What Does It Mean to Have High Functioning Anxiety?

by Micaha | Apr 21, 2025 | Anxiety/Depression

We talk about anxiety as though it is always a debilitating disorder – one that people struggle with *immensely*. Certainly, some people do have anxiety that makes it difficult to function, unable to leave the house or experience a happy and productive life.

But for others, anxiety is not a debilitating condition. It is a manageable one. Their anxiety affects their life, but it doesn’t control them, and so a person with anxiety can still manage relationships, work, parent, and perform normal tasks.

The thing is, that itself can be a problem.

When a person has this type of anxiety, they may be hesitant to treat it. Why see a therapist when you are still married, or you still work, or you have friends that you see regularly?

Yet, we know a few things to be true:

• Everyone deserves to live their best, happiest life, and that is often not possible when a person has anxiety.
• Someone that has more manageable anxiety now may not have manageable anxiety later. Untreated anxiety is at risk for getting worse over time.
• Anxiety may seem manageable because your life seems normal, but if you didn’t have anxiety, your life would be very different.

Individuals with this type of anxiety are sometimes referred to as having “high functioning” anxiety or being “high functioning.”

High functioning anxiety is not a clinical diagnosis, but rather a term used to describe individuals who appear outwardly successful, organized, and composed, while internally experiencing persistent worry, self-doubt, and emotional distress. These individuals often meet personal, academic, or professional expectations while privately struggling with anxiety symptoms that are either unrecognized or dismissed due to their high level of daily functioning.

This form of anxiety can be difficult to detect because it doesn’t disrupt responsibilities in obvious ways. In fact, it can drive people to be more detail-oriented, more dependable, or more productive. But beneath the surface, the emotional toll can be significant.

How High Functioning Anxiety Differs from Other Anxiety Presentations

Typically, a person that is high functioning with anxiety are still touched by the condition. Generalized anxiety disorder, for example, causes people to feel anxious more generally, without necessary a specific fear or issue. At work, they may feel anxious about meetings, but they’re still *at work* and doing their job, and to others they may just appear a bit more shy, or their heartbeat goes up a lot but they are otherwise able to manage their experiences. When dating, they may have more fears about “screwing up” a date, but they may otherwise be able to go on dates and just feel high stress and high anxiety throughout the time – possibly overthinking later.

Yet even though they’re functioning, they’re still being affected by their anxiety. They may, for example, be less likely to ask for a raise at work. Or they may be less likely to act confident on a date. Or they may be overly worried about their child running into a street. Their anxiety still touches everything they do in some form.

Compensatory Behaviors

Some people with high functioning anxiety go a step further. Unlike generalized anxiety disorder (GAD), which may interfere visibly with day-to-day functioning, high functioning anxiety may be marked by compensatory behaviors that mask internal distress. People with high functioning anxiety may manage their anxiety through over-preparation, perfectionism, and rigid routines – behaviors that may be socially rewarded but are mentally and emotionally draining.

They are often described as:

• Responsible
• Ambitious
• Reliable
• Detail-focused
• Self-motivated

But internally, they may also feel:

• Constantly worried or tense
• Afraid of failure or disapproval
• Overwhelmed by routine decisions
• Exhausted from overthinking or over-planning
• Anxious even during rest or downtime

While the outward appearance may suggest control and capability, internal symptoms often include:

• Racing thoughts or chronic overthinking
• Difficulty relaxing or feeling “off duty”
• Irritability or restlessness, especially when unproductive
• Fear of disappointing others or being judged
• Over-scheduling or trouble saying no to requests
• Perfectionism and fear of making mistakes
• Sleep disturbances, especially trouble falling asleep due to mental activity
• Physical symptoms such as muscle tension, headaches, or gastrointestinal discomfort

These symptoms may not be severe enough to stop the person from functioning, but they can contribute to long-term stress, burnout, or emotional fatigue.

Why It Often Goes Unnoticed

High functioning anxiety often goes unrecognized for several reasons:

• The behaviors it drives – such as punctuality, attention to detail, and overachievement – are socially reinforced.
• The person may not describe their experience as “anxiety” because they are not having panic attacks or visibly falling apart.
• Friends, family, and coworkers may see them as capable or calm, unaware of the internal pressure they are constantly managing.

In many cases, individuals don’t seek help because they believe their anxiety is simply part of their personality. They’re used to it. And because their life feels fairly normal, at least in the eyes of society, then they do not feel like they are in need of additional help.

Risks of Leaving High Functioning Anxiety Unaddressed

When high functioning anxiety goes unrecognized or untreated, it can lead to long-term complications such as:

• Chronic stress or burnout
• Increased risk of depression
• Relationship strain due to emotional unavailability or irritability
• Avoidance of rest or difficulty enjoying downtime
• Difficulty adjusting to failure, change, or reduced productivity

Even if your anxiety feels manageable, it does not need to be. Your life will often feel more fulfilling and energizing when your anxiety is under control.

