What is High-Functioning Anxiety?

Barbara Heffernan • July 24, 2024

You Can Have Anxiety and Still be High-Functioning. Here's what you need to know.

High-functioning Anxiety has become a very popular term on social media but there's a fair amount of misinformation out there. This blog will explain what it is and what you can do about it so you can help yourself feel better.

One of the main things I want to communicate to you is that if you have a lot of anxiety, don't stop yourself from getting help just because you're high functioning.

So not to state the obvious here, but what is high functioning anxiety? It simply means you have a lot of anxiety and yet you're high functioning.

Now, high functioning anxiety is not in and of itself a diagnosis, but you can definitely have a formal anxiety diagnosis and still be high functioning.

In fact, in my psychotherapy practice for 20 years, most of my anxious clients were very high functioning. So, I first want to clear up the issue about whether being high functioning precludes you from having a diagnosable disorder. Then I will discuss which types of anxiety sometimes present as high functioning, as well as the risks of high-functioning anxiety. Lastly, I will provide 6 key tips to recover from high-functioning anxiety.

Being high functioning DOES NOT preclude you from having a diagnosable anxiety disorder! This is the main confusion online. Many videos, even from reputable sources, are saying that a criteria to qualify for an anxiety disorder is that it has to have a significant impact on your functioning. This is not true.

The DSM-5-TR is the Diagnostic and Statistical Manual which provides the guidelines for diagnosis. For almost every mental health disorder, there's a criteria that says that the symptoms that are bothering the person must cause clinically significant distress OR impairment in social, occupational, or other important areas of functioning.

It’s an OR. Not an AND.

If the symptoms cause clinically significant distress, you can have the disorder. It doesn’t have to impact your functioning.

Now, what does clinically significant distress mean? There's no specific guidance in the DSM-V-TR as to what qualifies as clinically significant. But if a client of mine wasn't sleeping because of their anxiety, I’d consider that clinically significant. Maybe they had insomnia yet still functioned perfectly fine. However, it’s not healthy, it doesn't feel good, and it causes a lot of distress.

If someone was worrying so much, they couldn’t be present with their loved ones, I’d consider that clinically significant.. So, basically, if their worry and anxiety was causing them enough pain, that's clinically significant. So I want to encourage you, if you feel that you have anxiety, you can take it seriously and you can get help for it.

Which Anxiety Disorders Present as High Functioning?

In my clinical practice, I saw many people with OCD who were very, very high functioning. The OCD may remain hidden from others, or they might have found an occupation where their OCD was a benefit to the work (though not necessarily to their happiness). The OCD might cause problems with close relationships, but not to the point that they did not have close relationships.

I also saw very high functioning individuals who had panic attacks and phobias. And yes, panic attacks and phobias generally impact functioning within particular situations. But many people learn to manage around this anxiety, and they can be very high functioning in their careers and relationships. For example, a very successful executive I worked with had a phobia of enclosed spaces, such as elevators, and being in those situations could cause panic attacks. He became a great stair climber, and he was successful enough to usually be able to determine where people would meet him.

Social anxiety very often creates impairment in functioning, but not always. Some people with social anxiety can hide their disorder. They may be seen as “quiet” or “shy,” but they can still have close relationships. They “prefer” smaller gatherings and have skillful ways of avoiding certain events. They may also find careers that “fit” with their avoidance. So the pain is internal. Clinically significant for sure.

Probably the largest diagnosis that goes with being “high-functioning” is generalized anxiety disorder. (And I discuss generalized anxiety disorder in more depth in a video that I will link here).

Risks of High-Functioning Anxiety

Burn-out
There is a risk of burnout, collapse, physical collapse, and emotional collapse if you are ignoring your body signals and pushing yourself too hard. There is a risk that at some point the universe is going to intervene and say, “Nope! You can't do it all!”

