What is High Functioning Anxiety, What Are the Signs, and Symptoms?

High Functioning Anxiety
What is High Functioning Anxiety

High Functioning Anxiety

High functioning anxiety (HFA) is a treatable condition affecting over 43 million Americans. For most of us, anxiety is a normal, healthy response to the rigors, challenges and pressures of daily life. But some people don’t meet those challenges and pressures like others do. People suffering from high functioning anxiety appear to be thriving from all outside appearances. Inside, they are unduly anxious, not thriving. Many describe their lives as “just getting by.” HFA tends to be a chronic condition and it can be somewhat debilitating, but since the term doesn’t “officially” exist, mental health professionals rely on personal experience and symptoms to treat the condition.

What is High Functioning Anxiety?

There are no statistics regarding high functioning anxiety because the condition doesn’t exist in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Despite this, mental health professionals treat a patient’s symptoms even though there’s no specific DSM-5 diagnostic criteria to meet.

High functioning anxiety is often compared to generalized anxiety disorder (GAD) which is listed in the DSM-5. However, GAD can cause debilitating physical and emotional responses that HFA does not. With no set criteria to aid diagnoses, high functioning anxiety can be difficult to assess and is often “diagnosed” when other anxiety disorders are ruled out. That is called a diagnosis of exclusion.

Do I Have High Functioning Anxiety?

People suffering from high functioning anxiety tend to keep it hidden from others, all the while becoming adept at managing its symptoms. They may not even realize that anything is wrong. Many have simply lived with HFA for so long that their responses are just what they consider normal for them.

Additionally, those suffering from HFA aren’t necessarily responding to external forces that present in their everyday lives. Instead, they react internally to the condition’s holistic nature. The stresses and tensions that send them internally into turmoil are not always observable by others. On the outside, a person living with high functioning anxiety may appear to others as though there is nothing wrong. They often appear overachieving, meeting every work, family and personal obligation. Underneath that façade however, anxiety’s burdens are taking their toll physically, psychologically and emotionally. Over a period of years, HFA can manifest itself into mental health issues noted in the DSM-5.

Persons may suspect high functioning anxiety when they feel that their lives never move forward out of an unending cycle of stress, worry and strife that’s triggered not so much by extraordinary incidents but by ordinary life. Triggers that bother a person with high functioning anxiety don’t necessarily affect others. Therefore the condition uniquely affects each individual. Although there’s no official diagnostic criteria for HFA, there’s online screening tests that can give people snapshots of their mental health, alerting them as to whether or not they should seek further evaluation.

Signs of High Functioning Anxiety

Often the signs and symptoms of high functioning anxiety seem to overlap on an emotional and behavioral level with other anxiety disorders such as specific phobias, social anxiety or panic disorders. People with HFA may feel that they have “the blues” or are depressed. While the melancholy of the blues lasts a few days or a couple of weeks, depression lasts longer and tends to be more severe, differing from anxiety.


Signs of high functioning anxiety include being unable to relax due to worry, being a workaholic, overthinking, overanalyzing tasks and second-guessing oneself. Other signs include scrupulosity, superstitious thoughts and behaviors. A person with HFA may feel an impending doom, but it is not the same as the impending doom emanating from clinical depression. Often those suffering from signs of high functioning anxiety don’t go to their physician for a mental health screening because they learn to live with its symptoms. Those who decide to reach out because something “just doesn’t feel right” or “I’m tired of feeling this way” usually find their symptoms treatable with counsel and medication.

High Functioning Anxiety Symptoms

Anxiety trigger symptoms are different for each person. Family genetics, personal trauma and personality traits like shyness can contribute to individual triggers. Sometimes it takes just one trigger for someone to exhibit the physical and emotional symptoms. For others it takes a combination of triggers to send them into anxiety mode.

Physical symptoms

  • Chronic insomnia
  • Tension that tightens muscles causing pain
  • Shakiness or fidgeting
  • Heart palpitations, pounding heartbeat, increased pulse
  • Digestive problems

Emotional symptoms

  • Irritability
  • Frustration
  • Indecisiveness
  • Anticipatory anxiety
  • Memory issues
  • Concentration difficulties

Those suffering from these and other physical and emotional symptoms privately struggle with self-criticism and feelings of blame, helplessness or guilt about circumstances they know aren’t in their control. They often become expert at suppressing their anxiety and work hard at to diminish their anxiety to others. It’s a mindset that prompts HFA sufferers to “just do it” and to do it all the while silently struggling in their days.

High Functioning Anxiety and Depression

Depression is the leading cause of disability worldwide, according to the Anxiety and Depression Association of America. It’s estimated that 264 million people live with depression globally. Depression is not the same as anxiety, although anxiety can precede depression. Anxiety and depressive symptoms often overlap, sometimes with veracity–nervousness, irritability, sleeping, memory and concentration issues–causing persons with anxiety to believe that they are depressed. However, depression is a diagnosis that significantly disrupts life. Those symptoms and disruptions are more than persistent, they present themselves most days for at least two years. This is diagnosed as Major Depressive Disorder.


High functioning anxiety symptoms are much milder in both severity and duration than someone who suffers from major depression. Persistent Depressive Disorder (dysthymia) presents similarly to HFA, so many mental health professionals consider it a high functioning form of depression and treat it similarly to how they would treat HFA. Dysthymia and HFA aren’t the same and those suffering from both don’t fit into any stereotypical mold of either.

Living with HFA

Living with high functioning anxiety affects not only the individual, but their workplace and their relationships with family and friends. Those living with the condition may appear quirky, even detailed to a fault to those around them. They may also appear overachieving, but silently suffer with the worry about not living up to their own or others’ expectations. For those living and attempting to cope, the tribulation is very real, although the mental health community struggles with how to categorize it since the DSM-5 doesn’t recognize it as a viable mental health disorder.


High functioning anxiety
Living with high functioning anxiety
High functioning anxiety and depression
Anxiety statistics 2020
People suffering from anxiety and depression during the pandemic
Take a mental health test
The Anxiety and Depression Association of America
Generalized Anxiety Disorder
High functioning anxiety signs, symptoms and treatments
The characteristics of high functioning anxiety
Myths and misconceptions about anxiety
DSM-5 anxiety disorder overview