When you say the word anxiety, you probably just shrug your shoulder and think “we all have it, sometimes.”

And, you’re right. Anxiety is a very normal part of life. Anxiety is a response to stress and as humans, we are programmed to respond to stressors to get things done; finish the project, make a big decision or go for that last minute errand run. However, “regular anxiety” comes and goes. Anxiety that creeps in under your skin, into your thoughts and starts tiring your body is one that may develop into a disorder.


According to the National Institute of Mental Health, approximately 19% of American adults are diagnosed with an anxiety disorder. Anxiety disorders include Generalized Anxiety Disorder, OCD, PTSD or phobia related disorders. However, High Functioning anxiety doesn’t fall into a specific category.


The main difference between high functioning anxiety and regular anxiety is that one gets a “diagnosis”.

Diagnoses are all based off the Diagnostic & Statistical Manual of Mental Disorders. To be diagnosed with an anxiety disorder you need to meet a specific criteria which include: feeling worried, anxious, irritable, restless, have trouble sleeping and experience muscular tension for at least six months. But that’s not it, these issues need to be causing a substantial level of interference with your daily life in order for you to get a diagnosis.

However, since those with High Functioning Anxiety present as exactly that- “high functioning” their struggles are masked from the outside world, and their need for support, unseen.

The hidden but painful struggle- high functioning anxiety

They’re putting a smile on their face, getting their kids off to school and getting their tasks done, but it takes herculean effort and double the mental energy than someone without anxiety.

In a world like today, where being “busy” is popular, our glasses get foggy when determining who may really be suffering from anxiety, instead of calling it “a go-getter” personality.

Sometimes, it’s the seemingly “go-getters” who get lost under the radar because they are so skilled at keeping things rolling, contained and running smoothing. However, even though they may be dotting their I’s and crossing their T’s, showing up to their kids baseball league games and attending promotional events, they may be feeling a sadness, a lessening of joy and an overall reduction in their quality of life.

Here are 8 things people with high functioning anxiety would love for you to know:

1) “I’m good at surviving, but it’s tiring”

Just because I seem to be making it through the day, doesn't mean I'm not experiencing distress.

“You may wonder why I am tired at the end of a “regular” day, but my mind is like a bee-hive and I’m juggling a lot more than just my daily tasks. The worry in my brain is like a gas petal pressing on the gas all day long, and when I can finally sit down, I am not able to be “on” my game.”

I may need breather or some alone time and I don’t need to explain it.

If your’e the one with anxiety, you know that one of the first steps to pulling the reins back on high functioning anxiety is learning to slow down, practice breathing and shift your thoughts. In order to do that, you’ll probably be making changes that others around you will notice, and may make some comments. You don’t need to excuse yourself, but rather stay steady and fiercely protect the steps you need to take, or boundaries you need to set so you can help your anxiety levels lower.

2) I don’t just need a vacation!

“You may have the ability to bounce back to your regular, energized self after coming back from a spa-getaway or a weeklong vacation, but I’m not like that. My mind and body still have these symptoms wherever I go, so your well meaning comment of “just go on vacation, you’ll feel much better” just lets me know that you really just don’t understand. I am going to take time off when I need, all the while taking care of my anxiety in the ways I need so I can feel calm and balanced in my day to day life.”

3) It isn’t just perfectionism; it’s code word for safety.

Anxiety goes hand in hand with perfectionists, over-thinkers, and type A personality structures who put incredible pressure on themselves to excel in all areas of life; professionally, at work, in school, in their love lives and have a high bar in parenting. The anxious mind sees mistakes as failures and equates human, {expected} mess-ups to catastrophes. No one chooses to live this way, and perfectionism is often a desperate attempt to control and manage the fear that is beneath all of the pressure.

At the end of the day, it isn’t really about the failures disappointments or losing respect in other people’s eyes, it’s about safety.

“If I’m anxious, it means I’m feeling unsafe.

It can be because my brain and nervous system are extra sensitive and I overthink things, it could be because I have a history of trauma or am carrying some family-of-origin beliefs that are weighing me down. But, please see this as a responsible attempt to find relief from the fear. I don’t want to live with rigidity forever, but I am this way while I do my work to get better.”

4) Just because it’s invisible, doesn’t mean it isn’t real.

One of the most isolating aspects of having high functioning anxiety is that others dont seem to “get it” because it isn’t “obvious”. Just like having depression is different than being in a wheelchair, having anxiety is the same. All conditions that impact ones ability to live, love and engage are valid, regardless if they are visible or not.

