I think of “high functioning anxiety” as the kind of anxiety that is usually well concealed. I have heard it described as “anxiety hidden behind a smile and the outward picture of success.” It is the person who may appear calm, successful and very well put together on the surface, but internally they are in significant distress. It is common for it to be the type of anxiety that can be channeled into propelling individuals toward career and financial success and can be associated with several positive characteristics. However, while it may look like ambition is the driving force, it is actually usually crippling fears of failure, of disappointing others or making a mistake or “impostor syndrome” that is driving the achievement. The unfortunate consequence then becomes that no amount of success is rewarding or lowers the anxiety. If you don’t address the underlying distorted beliefs, then no amount of outward achievement will resolve the inner feelings of distress, anxiety and seeking of external validation. Individuals with high functioning anxiety are often objectively successful on paper but may tend to feel empty, overwhelmed and constantly worried and preoccupied. Essentially it is hard to ever feel satisfied or to slow down.


​In my practice I see a huge subset of high achieving and successful professionals in demanding and stressful fields (physicians, other mental health professionals, lawyers etc.) who may be successful in their careers but internally feel chronically anxious, overwhelmed and generally dissatisfied with their lives. These are often individuals who might be diagnosed with Generalized Anxiety Disorder (GAD). The formal diagnostic symptoms of GAD include restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances and intrusive thoughts. For others the symptoms may even be subclinical and not reach a diagnosis but still have a tremendous impact on their quality of life. In practical terms, the way this tends to play out for professionals and those with high functioning anxiety is in overthinking, rumination and chronic worry about mistakes and excessive focus on judgement and how others are viewing you. Common behavioral patterns are people pleasing, difficulty saying no, nervous habits, needing reassurance, being early and over-preparing. It can lead to a tendency to become excessively emotional or irritable when things don’t go as planned and feeling yourself be over-reactive to small changes and disruptions. It often involves excessive self critical reactions to any mistakes. The solution to feeling better becomes doing more and excelling higher and identity and sense of self become completely tied into these external validations. It then becomes difficult to slow down or enjoy relaxation or personal time because the thoughts continue to race and these individuals find it hard to ever shift out of work and achievement mode Essentially they use achievement as a way to manage the anxiety. Therefore, when not in the mode of achieving or staying excessively busy they are left with their thoughts and feelings of emptiness that they keep running from. Often this is the person who ends up needing to stay “busy” in attempts to avoid underlying anxious feelings. There is also a tendency to overthink and overanalyze social interactions and a need to put up a façade and show in social situations, thus making it hard to feel natural, present and connected in relationships. Over time it can lead the body to be so stressed and over-taxed that it can lead to excessive fatigue but difficulty sleeping and then can shift to feelings of emptiness and depression.


There are two main underlying mechanisms to this cycle. The first set are cognitive in nature and have to do with unhealthy and distorted thinking patterns and belief systems. The other mechanism has to do with how anxiety and stress works physiologically in the brain and body.


​The most common pattern and themes I recurrently see are underlying perfectionistic expectations and belief systems. Perfectionists often set excessively high goals, feel most things are not good enough, have excessive concerns about making a “mistake” and chronically doubt themselves. When your underlying core beliefs are perfectionistic it leads to over-preparing, self doubt, excessive reassurance seeking and social comparisons. It is often associated with extreme fear of failure and of making mistakes that drives people to excel but still constantly feel that they are not doing enough or need to be doing more. There are several other distorted thinking patterns or what we often refer to as “cognitive distortions” which underlie anxiety and the chronic drive for success to attempt to feel complete and lower anxiety. Essentially people attempt to manage their anxiety or feelings of self doubt or low self worth by achieving more, but they end up needing more and more and never feel satisfied. In therapy, we attempt to challenge and re-program these belief sets but often this is a long term process as the individuals identity has become tied up in productivity and busyness that he or she feel empty without it. It is a vicious cycle as the driving force that makes them feel more anxious, drained and overwhelmed is also part of how they define their sense of self so without it, they can feel lost and empty.


​The other underlying mechanism to this cycle, has to do with what we call the fight or flight response. This has to do with the impact that this low level but chronic and constant stress and anxiety have on our bodies. When we are constantly feeling anxious, our bodies are in a chronic state of mild fight or flight reactivity or diffuse physiological arousal. Put simply, the body is always in a “stress reactive mode” where the stress hormones are pumping through. This leads to several different emotional and physical consequences, especially the longer that it goes on. It is hard to slow the mind down when the body is constantly in stress mode or high alarm. This can then affect sleep which in turn affects the increased anxiety level in a vicious cycle of reactivity. People find themselves staying excessively busy because it is a way to drive their nervous and anxious energy towards a goal and then they don’t notice the underlying feelings and bodily signals of anxiety and stress. Then when they eventually slow down at the end of the day they feel increased anxiety and are flooded with all the things they have been avoiding all day. In therapy, we spend time working on relaxation skills, mindfulness and meditation skills and various ways of slowing down and learning to cope with and respond to the discomfort that surfaces when slowing down. Bottom line is what starts as high functioning anxiety can over time become much more significant anxiety that begins to interfere with functioning on a great scale.

The psychologists at Wellness Psychological Services are uniquely and expertly specialized in helping you target these kinds of fears and goals. We welcome the chance to discuss an individualized plan to meet your needs. Contact us for an appointment anytime. ​

205 S. Hoover Blvd. Ste 202
Tampa, FL 33609

(813) 563-1155

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