Simone thought she was exhausted and burnt-out. But her high-functioning anxiety was going unnoticed | Ashwini Padhi

High-functioning anxiety is a term that describes a paradox faced by many. On the outside someone may appear to have everything under control but inside they’re battling a relentless undercurrent of worry, fear and doubt.

Unlike other forms of anxiety that can cause obvious disruptions to everyday life, high-functioning anxiety often goes unnoticed by others, sometimes even by the person experiencing it.

It’s the silent battle of the overachievers, the perfectionists and the seemingly balanced people who are privately exhausted from managing their inner turmoil.

The mask of high-functioning anxiety

One of the reasons high-functioning anxiety is so hard to detect is because it often presents itself as a set of positive traits. People with this form of anxiety might be highly driven, organised and detail-oriented. They often excel in their careers, are dependable friends and may always seem on top of their responsibilities. But beneath this polished exterior lies a different story. Something that Simone* knew all too well.

A successful banker and mother of three, Simone first entered my office for her therapy session thinking she was overwhelmed and burnt-out from juggling too much in her life. But, as we delved deeper, it was obvious that Simone was constantly on edge, even though to her colleagues and friends she appeared calm. Her mind would constantly race with worst-case scenarios, what-ifs and fears of failure. She was a perfectionist at work and at home, not because she was solely striving for success but because she was terrified of making mistakes and failing as a corporate worker and as a mother.

High-functioning anxiety manifests in a range of symptoms and traits that can be emotionally draining. Individuals often measure their success by society’s standards, leaving them feeling dissatisfied even after significant achievements. They’re highly sensitive to criticism and rejection, constantly comparing themselves with others in a never-ending treadmill of self-doubt.

Hypervigilant and prone to over-planning, they prefer to be in control but frequently take on more than they can handle. Boundaries can become blurred as they struggle to say no and their emotions are often charged. This form of anxiety can stem from early attachment issues, such as abandonment or growing up in environments where parents placed exceedingly high expectations on them. These deep-rooted dynamics fuel an ongoing struggle to meet impossible standards, leaving them emotionally exhausted despite outward appearances of success.

The praise they receive for their achievements can often feel hollow because they know that, behind the scenes, they’re struggling to keep everything together – and this can be exhausting. There’s a constant need to be productive, to prove oneself and to avoid failure at all costs. This perpetual state of hyper-alertness leaves little room for rest or relaxation. Over time, this can lead to burnout and, in some cases, the anxiety can become more pronounced or develop into more debilitating mental health issues, leading to a breakdown.

Why high-functioning anxiety often goes unnoticed

High-functioning anxiety doesn’t always fit the stereotypical image of someone struggling with anxiety. When we think of anxiety, we often imagine someone who is visibly stressed, withdrawn or unable to cope with everyday tasks. But individuals with high-functioning anxiety often do the opposite – they overcompensate. Their anxiety manifests as a desire to stay busy, to overachieve and to maintain control over every aspect of their lives.

Friends, family members and colleagues may be unaware of the internal struggles of someone with high-functioning anxiety because there are no obvious signs of distress. Even healthcare professionals can miss it during routine check-ups, as people with high-functioning anxiety often don’t realise they have a problem, or they might downplay their symptoms. They believe their achievements should negate any sense of unease or fear and so they continue to push forward, dismissing their anxiety as “normal” or “just life stress”.

The impact on daily life

While high-functioning anxiety may not prevent people from completing their tasks, it does take a toll on their mental and emotional wellbeing. Constantly living in a state of heightened anxiety can lead to physical symptoms including fatigue, muscle tension, headaches, digestive issues and difficulty sleeping. There is also the mental burden of feeling as though nothing is ever good enough, no matter how much is accomplished.

Social relationships can also suffer. Someone with high-functioning anxiety may struggle with impostor syndrome, fearing they’ll be “found out” as a fraud, despite their success. They might avoid situations where they feel vulnerable or they may put pressure on themselves to always present a perfect image. Over time, this can lead to isolation, as they push people away out of fear of being judged or misunderstood.

One of the most significant challenges in dealing with high-functioning anxiety is recognising that it’s a problem in the first place. Because it’s so closely tied to positive qualities including productivity and organisation, it can be hard to distinguish when normal stress has crossed the line into something more harmful. There are a few key signs to look out for:

1. Constantly feeling on edge or overwhelmed

2. Difficulty relaxing or unwinding

3. Ruminating on past mistakes or worrying excessively about future scenarios

4. Perfectionism, so even small mistakes feel like personal failures

5. Physical symptoms including tension headaches, digestive and stomach issues or insomnia.

Seeking professional help

The good news is that high-functioning anxiety, like other forms of anxiety, can be managed with the right tools and support. Mindfulness techniques, including meditation and breathing exercises, can also help to calm the mind and reduce the constant need for productivity.

It’s also important to reframe the way we think about success and productivity. High-functioning anxiety often stems from a fear of failure or a need to prove oneself. Learning to accept imperfection, set boundaries and prioritise self-care is important. This doesn’t mean giving up on ambition or goals but recognising that rest and relaxation are equally important for long-term success.

With Simone, we worked on cognitive restructuring to help her reframe negative thoughts. We also explored her core beliefs and identified activities she enjoyed outside family and work, ensuring she made time for them. Simone kept a diary of her thoughts and emotions over several weeks, which helped guide discussions on setting healthy boundaries. For her this meant recognising that it was OK to say no to extra work tasks and social events. Improving sleep patterns, focusing on balanced nutrition and prioritising self-care all contributed to reducing her anxiety.

High-functioning anxiety is not something that should be glorified, even though society often rewards those who push themselves to the limit. While it may seem that having anxiety is part of what drives success, the reality is that it can be harmful to our mental health. With awareness, compassion and the right tools, high-functioning anxiety doesn’t have to go unnoticed or untreated.

*Name has been changed for privacy, and Simone’s story is an amalgam of several cases

Dr Ashwini Padhi is a psychiatrist at South Pacific Private, a trauma, addiction and mental health treatment centre