Treatment and Support

Even when anxiety does not appear to interfere with work or responsibilities, it is still valid and treatable. High functioning anxiety responds well to several approaches:

• Cognitive Behavioral Therapy (CBT) to challenge perfectionistic or anxious thought patterns
• Mindfulness-based practices to promote rest and present-moment awareness
• Behavioral techniques to reduce compulsive planning or avoidance
• Medication in some cases, for generalized symptoms that don’t respond to therapy alone
• Stress reduction strategies to support sustainable routines without over-reliance on anxiety as a motivator

Support from a therapist can help individuals develop healthier ways to manage pressure without sacrificing well-being.

Get Therapy for Anxiety Today

Having high functioning anxiety means living with a constant undercurrent of fear or worry, even when everything appears to be in order. It often looks like success from the outside but feels like survival on the inside.

Awareness is the first step toward change. With the right support, individuals can learn to function not from fear, but from a place of clarity and balance – still achieving, but with far less cost to their emotional and physical health.

For more information, reach out to Flourish Psychology, today.

All About Anxiety Related Hallucinations – What They Are, What Causes it May Have

by Micaha | Apr 7, 2025 | Anxiety/Depression

Anxiety is often self-sustaining. When a person struggles with anxiety, they often have symptoms and experiences that can create more anxiety.

Although uncommon, one issue that is especially prone to creating more anxiety in anxiety-prone individuals is the presence of what are often called “hallucinations” – experiencing sights or sounds that are not actually there, that no one else can see or hear.

Hallucinations are more common in those with panic attacks and PTSD, but can affect anyone with any anxiety or stress disorder. They’re also a trigger for more anxiety, because a person that experiences a hallucination often finds that they experience either fear of the hallucination, or fear of what the hallucination means about their mental health.

But before we begin talking about anxiety-related hallucinations, it’s important to make clear that these are *not* true hallucinations. While many people experience a perception of hallucinations with anxiety, they’re not an altered reality. They’re not psychosis. Instead, they’re just a way our brain is responding to things (stimuli) that are happening around us, as well as our anxiety itself.

Who We Are – Flourish Psychology

Flourish Psychology is a New York City based boutique private practice that treats patients struggling with anxiety and anxiety related symptoms. We consider ourselves to be a partner in our mental health, with a team of amazing therapists that are here to help you with your needs. Please reach out today for more information, or to schedule an appointment.

What Causes These “Hallucinations?”

Anxiety related hallucinations are not necessary hallucinations, at least not the same way that psychosis can cause hallucinations. Instead, they’re perception issues caused by the mind and how it is processing information, as well as symptoms of anxiety that are being misinterpreted by our anxiety.

But that doesn’t mean that it’s not worrisome when you experience it. These symptoms are common, and can be caused by issues such as:

• Hypervigilance and Sensory Overload – Anxiety heightens your awareness of potential threats. This hypervigilant state can increase sensitivity to sound and sight, and create the illusion of auditory/visual input. In overstimulated environments, the brain may try to “fill in” missing sensory information, sometimes resulting in the perception of non-existent sounds.
• Stress-Induced Cognitive Distortion – Prolonged stress can impair the brain’s ability to differentiate between internal thoughts and external sounds. An anxious mind may interpret internal self-talk or intrusive thoughts as external voices, or may see unexpected movements or shadows as signs of danger.
• Sleep Disruption and Fatigue – Chronic anxiety often interferes with sleep. Severe sleep deprivation is known to cause perceptual disturbances, including visual and auditory issues, as well as make it much harder to calm an anxious mind and process various senses.
• Intrusive Thoughts with Sensory Characteristics – Some individuals with anxiety disorders experience intrusive thoughts that are vivid and have sensory qualities. These may be misperceived as external voices, especially during panic episodes or emotional distress.
• Anxiety Symptoms – Anxiety itself causes symptoms that can appear at first glance to be a hallucination. For example, it may cause changes to light perception, or buzzing in the ear. These can then be misinterpreted by the person’s anxious mind.

These are only a few of the examples of ways that anxiety can create a perception that there are hallucinations, despite no hallucinations taking place. Anxiety also makes a person more likely to worry about their mental health, increasing the risk further.

Types of Anxiety Hallucinations

Hallucinations can affect all of our senses, but are most likely to be auditory or visual. Examples of these hallucinations include the following, though this is not a comprehensive list.

Auditory Hallucinations

Most “hallucinations” from anxiety are going to be auditory (related to hearing). That is because, as we discussed earlier, most hallucinations are not true hallucinations but rather ways that our brain is perceiving other sounds and stimuli, and our ears are far more likely to be responsible for picking up “extra” information that we’re not otherwise paying attention to.

You can think of it like this: when you’re looking at an object, you know exactly what the object is, you can see it, and you’re focused on it. It’s in front of you.

But sounds can come from any direction. They can be loud or quiet. They can be unexpected, and they can’t be turned off when we’re not paying attention (we can’t close our ears and it goes away). This is why we are likely to be more prone to auditory hallucinations. For example:

• Name – We may hear someone calling their name when no one is there, or hear our name being talked about within a crowd when it was not actually said.
• Background Noise – We may perceive faint music, buzzing, or whispers.
• Weird Noises – We may experience distorted or exaggerated environmental sounds.
• Self-Talk – We may hear internal dialogue that feels louder or more intrusive than usual.

