Written for: Nos Curare (2025)
High-functioning anxiety doesn’t always look like the nervous jitters you see on the surface. In fact, many people with this form of anxiety typically appear calm, organised, and even highly successful. But beneath the surface, there’s often a constant undercurrent of worry and need for perfection that’s hard to switch off. Because these signs are easy to dismiss, or sometimes even praised as ambition, many people don’t realise they’re living with this condition until it takes its toll, quietly eroding their mental health over time. That’s why we spoke to Dr. Bijal Chheda, Consultant Psychologist and Founder of Nos Curare, a clinic specialising in inclusive mental health care, who shares 7 subtle but powerful ways high-functioning anxiety shows up in daily life, plus some expert-backed tips on how to manage each one.
1. You’re ‘always on’
With high-functioning anxiety, it often feels like the mind is constantly running. This lack of mental break is known as ‘rumination’ or the tendency to continuously replay the same negative thoughts, usually about perceived mistakes or future fears. Commonly associated with anxiety-related conditions like obsessive-compulsive disorder (OCD), this persistent ‘on’ state means the person is always on high alert, constantly preparing for the next challenge, regardless of whether this new potential problem actually exists. This eventually leads to chronic stress, irritability, and burnout. Try scheduling intentional breaks throughout the day to breathe or meditate, at least for 5 minutes every hour, to reduce the constant mental noise and recharge your focus.
2. Overthinking social interactions
High-functioning anxiety often manifests as replaying conversations and constantly worrying about what you said or how you came across. This mental loop can make even the briefest social interactions feel draining as they analyse every detail of the interaction, from facial expression to tone of voice. This is especially the case for individuals on the autism spectrum where ‘masking’ (the act of suppressing natural behaviours to mimic neurotypical social norms to fit in) is common. While ‘masking’ usually helps them navigate social expectations, it also leaves them feeling disconnected from authenticity. I would advise practicing reality testing through Cognitive Behavioral Therapy (CBT) techniques. By identifying and challenging negative automatic thoughts, you can reduce this pattern of post-interaction anxiety.
3. Perfectionism as a coping mechanism
Aiming for perfection is a common way people with high-functioning anxiety attempt to control outcomes. This type of perfectionism is common in those with Attention-Deficit Hyperactivity Disorder (ADHD), who may have grown up being told they ‘lacked discipline.’ In response, they often overcompensate by setting extremely high standards for themselves in order to avoid further criticism. Instead of hyperfixating on past mistakes, try reframing them as learning opportunities instead. Set realistic, flexible goals and learn to celebrate progress, whether big or small. After all, growth isn’t linear. I suggest booking a cognitive talk therapy session to help unpack the roots of this issue and build healthier self-expectations going forward.
4. Constant productivity
Chronic overproductivity is a trademark of high-functioning anxiety. Work, hobbies, and even chores can become ways of disconnecting with emotions or silence racing thoughts, making it harder to recognise when you really need help. Any downtime can trigger guilt, even when rest is desperately needed. But you must remember that rest isn’t a luxury, but a necessity. Without enough of it, you can experience increased irritability, difficulty concentrating, and even a weakened immune function, making it even more difficult to be productive when needed. So, create boundaries around work and schedule rest. Learn to acknowledge when productivity equals avoidance, and practice self-care that nourishes you both physically and mentally.
5. Struggling to say no
High-functioning anxiety can lead to ‘people pleasing’ habits and difficulty setting boundaries. Because the person fears disappointing others, they may have the tendency to overcommit to plans and requests, regardless of whether they can handle these tasks at the moment. This can result in both mental and physical overexertion, eventually leading to resentment that worsens anxiety symptoms. While practicing assertiveness can be hard at first, you must recognise that saying ‘no’ is also an act of self-care, not selfishness. I suggest developing scripts at the ready to politely decline requests. By evaluating your capacity before agreeing to anything, you’re also ensuring you’re taking on new tasks intentionally, without guilt or pressure.
6. Exhausted yet restless
Despite feeling tired, people with high-functioning anxiety often find it hard to truly relax or fall asleep. They may feel physically drained, but mentally they’re stuck in overdrive, spiraling over worries or imagining worst-case scenarios. This persistent cognitive stimulation can lead to sleep disturbances such as insomnia or delayed sleep phase disorder, a condition where anxiety delays the body’s natural ability to wind down and initiate sleep. At bedtime, incorporate techniques like progressive muscle relaxation (systematically tensing and releasing muscle groups to reduce physical tension) or guided imagery (visualising calming scenes or experiences). If sleep problems persist, consult with a mental health professional for more tailored support.
7. Outward confidence, inner tension
Many with high-functioning anxiety appear confident and successful on the outside while hiding a relentless inner turmoil. This discrepancy often leads to feelings of isolation, as others may not realise the person is silently struggling beneath the surface. Because they feel the need to appear a certain way, they may feel as though they have no safe outlet and end up keeping their emotions bottled up. Over time, this suppression can contribute to major depressive disorder. That’s why it’s important to build a well-trusted support system where you can share your true feelings without fear of judgment. Counseling or local peer support groups can offer non-judgmental spaces for honesty and connection. Remember, no matter how difficult it may seem, there’s real strength in acknowledging your emotions and reaching out for help.
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