High-functioning anxiety: what are the signs?
Coping on the outside, anxious inside. It isn’t a medical diagnosis, but the signs are real. And the habits you rely on to feel safe may keep the worry going.
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What are the signs of high-functioning anxiety?
High-functioning anxiety is a name people use for anxiety they hide behind getting things done. You hit your deadlines and look calm. Inside, you worry most days.
Think of a swan. It glides on top and paddles hard underneath.
The signs are the same as for any anxiety. The NHS says it’s not always easy to tell when anxiety is the reason you feel or act differently.
| Where you notice it | Signs |
|---|---|
| Your mind | Feeling tense or nervous, being unable to relax, worrying about the past or future, fearing the worst, finding it hard to concentrate, not being able to sleep. |
| Your body | A faster, irregular or more noticeable heartbeat, headaches, chest pains, indigestion, stomach cramps, bloating or feeling sick, sweating, breathlessness. |
| Your habits | Compulsive behaviour such as constantly checking things, not enjoying your free time, finding it hard to look after yourself, struggling with relationships, avoiding places and situations that make you anxious. |
Source: NHS
A swan can paddle for a long time. That doesn’t mean the paddling is fine. If anxiety is affecting your daily life, the NHS says to contact 111 or talk to a GP.
Tick the signs you’ve had most days this month. Take that list with you if you see a GP.
Is high-functioning anxiety a real diagnosis?
No. It’s not a medical diagnosis, and the main NHS anxiety pages don’t use the term. A 2019 review said the idea had escaped a research spotlight.
The feelings are real anxiety, though. It’s more likely to be generalised anxiety disorder (GAD) if you feel anxious most of the time and it affects your everyday life.
A GP may diagnose it if you have the typical symptoms and:
- you often worry about a wide range of things
- feelings of anxiety are affecting your daily life
- you’re finding it hard to control your feelings
- you’ve felt anxious a lot of the time for at least 6 months
Most people feel anxious sometimes, and that doesn’t always mean GAD. If these sound like you, or anxiety is affecting your daily life, book a GP appointment.
Can coping keep the worry going?
The NHS says relying on habits we think will keep us safe might actually make anxiety worse. Those are safety habits.
If you cope by working harder, they might look like over-preparing or checking your work again and again. Constantly checking things is on the NHS list of anxiety signs.
Perfectionism is linked too.
In 416 studies of 113,118 adults, the side of perfectionism that worries about mistakes and what others think had a medium link with anxiety symptoms. Striving for high standards had a small link, except with social anxiety.
These are links, not proof that one causes the other.
| Instead of | Try |
|---|---|
| Trying to do everything at once | Set small targets that you can easily hit. |
| Avoiding what makes you anxious | Slowly build up the time you spend in worrying situations. |
| Worrying on and off all day | Set a daily worry time, at the same time each day. |
| Thinking the worst | Ask what advice you’d give a friend. |
| Lots of coffee, tea, cola or energy drinks | Cut back. Caffeine can disrupt sleep and make anxiety harder to control. |
| A drink to unwind | Try not to use alcohol, cigarettes, gambling or drugs to relieve anxiety. |
Sources: NHS; NHS: GAD; Every Mind Matters
Pick one row and try the swap this week. Need a later coffee cut-off? See caffeine and sleep.
How can I manage high-functioning anxiety?
Six NHS steps to try this week
- Keep a diary of what you’re doing and how you feel at different times.
- Set a daily worry time, at the same time each day.
- Breathe in through your nose and out through your mouth, counting 1 to 5, for at least 5 minutes.
- Exercise regularly, such as running, walking, swimming or yoga.
- Try to get enough sleep.
- Talk about how you feel with a friend, family or Samaritans on 116 123.
Sources: Every Mind Matters; NHS: breathing; NHS: GAD
The breathing works best if you do it regularly, as part of your daily routine. You may not reach 5 at first.
Perfectionism can be worked on.
CBT (cognitive behavioural therapy) is a talking therapy that helps you change how you think and act. In 15 trials, CBT aimed at perfectionism had a small to medium effect on anxiety. There were only 15 trials, they didn’t compare CBT with other treatments, and the average age was 23.
For more ideas, see natural remedies for anxiety, stress at work and how to fall asleep faster.
What help can I get on the NHS?
You don’t need a diagnosis. You can refer yourself to NHS talking therapies for worry and anxiety without seeing a GP.
How NHS help for anxiety usually works
- 1
Refer yourself
Aged 18 or over (16 in some areas) and registered with a GP? No GP visit needed.
- 2
Guided self-help
May come first: a workbook or online course with a therapist’s help. For GAD, usually 5 to 7 sessions of 20 to 30 minutes.
- 3
CBT
May follow if symptoms don’t improve, or come sooner if anxiety is having a big effect on your daily life. For GAD, usually 12 to 15 weekly sessions of 1 hour.
- 4
Medicine
A GP will usually suggest talking therapy first. The usual medicine is an SSRI, a type of antidepressant.
Sources: NHS: talking therapies; NICE CG113; NHS: GAD
Never stop or change a prescribed medicine without your prescriber.
Talking therapies are sometimes free through your employer, university or local charities. Paying privately? Check the therapist is registered with a body accredited by the Professional Standards Authority.
Wondering if something physical is behind how you feel? See blood tests for anxiety.
When to speak to a GP
Book an appointment if:
- You’re struggling to cope with anxiety, or the things you’re trying yourself are not helping.
- You think you might have GAD, or you feel anxious most of the time and it affects your everyday life.
- You’d prefer a GP to refer you to NHS talking therapies.
- You can’t tell if shortness of breath is from anxiety, or you’re worried about any other symptoms.
- You need urgent help for your mental health. Call 111 and select the mental health option, or ask for an urgent GP appointment.
Call 999 or go to A&E now if someone’s life is at risk, for example they’ve seriously hurt themselves or taken an overdose. Do the same if you don’t feel you can keep yourself or someone else safe. Samaritans are free on 116 123.