The Science of High Functioning Anxiety and Mental Health
When Worry and Anxiety Are a Fuel for Achievement – But a Strain On Your Life
Flourish Psychology is a boutique private practice in Brooklyn. Our therapists provide mental health support in the NYC area, with particular emphasis on those in high-stress, high-performance positions. Many of our patients are CEOs, celebrities, business owners, lawyers, influencers, doctors – people who are, by most metrics, high-achieving.
Yet, many of them struggle significantly with their mental health. Why?
The answer is that many people who have achieved significant things are being fueled not by a happy, internal drive, but by something called “high functioning anxiety.” It is a situation where anxiety, not joy, is what motivates people to achieve bigger and bigger things.
Let’s talk about “High Functioning Anxiety,” the science behind it, why it is a problem despite a person’s achievement, and the process for addressing it.
Note: If you think you have high-functioning anxiety and need help, please contact Flourish Psychology, today.
Starting Simple: What is Anxiety?
Before we can talk about “High Performance Anxiety,” we should first address anxiety in general. Your body is equipped with a survival tools. One of these tools is known as the “Fight or Flight” system. It is the system responsible for keeping you safe from harm and danger.
The Fight or Flight system occurs when a part of our brain (the amygdala) perceives a threat, and sends a message to our brain and bodies using hormones (adrenaline, cortisol) to tell the bodies to prepare to respond to that threat. It heightens senses and changes how your body works to make this possible.
While we typically talk about the “Fight or Flight” system negatively as it relates to anxiety, it is actually a good thing. It help us rapidly respond to dangers by prepping our body for everything it needs:
Your heart beats faster so blood can get to your muscles.
You sweat to keep you cooler if you’re running or fighting.
Your eyes dilate so you can see movement better.
You think faster so that you can quickly make instinctual decisions.
These are only a few examples of the changes that happen with the fight or flight system. Without it, you would be slower, weaker, less afraid (some fear is good when faced with danger) and overall less able to respond to stress.
The problem is that we don’t have as many dangers, and our fight/flight system malfunctions. Those same symptoms (rapid heartbeat, sweating, eye dilation, racing thoughts) become problematic, and we get symptoms that impact our lives.
How Anxiety Affects Us Today
So we know that anxiety is meant to keep us safe from harm. We also know that our “dangers” are not the same as they were in the past.
What we’re finding is that, in today’s time, our brain is responding to things like emails and deadlines the same way it responds to predators.
For some people, the response to this anxiety is to be distracted and let it drain them.
But not everyone has that type of response. Some people have a very different reaction, one that actually fuels them to respond in ways that can help them achieve great things.
When anxiety is triggered, the activation of the amygdala disrupts a person’s prefrontal cortex and overloaded it – This is the part of the brain responsible for things like:
Planning
Analyzing
Controlling
The person is on overdrive trying to control everything they can in order to keep themselves safe from threats. But remember, these threats are deadlines. They’re making mistakes. They’re failing to make money, or concerns that they be turned down for jobs or promotions.
When those are the threats, a person’s anxiety motivates them to keep going: work harder, take on more, make sure everything is perfect, and more. What happens when those people take on more projects, work harder, and try to make everything perfect?
They succeed. Sometimes a lot. They are seen by many as “high achieving,” and often are.
We call this “High Functioning Anxiety” – an unofficial term that describes those that are able to achieve incredible things, but the motivation for that achievement is anxiety rather than a more traditional internal drive.
What High Functioning Anxiety Looks Like
High Functioning Anxiety is not a formal diagnosis in the DSM-V (the manual that therapists are trained to use to diagnose mental health issues), but it is a descriptive term for those that present with very specific anxiety symptoms.
Typically, there is an external presentation that appears:
Confident
Punctual
Proactive
High-Achieving
Detail-Oriented
In Control
Most people are unable to guess that this person has anxiety, or is impacted by their mental health at all. But inside, the person is struggling with:
Chronic Overthinking
Pervasive Sense of Impending Doom
Fear of Failure
People Pleasing Tendencies
Intrusive What-If Thoughts
Inability to Relax
Achievement and busyness are often coping mechanisms to manage and outrun underlying anxious feelings.
