Why high-functioning anxiety is the most dangerous mental health issue no one talks about

What is high-functioning anxiety?
High-functioning anxiety isn’t a clinical diagnosis, but it’s a very real, deeply felt experience for many. Typically, a mental health diagnosis requires some impact on daily functioning, but in this case, functioning remains intact, sometimes even exceptional. Individuals with high-functioning anxiety often perform well academically, professionally, or socially, which can make their internal struggles almost invisible.

Yet, behind the scenes, they experience symptoms similar to other anxiety conditions: physical restlessness, trembling, difficulty breathing, persistent worrying, overthinking, and an inability to fully relax.

The mask of productivity
What makes high-functioning anxiety particularly problematic is that the behaviours it manifests, perfectionism, high productivity, attention to detail, are often praised and rewarded. Because the outcomes are socially desirable, they’re rarely questioned. In fact, they can become part of one’s identity.

This makes it difficult for others to spot the signs, and even harder for individuals to recognise that they need help. The internal distress, however, is real and often debilitating. Many individuals battle overwhelming self-doubt and harsh self-criticism, even while achieving visible success.

Where anxiety meets impostor syndrome
High-functioning anxiety often overlaps with impostor syndrome. Despite evidence of competence, individuals may constantly second-guess themselves or live in fear of being “found out” as a fraud. This chronic fear of inadequacy feeds anxiety, no matter how high the achievement.

A cycle that feeds itself
High-functioning anxiety can become a self-reinforcing loop. Some individuals are anxious because they feel pressure to maintain high standards, a fear of failure that becomes all-consuming. Others may be high-functioning as a way to cope with their anxiety. Organising, list-making, and staying on top of everything becomes their safety net, a way to maintain a sense of control.

But these “safety behaviours” have a downside. While they provide temporary relief, they prevent individuals from learning how to feel safe without them. Anything outside these carefully controlled patterns starts to feel dangerous or overwhelming, further fuelling the anxiety.

So, how do you know if you're experiencing high-functioning anxiety?
If you find yourself always pushing to meet high standards, call yourself a perfectionist, and constantly worry about outcomes, even when others see you as successful, this might resonate with you. If you’re a people-pleaser who gives a lot and asks little, and even the smallest mistakes feel catastrophic internally, you may be dealing with high-functioning anxiety.

And while things may look fine on the outside, it’s essential to check in with what’s happening within.

So, how can you begin to address it?
Start by recognising your symptoms for what they are, and identify what triggers your anxiety. Are you afraid of negative feedback? Do you constantly worry about disappointing someone else? These are important clues.

Try identifying your core values. Often, trying to live up to all the standards of success set by the world is the reason for burnout. It also leads to a compromised sense of well-being. Focus on what is important to you outside society's expectations, and try to align your thoughts and actions with these values.

Practice self-compassion - It is human to make mistakes and also have someone else see your mistakes, and it’s okay. Focus on the “human-ness” of your actions instead of the aspirational perfection that you wanted for yourself. Give yourself some grace and compassion.

Create a support network of people who see you and value you for who you are- they will help you accept your whole self as well

Reconnect with your body. Make sure you practice some deep breathing, get some regular exercise, along with balanced meals and adequate sleep. A mindful connection with your body will always help you disconnect from the worries in your head.

High-functioning anxiety doesn’t always look like distress. It often looks like doing well, staying on top of things, being dependable. But if that’s coming at the cost of your peace of mind, it’s worth pausing to check in. You don’t need to wait for something to break to reach out for support. Even if things seem fine on the outside, it’s worth paying attention to what’s happening within.

Dr. Amit Malik, Founder & CEO, Amaha