An Integrated Approach to Young Adult Mental Health Rehab

Young Black male dealing with high-functioning anxiety at work

High-Functioning Anxiety: What It Is and How to Cope

Reading Time: 7 minutes

When we think about anxiety, we usually think about being paralyzed with fear and worry, to the point of being unable to deal with everyday tasks. However, anxiety doesn’t always manifest that way. In fact, young adults with high-functioning anxiety are often overachievers who appear to be succeeding in every aspect of life. But on the inside, they struggle with intense stress and feelings of fear and inadequacy.

People with high-functioning anxiety typically show an enthusiastic and capable face to the world, while hiding the pain they’re feeling. That’s why dealing with high-functioning anxiety can be so exhausting and overwhelming. 

What Is High-Functioning Anxiety? 

High-functioning anxiety is not an official mental health diagnosis, because it’s not one of the anxiety disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). One of the benchmarks of anxiety disorders is that the symptoms disrupt everyday functioning. Clearly that’s not the case with this type of anxiety. Hence, it is considered subclinical, meaning it doesn’t meet the criteria for a diagnosis. 

But that doesn’t mean high-functioning anxiety isn’t real. This form of anxiety is very common in young adults, with high-functioning meaning that the person is able to manage and even excel in daily life, despite experiencing ongoing anxiety. Young adults can do well in school, succeed in the workplace, competently manage their finances and self-care, and maintain strong relationships and a busy social life—all while dealing with high-functioning anxiety.

Know the Facts

21 percent of young adults experience high levels of anxiety, up from 9 percent before the pandemic.

How Do I Know If I Have High-Functioning Anxiety?

Young adults are particularly prone to high-functioning anxiety. They’re forging their identities and careers in the face of numerous pressures. How they perform in school or in the workplace feels incredibly important, as if it might shape their entire future. And there’s also the pressure to find meaningful relationships in a time when dating has become almost like online shopping, with another choice always just a click away. 

As a result, young adults feel like they need to be their best selves all the time. And for some personality types, that can catalyze high-functioning anxiety symptoms. People with high-functioning anxiety tend to share certain traits and priorities. Some of these are typically considered positive, like being organized, detail oriented, punctual, reliable, ambitious, and loyal. However, when these traits are driven by anxiety, they can also have negative aspects.

For example, perfectionism can help you achieve your full potential, but it can also cause you to procrastinate and to constantly criticize yourself and your work. Responding to others’ needs and requests can make you a great friend or colleague. But ignoring your own needs in order to make others happy (aka people-pleasing) can lead to codependency. Self-discipline can support you to get things done. And it can also prevent you from doing things that enhance well-being but aren’t “productive,” like reading a novel or going out with friends. 

10 Questions to Identify Signs of High-Functioning Anxiety

Considering these questions can help young adults recognize the emotional and behavioral signs of high-functioning anxiety. 

  1. Do you constantly overthink and overanalyze your interactions and decisions?
  2. Are you terrified of failing or making mistakes?
  3. Do you find it hard or impossible to say “no” to a request from a supervisor, colleague, or friend?
  4. Are you always comparing yourself to others and feeling like you don’t measure up?
  5. When you think about the future, do you tend to worry about the bad things that might happen rather than what might go well?
  6. Is “perfect” the only acceptable result for you, while “good enough” means you’re slacking?
  7. Are you constantly afraid of letting others down, being rejected, or being seen as a bad friend or employee?
  8. Do you put off big projects until the last minute and then work nonstop to get them done?
  9. Are you so anxiety-ridden that you find it difficult to relax and enjoy the moment? 
  10. Do you use alcohol or substances to help you feel less anxious?

If you answered yes to most or even some of these questions, you might be dealing with high-functioning anxiety. 

Know the Facts

In a study of young adults during the pandemic, 61 percent reported moderate to severe anxiety, and 52 percent reported using drugs or drinking heavily.

Additional High-Functioning Anxiety Symptoms

In addition to the experiences listed in the questions above, signs of high-functioning anxiety may include the following physical, mental, and emotional symptoms:

  • Insomnia and mental and physical fatigue
  • Racing thoughts, inability to slow down the mind
  • Rumination—obsessing over negative thoughts and dwelling on past mistakes
  • Difficulty expressing emotions, being seen as unemotional or cold
  • Nervous chatter and/or nervous habits (playing with your hair, cracking your knuckles, biting your lip, shaking your leg)
  • Compulsions to do repetitive things (counting objects, rocking back and forth)
  • Intense need for reassurance 
  • Having an overloaded schedule or continually turning down social invitations in order to do work
  • Irritability, always feeling on edge
  • Physical symptoms of stress, such as muscle tension, hunched shoulders, headaches and digestive issues
Young adults dealing with high-functioning anxiety

Why Some People with High-Functioning Anxiety Don’t Seek Help

Many high achievers believe that without anxiety and fear of failure, they wouldn’t be motivated to perform or to get anything done at all. For example, an introvert with high-functioning anxiety may believe that if they didn’t constantly push themselves to engage in social activities, they wouldn’t have any friends. 