However, I do want to reassure you on one thing, Some of my clients would worry that at some point their worry would “make them go crazy,” meaning that they would become psychotic. So this is not a risk. One disorder does not lead into another. So, if you have this worry, identify it simply as another anxiety thought (or theme). But you can get help because you are unhappy, you don’t need to be avoiding psychosis to go to therapy!

Minimizing Your Problems

I'd say that one of the biggest risks with high functioning anxiety is that the person who is anxious and high functioning can minimize their own problems. They can minimize their worry and concern because they are functioning so well. Their thinking is likely to be “My anxiety keeps me productive,” and “I'm doing fine, I'm doing fine.” So dismissing your own pain continues the problem, leading to the burn-out mentioned above.

Not Recognizing It As Anxiety At All

Quite a few of my clients would say “I don't have anxiety,” yet their thought patterns and behavior indicated a lot of anxiety. There is an element that if you've lived with anxiety your whole life, and society keeps labeling you successful, you don’t recognize it as anxiety. This goes beyond minimizing your anxiety (discussed above) because you don’t even see it as anxiety! Perhaps your parents were anxious, and basically for generations, everybody was anxious, so it may just seem normal to you. “Isn't everybody like this?”

Help for High Functioning Anxiety

So if you think you might have high functioning anxiety, what should you do about it?

Tip #1

Treat it as anxiety. It actually doesn't matter whether you qualify for a full anxiety diagnosis or not. Psychotherapy is still reimbursable if someone doesn't qualify for a full anxiety disorder. There are other diagnoses that can be put down that qualify somebody for insurance reimbursement (diagnoses that basically indicate the person is having a very tough time right now in life). You also don't need to know whether you qualify or not to get help.

Anxiety is treatable. You can get better.

Tip #2

Educate yourself on what anxiety is and how to deal with it. Read reputable sources on the topic, or watch the longer videos on anxiety. If the examples used seem extreme, you can still practice the things that can help. I have a playlist of videos on anxiety that I can link here, YouTube Anxiety Playlist, or check out this blog.

Tip #3

Validate your own feelings. Validate the fact that you are worrying too much and you're in pain. Speak gently to yourself about having anxiety. Being critical of how anxious you are ("I shouldn't be this way") does not help, it hurts.

Tip #4

Have hope. Have hope that this can change. It can!

Tip #5

Don’t be attached to your anxiety.

A lot of people with high functioning anxiety will say, “I need my anxiety to function. My anxiety is what makes me successful.” So they're very attached to the anxiety, even if it's causing them pain. Success is important to them, their family, their values. They feel they won’t have this success if they let go of their anxiety.

If this sounds like you, understand that you can have “productive worry.” You can retain your forward-thinking, your ability to anticipate problems, your facility with putting in place a plan to deal with those problems AND you can let go of the unproductive worry about those things you have no control over (and yes, you’ll have to accept that there are some things you have no control over, which can be hard as well…, but possible, and worth it).

You can let go of the unproductive worry that keeps you awake at night or makes you ruminate.

So there is a way to keep your motivation, keep your ability to anticipate problems, but not have it turn into full blown anxiety.

Tip #6

Self-Care Requires Deeper Work

And so, lastly, I want to highlight the issue of self-care. Many of the blogs and videos on this topic will tell you, “practice self-care, get enough sleep, rest,” etc. And yes, you know this would be good, I’m sure. Yet your anxiety doesn't let you, right? It's just not that easy.

It can be very hard for people who consider themselves very successful and high functioning to make the time for self-care. It can be very hard to say no to something, to not take on too much.

And yes, this is a question of having boundaries, but the answer to being able to have those boundaries is not simply to say “no,” or follow a set of guidelines.

The answer is really doing deeper work: looking into the negative core belief you have that drives you to need to perform so well that you might be damaging your health. It is probably something you learned very early in life about your role within your family.

Being able to set boundaries for yourself and with other people requires self insight, healing negative beliefs and emotional regulation. Regulating emotion is important so you don't get too anxious if you do actually say no to something or stop working on a project or ask for help. These are all things that can make people so anxious they don't do them.

