What Is High-Functioning Anxiety? How to Tell If You Should Worry About Your Everyday Worries

On any given day, there are probably dozens of worries, big and small, that race through your mind: Can I make this deadline? Is my sick family member going to be OK? Did I shut off the stove? Is my friend mad at me?

Despite this steady stream of concerns, you always manage to make your train on time, plow through your workload, and check off the items on your to-do list — all while maintaining a calm exterior demeanor.

If this sounds like you, you might be dealing with high-functioning anxiety, a condition in which you experience the symptoms of anxiety, such as persistent feelings of fear, unease, or worry, while still successfully managing all the demands of daily life.

High-functioning anxiety isn’t a recognized clinical disorder — it isn’t included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — but that doesn’t mean its impact isn’t felt.

“The chronic stresses, worries, and anxiety that people feel are real, and their symptoms are valid,” says Dr. Jacques Ambrose, a psychiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center. “The stress and suffering people feel come at a cost to their overall well-being. And when it becomes disruptive and impairing, that’s when it can be formalized to a diagnosable disorder according to DSM.”

But if you’re able to keep it all together, how can you tell if the level of anxiety you feel is “normal,” and what can you do to help keep it in check? Health Matters spoke with Dr. Ambrose to learn more about the signs of high-functioning anxiety and what to do if you think your anxiety is getting more severe.

To be sure, a certain degree of anxiety in life is to be expected. “When you’re experiencing a stressful situation, in theory you would have a stressful response, like anxiety, and feel like you’re on edge a bit,” says Dr. Ambrose, who is also an assistant professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons. “It can even be used as a tool to help motivate and galvanize you to get work done. At the same time, you need a balance of making sure that energy, that motivation, is not impairing another aspect of your well-being.”

It can be hard to detect the toll of stress and worry on people with high-functioning anxiety because they tend to keep it to themselves while maintaining a calm facade. “They’re often really well-performing at work or school, but will still report a lot of worries and mood symptoms,” says Dr. Ambrose, who has treated investment bankers, corporate executives, physicians, and high academic achievers with the condition, among others typically deemed highly successful by society. “I’ll often ask patients, what is prompting you to be a perfectionist or really hardworking? Oftentimes, the person will tell me — and I hear this all the time from very high-functioning folks — that it’s because they worry something bad is going to happen or that people will think badly of them.”

Because everyone’s ability to deal with stress is different, the key to gauging whether high-functioning anxiety may be turning into a diagnosable anxiety disorder is when the anxiety starts interfering with your ability to carry out your activities. “When the stresses exceed the person’s ability to cope with them and reach a degree of intensity that you’re no longer able to do the things you need to do, that’s when the anxiety can become more severe and impairing,” says Dr. Ambrose.

For example, an executive may use their perfectionism to create excellent work presentations, but it starts to become impairing if they spend three hours a day obsessively checking and rechecking for typos. Or a student with a big exam coming up may feel a certain level of nervousness that helps them prepare better, but when that nervousness causes them to lose sleep every night to the detriment of their grades, it’s become a hindrance.

“Those should serve as red flags. When your physical health isn’t doing well or it’s beginning to impact your productivity, then anxiety is no longer a useful tool,” says Dr. Ambrose.

If left untreated, there are a number of diagnosable anxiety and mood disorders that high-functioning anxiety could lead to. Dr. Ambrose points out some of the more common ones:

Generalized anxiety disorder is when you experience excessive anxiety and worry more days than not for at least six months. Generalized anxiety disorder interferes with your ability to function and get things done.

Social anxiety disorder is a constant fear that what you do or say will be criticized or scrutinized by others, which leads you to avoid social settings.

Major depressive disorder causes persistent feelings of sadness or a sense of worthlessness that can make you lose interest in regular activities.

Obsessive-compulsive disorder causes chronic and uncontrollable recurring thoughts or repetitive behaviors that feel excessive, intrusive, or unreasonable.