“Try to do your best to understand that I am struggling. My brain wiring is different, and even though you cant see my brain scans, they look different from someone whose mind is calm.”

Validation goes a long way in supporting your high functioning loved one or friend. As Jill Bolte Taylor has been quote, “just like children, emotions heal when they are heard and validated.” By listening authentically, being curious and wanting to expand your understanding of how someone with anxiety functions, you offer a sense of healing and compassion. And that is a true gift.

5) Be Patient with me

“I know you wish I can just “snap out of it” but I’m doing my best. I might even be attending my yoga class, eating organic, sniffing essential oils and spending time with the best of people, and some days I’m on my game and other days I struggle. I may be attending therapy and trying a new prescription my doctor suggested, and it’s taking time to see if it’s being effective. I am doing my best to be patient with this condition, and you being patient goes a long way, and offers heaps of support. “

6) I’m learning to appreciate the gifts I come with..I’d love if you can too.

“Being sensitive and easily affected by stressors can be tough, but it has also taught me how to be more empathetic, humble and compassionate. It’s made me into a deeper person and I’d love if you’d see that I’m a package deal. We all have struggles, and often, our struggles change us in ways that are good as well. I learning to se the bright side of this, and I hope you can too!”

7) Don’t Be Jealous

“I’d love to kick my feet up and sometimes worry a bit less. Laugh a bit more. Trust the process or space out for more than five minutes”. We all have personality types and different brain structures, don’t be jealous of the perks I have, and please don’t mock me for working so hard when you’re programmed differently. “

Though high functioning anxious people may be more productive and get much done, it comes with a cost. Remember, anxious overachievers come in many presentations; It may be the stay-at-home mom next door, your over-achieving best friend, or high power attorney sister- who all seem to “get things done so well” but struggle with anxiety.

8) My “day-off “is bliss, don’t tell me to make it different

“Your days off seem to be full of activity, social engagement and a laundry list of sites to visit. Mine? A warm cup of tea and a slow read on the sofa, with a late afternoon walk with a loved one. I’m not boring, I’m just different. Just because my brain is focused, and uber attentive at work, it does not mean I have to, or want to be like that at home. I need my down time to nourish and replenish me, and that’s ok. Don’t call me antisocial, a hermit or old. I do what’s good for me.”

If you’re the one struggling with high functioning anxiety, know that there are many out there with these symptoms. They are real and they are hard, and they are treatable!

The earlier you address the issue, the sooner you’ll be able to reduce your high-functioning anxiety symptoms. No matter how severe or light your symptoms are, learning skills and reaching out for support will go a long way in living a better life.

Some tips for dealing anxiety begin with identifying “stinkin thinkin” also known as catastrophic thinking and dialing it back. Your mind and body need to re-learn how to deal with worries, stressors and change. You may also want to integrate mindfulness activities, listen to relaxation techniques and create daily routines that keep you grounded. .

Psychotherapy treatment has proven to be effective for treating anxiety using cognitive behavioral therapy, Eye Movement Desensitization Reprocessing, Psychodynamic Psychotherapy and Expressive Arts, amongst a few science based modalities.

You may also combine therapy with medication to get best results in your treatment. Anxiety is totally treatable, and as soon as you begin addressing the underlying core, you’ll start experience relief and clarity.

For those of you who know someone with anxiety, you play a big role too!

Research proves that those with emotional support achieve greater gains in emotional healing than those who don’t have the support.

We all go through ups and downs, and the best we can do is show up for ourselves, and each other, with compassion, curiosity and care.

*originally posted on integrativepsych.co


Esther Goldstein LCSW is psychotherapist and trauma specialist who runs a private practice called Integrative Psychotherapist in Cedarhurst, NY. At Integrative Psychotherapy we are passionate about helping adults reduce anxiety and find a richer way of living, loving and "being" that promotes joy and connection. Our therapists use science based methods and modalities such as psychodynamic psychotherapy, Eye Movement Desensitization Reprocessing (EMDR) Sensorimotor Psychotherapy (somatic), Expressive Arts and Parts work (Ego State Work) to help clients feel relief that last way beyond their time on the therapy couch.

Specialties include treating anxiety, trauma survivors, relationships issues, family-of-origin work, Inner-Child work, Attachment focused Therapies, Healing for Complex PTSD And Dissociative Disorder Treatment.

We also offer Trauma Informed Consultation To Therapists Committed To Improving Their Trauma-Informed Practice And Attachment Focused EMDR Consultation To Therapist Attaining Hours Towards EMDRIA Certification.

Website: Integrativepsych.Co