The work of healing negative core beliefs and regulating emotion is the work that people do in my program on boundaries. Having healthy boundaries and healthy self-care requires more than the “information,” the list of things you “should” and “shouldn’t” do. Most of us have heard all of this already and, despite trying, still don't do it.

So healthy boundaries and self-care is about fully understanding yourself, your values and your value. Your value as a human being, not a “human doing”. If you are interested, I’ll link my boundary program here The Ultimate Boundary Program. (I just received another five star review that said "Awesome!")

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Blog Author: Barbara Heffernan, LCSW, MBA. Barbara is a licensed psychotherapist and specialist in anxiety, trauma, and healthy boundaries. She had a private practice in Connecticut for twenty years before starting her popular YouTube channel designed to help people around the world live a more joyful life. Barbara has a BA from Yale University, an MBA from Columbia University and an MSW from SCSU. More info on Barbara can be found on her bio page.

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Emotional Regulation and Relationships: 5 Critical Skills to Improve Relationships

By Barbara Heffernan • April 3, 2026

You can probably recall a time when you were with someone who was intensely anxious—and within minutes, you began to feel anxious yourself. Perhaps your heart rate increased. Your breathing became shallow. The knot in your stomach tightened. Or maybe you remember the opposite: a time when you were with someone who was truly grounded and calm, and their presence actually calmed you down. Your shoulders dropped. Your breathing deepened. The tension you had been carrying began to dissipate. This is not your imagination. This is emotional contagion, and it is scientifically proven. Understanding how your own emotional regulation—or lack thereof—impacts other people, and how other people's emotional states impact you, is essential for healthy relationships. Learning emotional regulation tools can improve your relationships significantly. Learning how to lower your susceptibility to emotional contagion can help as well. In this article, I will explain what emotional contagion is, how it impacts relationships, and provide five specific strategies for improving regulation in your own relationships. What Is Emotional Contagion? Emotions are contagious. Extensive research—both behavioral research and neuroscience—shows that we pick up the emotions of the people around us. The closer our relationship with them and the more invested we are in that relationship, the more this phenomenon occurs. This may not always feel accurate because we also tend to balance each other out. If someone is very upset, we might suppress our own emotions in response. But as I will explain, that suppression is actually part of the same dynamic. Three Pathways to Emotional Contagion There are three pathways that lead to emotional contagion: Pathway 1: Automatic Mimicry Unconsciously, when we see facial expressions in another person, we mimic them. If someone smiles, we tend to smile immediately. If someone frowns, we might make the same expression. This happens not just with facial expressions but also with voice, tone and body posture. Pathway 2: Autonomic Mimicry This involves our autonomic physiological system which works in synchrony with other people. Our heart rate, our breathing rhythm, and even our pupil dilation tend to mimic each other. Our nervous systems influence each other constantly. Pathway 3: Affective Convergence This is the convergence of feelings. When our facial expressions and body posture mimic another person's, and our physiological system aligns with theirs, we develop the same affective feelings. We end up experiencing a version of that emotion ourselves. The Suppression Trap: Why "Staying Calm" Can Make Things Worse If someone is extremely upset, you might calm way down. If this happens almost automatically, you are probably suppressing your emotions rather than regulating them. Extensive research shows that when one person suppresses their emotions, it actually makes the other person more anxious. And the person who is suppressing—while they might appear calm externally - is experiencing all the physiological signs and symptoms of anxiety or a heightened emotional state. Even when we are trying to be the balance in the room, we might actually be escalating the emotions present. This is particularly true for those who grew up parentified. Adults who were parentified as children often feel their emotional regulation is better than anyone else's in their families. While that might be true to some extent, without substantial self-awareness and genuine emotional regulation tools, you are likely using emotional suppression, not regulation. Where Emotional Regulation Patterns Come From The means by which you emotionally regulate—and whether you are highly regulated or highly dysregulated—is largely due to how you were raised. I am