If you think you have high-functioning anxiety that is bordering on becoming disruptive or unbearable, Dr. Ambrose suggests a few tips to help manage it.

Watch your symptoms. Self-awareness is important because those with high-functioning anxiety often don’t make the connection between their symptoms and their chronic stresses, explains Dr. Ambrose. Sometimes the symptoms are physical, like chronic headaches, upset stomach, or trouble sleeping. But they can also include mood changes or feeling like your situation and responsibilities are untenable. “If you’re beginning to develop thoughts like, ‘This is too stressful,’ or ‘I just can’t handle this anymore,’ that is a red flag and a sign to reach out and get care,” says Dr. Ambrose.

And give credence to what those close to you say, as they may recognize symptoms you don’t see in yourself. If they’ve noticed, for instance, that you are more irritable than usual or don’t seem to be sleeping well, take it seriously.

Weigh the pros and cons of your decisions. People with high-functioning anxiety, especially in high-stress professions, often feel like they have no control over their situations. But talking through your options and their potential impact can help you recognize what choices you do have.

For example, let’s say you’re stressing over a major project at work and can’t decide whether to take a day off. Ask yourself: What happens if you do take a day off? How will that impact your goal? How will it impact your wellness? Would taking a day off actually help you return to work more refreshed and productive so you can still meet deadlines?

“We bring the well-being cost into their decisions,” says Dr. Ambrose of how he works through these questions with patients. “Weighing all the pros and cons helps empower the person and gives them more agency and control so that they can make a more informed decision.”

Set realistic guardrails. It’s important to establish attainable guardrails to help keep your stress in check — otherwise, you’re just creating more pressure on yourself to complete yet another difficult task. “Creating situations in which people can actually succeed and feel like they have a chance of creating an adaptive change is really, really important and therapeutic,” says Dr. Ambrose. Below are examples of setting realistic guardrails.

• If you work long hours every day of the week, pick one or two days where you work a shorter workday. If that’s not practical for your work situation, aim to incrementally reduce the number of hours you choose to work a week.
• If there are particular worries that take up a lot of your thoughts during the day, consider scheduling a specific “time to worry” when you can make plans to help address them. Making the appointment with yourself may not completely get rid of the worrying, but it can help train your brain to make it less intrusive throughout your day.
• Not everyone can pause their day to spend an hour doing yoga, meditation, or another stress-reducing activity. Consider fitting in short and frequent activities throughout your day that allow you to disconnect from what’s causing you stress, like giving yourself 10-minute blocks of time to stand up and stretch, or going for short walks. Even small increments of activity can provide a much-needed mental health break.

Seek professional help. “Just the way you wouldn’t wait until you have a heart attack to proactively address your cholesterol levels, we hope that people don’t wait until things are catastrophic to seek care for their mental health,” Dr. Ambrose says.

Unfortunately, all too often people don’t get the help they need: An estimated 31% of Americans will have an anxiety disorder at some point in their lives, but just over a third of those with an anxiety disorder actually receive treatment.

Working with a mental health professional can help you build awareness of how you’re coping with anxiety and help you explore different types of therapies — for example, cognitive behavioral therapy or mindfulness practices — for when it starts to feel like too much. But only a psychiatrist can help determine if medication should be part of your treatment, or if another medical condition, like hyperthyroidism, is a cause or a contributing factor to your anxiety.

“Mental health is a core component of everything we do,” Dr. Ambrose says. “Most people tend to have an easier time caring for others. I hope people can cultivate a sense of empathy for themselves and realize that they are also well-deserving of the same care and support.”

Dr. Adrian Jacques Ambrose is assistant attending psychiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center, assistant professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and senior medical director of the Psychiatry Faculty Practice Organization at Columbia University. He subspecializes in managing treatment-resistant mood disorders for adults, children, and adolescents. Dr. Ambrose has also served as a senior consultant for corporations and management leaders in diversity, equity, and inclusion program development; wellness promotion; and burnout prevention.