One weird auditory hallucination that we have yet to find the cause of is people that complain they hear a loud pop or bang. This is more common in those that have panic disorder. It’s not entirely clear what causes this noise. It may be that a slightly quieter banging noise is made loud by our sensitivity to anxious noises. But it does seem to be an experience that many share.

These experiences often occur during panic attacks, periods of severe stress, or chronic sleep deprivation, all common features of anxiety disorders. They may also occur for seemingly no reason at all in someone that has anxiety, because anxiety is more likely to cause sensitivity to anxiety-producing sounds.

Visual Hallucinations

Visual hallucinations are less common with anxiety, but can still occur. When they do, they’re not that different from auditory hallucinations, in that they’re more likely to be misinterpretations of more common visual experiences, or issues caused by anxiety itself.

For example, anxiety causes the pupils to dilate, which brings in more light. It can also causes “tunnel vision,” which is where you’re able to see better directly in front of you while the sides of your vision may appear blurry or checkered. Like with auditory hallucinations, a person may also overreact to visual stimuli. Examples of these visual hallucinations include:

• Fleeting shadows or flashes of light
• Movement in the peripheral vision with no identifiable source
• Visual static or “visual snow” during panic or hyperventilation
• Seeing patterns, blurs, or spots that resolve quickly
• Perceiving shapes or outlines that disappear upon closer inspection

As you can see, many of these are related to your eyes letting in more light. Hyperventilation can also affect your vision, and people with anxiety are prone to eye pain/discomfort, eye tiredness, and more.

Anxiety is also going to cause people to be more fearful of what they see, and possibly interpret it as dangerous. A tiny unexpected shadow may appear to be a person to someone with anxiety, and their imagination can make them feel like a person is hiding near them, leading to more anxiety symptoms.

All of these are examples of how a person might experience what feels like a “visual hallucination” but is instead just anxiety leading to misinterpretation of normal visual experiences.

Other Hallucinations Caused by Anxiety

Most of our “hallucinations” are going to come from our eyes and ears. But we might also experience what we think are hallucinations caused by other senses. For example:

• Unexplained Smells – Anxiety can heighten our senses and make us more sensitive to different smells. This means that not only might we smell things that others cannot, but also we may interpret those things as unpleasant or scary because of our anxiety.
• Weird Sensations – Anxiety, panic attacks, and related symptoms like hyperventilation, can cause a person to experience a combination of hypersensitivity and “Self monitoring.” This is where they are subconsciously scanning their bodies for weird feelings, and then experiencing those feelings stronger than a person might otherwise. This can make it feel as though you’re hallucinating a touch or other feeling.
• Odd Tastes – This may not be so much a hallucination, but a symptom of anxiety. Many people experience a change in their taste buds with anxiety, with bad tastes or metallic tastes that show up while eating or while nothing is in your mouth at all.

These are other examples of issues that may be viewed as “hallucinations” in some form, but are otherwise normal.

Difference Between Anxiety Hallucinations and Psychosis

When a person experiences these types of strange hallucinations, one of their biggest fears it that they’re experiencing a form of psychosis. That fear itself can also cause more anxiety. Luckily, there are many ways to tell that this is anxiety and not another mental health issue.

The biggest tell is that you’re aware of it – that you have the concept that what you’re seeing isn’t real. Someone with psychosis typically believes that what they’re seeing and feeling is real, and so the very act of questioning whether or not you’re truly hallucinating is itself a sign that you are not. Other examples include:

• Content – Anxiety-related disturbances are often vague or brief (e.g., hearing one’s name called), and may not include ongoing complex or commanding voices.
• Frequency – Anxiety-induced hallucinations tend to be less common, and not part of a persistent pattern of sensory disruption.
• Anxiety-Triggers – Anxiety-related hallucinations tend to trigger anxiety as they occur, or happen during periods of anxiety. Psychosis related hallucinations rarely trigger anxiety unless the content of the hallucination is specifically frightening, in which case it’s because the person is perceiving it as real.

Only a therapist or doctor can truly identify what is anxiety and what is psychosis, but most individuals that struggle with psychosis are unaware of it, and are not experiencing anxiety in the same way as someone with an anxiety disorder.

What Happens Next?

If you’re experiencing anxiety-related hallucinations, it’s almost always a sign that your anxiety has become difficult to manage. Whether it’s panic attacks, generalized anxiety disorder, post-traumatic stress disorder, or something else, feeling like you might be hallucinating is a sign that your anxiety is in need of professional support.

Here at Flourish Psychology, we provide mental health treatment in New York for those that are looking for help with their anxiety or other mental health issues. We can teach you skills to help you manage your anxiety, and train your mind to experience less fear if and when you do have these manifestations.

For more information, or to get started, please reach out to Flourish Psychology, today.