Moreover, people with high-functioning anxiety may believe they don’t need or deserve professional help because they’re doing fine according to all the outside measures. They might not want to tarnish their perfect image by admitting they need support. They may even be afraid others won’t take them seriously if they open up about their struggles, because they’ve never revealed their vulnerability before. Or they may think the kind of anxiety they experience is normal and unavoidable—simply part of the stress of “adulting.”

The Difference Between Good Stress and Bad Stress

The main difference between good stress and bad stress is the level of intensity. Stress in the right amount can be a motivator. When you’re confronting challenges of any kind—whether it’s a deadline, a marathon, or planning a party—stress can help you do what needs to be done. There’s even a model of the relationship between stress and performance, the Yerkes-Dodson law. Developed in the early 20th century, this model shows that performance increases with stress to a certain point. But when stress becomes too high, performance starts to go down.

Furthermore, when stress crosses over into anxiety, the net effect is negative. That’s true even when performance remains high, as in high-functioning anxiety. Pushing oneself to be as productive as possible frequently leads to mental and physical burnout. In addition, chronic stress can progress into a diagnosable anxiety disorder. Or it can lead to depression, which often occurs in association with anxiety. Without lifestyle changes and/or professional support, high-functioning anxiety will eventually take a toll.

How to Cope with High-Functioning Anxiety

Here are some approaches for dealing with high-functioning anxiety. Integrating these habits and practices into your daily schedule can help you feel less anxious and give you tools for coping with stress.

Create a daily routine that prioritizes your well-being. 

That includes building in regular mealtimes and exercise, good sleep hygiene, and breaks during your work days. Small changes, like going to bed at the same time each night or limiting your caffeine intake, can make a big difference in your level of anxiety. 

Question your thoughts. 

Notice when you catastrophize—expecting and worrying about the worst possible result. For example, “If I don’t do an amazing job on this presentation, I’ll probably get fired.” Then take a step back and try envisioning a more realistic outcome. “My job doesn’t depend on this, and I know that what I achieve will be good enough.”

Practice relaxation techniques. 

Stress and anxiety create a fight-or-flight response in the body and mind. Techniques like progressive muscle relaxation, deep breathing, gentle yoga, and meditation can help your nervous system shift into rest-and-relax mode, naturally decreasing your anxiety.

Examine your attachment to your anxiety. 

Are you holding onto your anxiety because you believe it’s helping you perform better? Could it actually be holding you back? If you’re able to perform at high levels even while dealing with high-functioning anxiety, you’re probably naturally high-achieving, energetic, and competent. Imagine how much more you could do if you were motivated by enjoyment and a sense of purpose, rather than by fear and worry.

Find positive substitutes for unhealthy coping mechanisms.

Party drugsalcohol abuse, and distractions like social media may seem helpful in the moment, but they actually create more stress on the body and mind. Instead, develop a go-to list of healthy ways to deal with moments of intense anxiety, like taking a walk, taking a hot shower, doing something creative, or calling a supportive friend or family member.

Be compassionate with yourself. 

Achievements can boost self-esteem, but studies show that building self-compassion is actually more beneficial for mental health. Self-compassion means being kind to yourself, just as you would be to a good friend. It means offering yourself reassurance, acceptance, and caring even when—especially when—you feel self-critical and insecure. 

Share your experience with others. 

The pressure to be perfect is part of what drives high-functioning anxiety. The more honest you are about your own struggles with anxiety, the less alone you will feel. Whether you talk with friends about it or attend a support group, you are likely to find others who understand and relate to what you’re going through. Being open about your high-functioning anxiety symptoms also helps reduce the stigma around mental health conditions.

How to Treat High-Functioning Anxiety

Strategies like the ones listed above can be very beneficial. However, dealing with high-functioning anxiety should also include working with a mental health professional. Here are some therapeutic modalities that are proven to be successful in treating high-functioning anxiety.

Cognitive Behavioral Therapy, considered the most effective treatment for anxiety, helps young adults reframe negative thought patterns.  

Dialectical Behavioral Therapy supports people with high-functioning anxiety to question their beliefs about themselves and the way others see them. 

Family therapy focuses on healing underlying attachment wounds that can catalyze anxiety and low self-esteem.

Group therapy helps young adults with high-functioning anxiety feel less alone in their experiences and struggles.

Acceptance and Commitment Therapy guides young people to identify the values that matter to them and take actions to live in alignment with those values. 

Mindfulness techniques support young people to be present in the moment rather than fretting over the past or worrying about the future

Finding the Right Care for High-Functioning Anxiety Symptoms

A trained clinician can administer a mental health assessment that measures the severity of a young adult’s high-functioning anxiety symptoms and indicates the appropriate level of care. Ongoing therapy, an outpatient program, or residential treatment can all be effective in helping you or a loved one learn how to cope with high-functioning anxiety. 

Contact our Admissions experts today to find out how Newport Institute’s specialized treatment helps young people discover how to overcome high-functioning anxiety. Through building self-compassion, self-esteem, and healthy coping mechanisms, young adults can let go of anxiety and soar into the next steps of their life journey.


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Mental Health / April 15, 2022

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