not saying this to assign blame, nor do I want you to spiral into worry about what you may have done to your own children. These are intergenerational patterns, and all we can do is work with the present. However, it can help to recognize that if you feel your own emotional regulation is lacking, you probably learned from dysregulated caregivers. If you have a partner who is very dysregulated, the same is likely true for them. This understanding allows us to remove blame and accusation from the discussion. We can approach this with compassion, recognizing that these are skills that should perhaps be taught in school or more seriously in our society—but they are not. The good news is that you can learn them now. Five Practical Tools to Improve Emotional Regulation in Your Relationships It truly is possible to improve your own emotional regulation and have a postiive impact on your relationships. These tools are helpful even for the partner that feels they are the one who is more emotionally regulated. And as a heads up, Tools 1 and 5 require substantial work - but gradual improvement is helpful! Tools 2, 3, and 4 are easier to implement immediately. Tool 1: Develop Your Emotional Boundaries Because emotional contagion is so strong—particularly if you grew up in a caretaker role in your family—it is important to begin recognizing when the emotions you are feeling are the ones you are absorbing from someone else. Begin to visualize a see-through bubble around you which represents you and your emotional boundary. Begin to think of your emotions as existing within that bubble. And picture another bubble around the other person - give it a light, see-through color. Picture that all their emotions are within their bubble. Differentiate between what you are feeling and what they are feeling. Bring in your observer brain to look at what you are feeling. For example... "Wait a second. I am feeling anxious because my partner is anxious about their interview tomorrow. What is my anxiety about?" You can begin to see whether your anxiety is about getting them to calm down so they can perform well in their interview. Perhaps you don't want them to be disappointed, or you have a vested interest in them getting a job. Once you understand why you are feeling anxious, you can apply tools to reduce your own anxiety, rather than focus on theirs. Because if we get anxious about making sure someone else is not anxious, it simply escalates the anxiety in the room. Part of developing emotional boundaries is understanding that other people's emotions are not ours to solve. We can be empathetic without feeling responsible for calming the other person down or changing their emotional state. Your observer brain can help you think through, "I do not have to convince them. I can recognize the impact their emotional state has on me, but I do not have to spiral into desperately trying to fix something I cannot fix." Tool 2: Use Your Breathing Deliberately If you learn diaphragmatic breathing and use it during difficult moments in relationships, you can keep your physiology within a tolerable range. In EMDR therapy, there is a concept of keeping your emotions within a "window of tolerance." They can still fluctuate, but you remain relatively regulated throughout. Diaphragmatic breathing is a powerful way to help yourself do that. When you breathe in a calm, regular manner, it is actually helpful to the other person as well. Your regulated physiology can support theirs. Tool 3: Establish a Guideline for Taking Breaks Put in place for yourself a boundary about taking a break from a conversation if you become too emotionally dysregulated. What typically happens in couple relationships (and I saw this extensively during 20 years of couples counseling) is that one person is visibly out of control upset, and the other says, "We need to take a break until you calm down" (and there's usually a finger point that goes along with the "you"). Generally, this escalates the emotions in the room. In actuality, even if you are the one who appears less upset externally, you are probably very physiologically activated internally. There is a marriage and family therapist and researcher who has a rule: if your pulse rate is 10% above its normal resting rate ), you need to take a break. ( John Gottman, PhD, Seven Principles for Making Marriage Work ) The problem with telling the other person they need a break to calm down is that it will make things worse. It feels like criticism and attack. It makes someone defensive. It increases their fight-flight-freeze response. Instead, say: "I am having a hard time regulating myself in this moment. Can we take a 10-minute break? I will be right back. I just need 10 minutes to do some slow breathing. We can set our alarm." You must put a time frame on it. Take a five-minute break, a 10-minute break, or if you are extremely dysregulated, revisit the conversation in the morning. Without a time frame, the other person will feel abandoned, which escalates their emotional dysregulation. You may also be feeding into your flight mode—your reactive