You are organised. You show up. You get things done. People trust you because you’re dependable. At work, you may be the person others come to when something needs sorting out. From the outside, there may be little to suggest that you’re struggling.  Inside can be a different story…

Your mind is rarely quiet; you think about what might go wrong before it happens and you rehearse conversations that haven’t taken place yet. Afterwards, you go over what you said and wonder whether you should have said something differently. You prepare thoroughly because being unprepared feels unbearable. You might arrive early because the thought of being late makes you anxious. You reply to messages quickly because leaving somebody waiting feels uncomfortable. You find it difficult to say no because you worry about disappointing people and because you continue to function well, nobody thinks to ask whether any of this is exhausting you. You probably don’t ask yourself either?

What is high-functioning anxiety?

“High-functioning anxiety” isn’t a formal clinical diagnosis. It is a phrase commonly used to describe an experience that can be difficult to see from the outside: feeling anxious while continuing to manage work, relationships, and everyday responsibilities. This is one of the reasons anxiety doesn’t always look the way we expect it to. Someone experiencing anxiety may not be avoiding work or unable to get out of bed. They may be leading meetings, treating patients, appearing in court, running a business, producing a programme, looking after a family, or managing a team. But the anxiety is still there. They have simply become very good at functioning alongside it.

When anxiety drives success

There is another complication. Some of the things anxiety encourages you to do may also be things other people value about you. Worry makes you prepare. Fear of making a mistake makes you thorough. Concern about disappointing people makes you reliable. Thinking ahead means you often notice problems before anybody else does. You may even have come to believe that anxiety is part of what keeps you successful. If I stop worrying, will I become careless? If I don’t think through every possibility, will something go wrong? If I relax, will I lose my edge?

That can make the idea of changing your relationship with anxiety surprisingly frightening. After all, why would you want to get rid of something that seems to be helping you? Perhaps the question isn’t whether it helps but how much it costs?

There can be something lonely about appearing calm while working very hard internally to stay that way. People see the polished presentation, not how many times you checked it. They see that you managed the difficult situation, but not how you replayed it in your mind for hours afterwards. They see somebody confident and capable. You experience everything it takes to maintain that appearance.

Over time, you may become so accustomed to this internal noise that you stop recognising it as anxiety. It is simply how your mind works. You might only notice the consequences. Difficulty sleeping, irritability, tension in your body, an inability to switch off, feeling exhausted despite apparently managing everything perfectly well.

Giving your mind somewhere to stop.

You don’t have to suddenly become carefree. Trying to order yourself to “stop worrying” is rarely particularly helpful. Instead, you might begin by noticing when your mind is trying to protect you from something that hasn’t happened yet.

When you find yourself rehearsing a conversation repeatedly, ask yourself whether you are preparing for it or trying to remove every possibility of uncertainty. If you are checking something for the fifth time, notice whether you are still improving it or whether you are looking for reassurance that nothing can go wrong. And when your mind begins replaying something that has already happened, you might gently ask, “Is there anything I can actually do about this now?”

Sometimes the answer will be yes. Sometimes it will simply be no. Learning to tolerate that uncertainty can take time.

Therapy can offer a space to understand what sits underneath the anxiety rather than simply trying to make it disappear.

Perhaps there are reasons you learnt to anticipate problems, remain in control, or make sure you never let anybody down. Understanding those patterns doesn’t mean giving up the qualities that have helped you build your life.

You can still be conscientious, prepared and care deeply about doing things well. However, those things don’t always have to be driven by fear, because looking as though you’re coping and feeling at ease are not the same thing. You shouldn’t have to wait until you stop functioning before deciding that how you feel matters too.