Bethesda is with people who look, from the outside, like they have it all together. Therapy gives you a place where you don’t have to be the capable one for an hour. If that sounds appealing, get in touch through my contact page. We can talk about what you’re carrying and how you might keep what’s working about it without it running the show.