pattern of running away from conflict. Set the boundary for yourself, not for the other person: "If I get too upset, I will take a mini timeout to calm myself down." I recognize this does not work in every situation. You cannot simply walk away from a young child. But you can incorporate this thinking to develop creative strategies of your own. Tool 4: Validate Before You Fix or Problem-Solve One of the most regulating things you can do for someone else is help them feel truly heard. Acknowledging their emotional experience before moving to "let's fix this and problem-solve" will de-escalate their emotional response and prevent the conversation from escalating out of control. I know I said you are not in charge of their emotional regulation—and you are not. However, knowing strategies that benefit the relationship benefits you. These are basic relational tools. If you have a partner who has difficulty validating your emotions, and you are emotionally regulated, you can say: "I am very upset about this, but I do not want to jump into problem-solving. I simply want to feel heard." There is an element where we sometimes have to help train people how to be in relationship with us. If you are in couples counseling with a therapist facilitating this, excellent. But if you are not, sometimes it helps to explain these concepts to your partner. Let them know what will help you calm down when you are upset. You might have to remind them, and I know that takes substantial emotional regulation on your part. But honestly, that is the big picture here: the best thing you can do for your relationships with others—as well as your relationship with yourself—is learn emotional regulation tools. Tool 5: Practice Honest, Regulated Communication This can be understood as assertive communication that is also compassionate. If you are feeling overwhelmed, I understand. These concepts can seem complex and somewhat unattainable. I have an online boundary program that addresses emotional regulation as the foundation for healthy boundaries. It includes an exercise on visualizing emotional boundaries to strengthen that skill, and an entire section on assertive communication so you can set and maintain boundaries. Healthy boundaries are not about keeping people away or controlling other people's behavior. Healthy relationships actually require good boundaries. Good boundaries are about knowing yourself—where you end and the other person begins—and knowing it is acceptable for you to have needs. Compassionate, assertive expression of whatever needs to be communicated will help the relationship. It can be done in a way that supports your own emotional regulation and possibly helps the other person—or at minimum, does not contribute to escalation. Suppressing your own emotions and needs will escalate the negative cycle of conversation. This is not about suppression. It is definitely not about lashing out, exploding, or releasing everything you have been suppressing because you are angry and frustrated. If you have taken that timeout when needed, if you have been aware ("my heart rate is way up; I am in fight-flight-freeze mode"), you will not reach that explosion point because you will have taken your break and calmed down. All these steps are interrelated. Expressing what you feel in a regulated manner keeps you in connection with the other person. Remember: it is not just what you say but how you say it, and even how you are feeling when you say it. A statement like "I am feeling overwhelmed right now with too much to do" will enable you to stay in connection far more effectively than exploding because your partner has not done what they were supposed to do. Anytime we explode with attack or criticism, we contribute to emotional dysregulation in the room. Bringing It All Together Consciously keep track of your own emotional regulation Visualize your emotional boundary Use breathing techniques to stay within your window of tolerance, aware that you might need to take a mini timeout for yourself if you cannot stay within that window Validate the other person's feelings, emotions, and experience. Pay attention to: "This is me and my emotions, and that is them and theirs." Practice assertive communication which includes compassion for yourself and the other person This is not easy work. I know that. But what I want you to understand is that emotional contagion is real, and there are tools you can use to work with it. You can understand the other person without fully absorbing their emotional state. We are not individual emotional islands. Each one of us impacts those around us. Let me be very clear: Impacting others is not the same as causing their emotions or being responsible for their emotions. They are not responsible for ours. We are responsible for our own emotions and what we do with them. Yet there is this framework of interconnectedness among us, and knowing how to work with it can improve your life and your relationships significantly. Please share in the comments if you found this valuable. What resonated with you? What questions do you have?