Then, achieving a goal provides temporary relief from anxiety, reinforcing the cycle of using work and achievement as a primary coping tool.
Why Do Some People Develop High Functioning Anxiety and Not Others?
Many with anxiety find that it impedes function. It makes it much harder to manage day to day tasks. It clouds thinking and reduces the energy they have to put into their tasks.
But for others, anxiety becomes the primary fuel that drives them forward due to a number of possible factors, including:
Biological Vulnerability – Anxiety disorders tend to run in families, and so too might there be a biological reason that some individuals have nervous systems that react this way to perceived threats.
Upbringing and Early Experiences – Children raised in environments with high expectations, inconsistent praise, or pressure to succeed may internalize the idea that achievement is the only way to feel safe or valued.
Personality Traits – Traits such as perfectionism, conscientiousness, or people-pleasing tendencies make it more likely that anxiety will intertwine with achievement.
Environmental Demands – Competitive industries, cultural expectations, or environments that reward constant productivity reinforce the link between anxiety and success.
Reward – As discussed, some people find that achievement helps reduce some of their anxiety, which then makes achievement one of their coping tools.
It may be a combination of these factors at play. In any case, it’s not clear why it differs from the traditional symptoms of conditions like generalized anxiety disorder, but most likely there are several factors at play.
Anxiety Becoming a Double-Edged Sword – and How to Address It
Someone with high functioning anxiety may have these “positive qualities” – qualities that will help you achieve societally great things. High attention to detail, problem solving skills, drive and motivation to excel: all of these are qualities that society values.
But achievement is only a small part of living a happy life. Those with high functioning anxiety also experience:
Burnout and Exhaustion – Unsustainable energy expenditure and difficulty continuing onward.
Physical Health Impacts – Sleep disturbances, digestive issues, tension headaches, a weakened immune system due to chronic stress.
Mental Toll – Perfectionism, catastrophic thinking, difficulty with procrastination (often until the anxiety provides enough motivation to act), and emotional dysregulation.
Imposter Syndrome – A constant fear of being “found out” as a fraud, despite evidence of competence.
Interpersonal Challenges – Irritability, difficulty being present, and setting unrealistic expectations for others.
Increased Risk of Depression – Being under constant stress runs the risk of developing other mental health conditions, like panic disorder or depression.
This is why achievement is not “everything.” It is only part of the puzzle, and when it comes with significant mental health costs, it can become a significant life problem.
What Can We Do About High Functioning Anxiety?
One of the challenges that many people face is that they don’t want to stop achieving. They simply want to reduce the anxiety side: the stress that they experience and the way it affects their mental health.
So, we need to address high-functioning anxiety without hurting the “high functioning” part. We do this by:
Challenge Cognitive Distortions – Identify and reframe “all-or-nothing” thinking, catastrophizing, and perfectionism (core tenets of CBT).
Values-Based Action (ACT) – Learning to take action guided by personal values rather than by the need to quell anxiety.
Scheduling Rest – Literally block out time for non-negotiable, non-productive rest to counter the “always on” drive.
Setting Boundaries – Learn to say “no” to reduce overwhelm and people-pleasing.
We don’t have to stop your achievement. But we do have to teach you to achieve from a different place, and make the changes to your life that will help you feel your absolute best.
High-Functioning Anxiety is a real and exhausting experience, even if it’s invisible to others. The goal is not to eliminate the drive but to decouple it from suffering.
Let’s Use Your Skills to Help You Build a Better Life
You’ve been a high achiever. It may be fueled by anxiety, but no one can deny that you’ve managed to create a life for yourself that is impressive.
It’s time to use that fuel to your advantage and have it motivate you to not only achieve better things, but to take control of your mental health as well.
Our therapists here at Flourish Psychology often specifically work with individuals who meet these criteria. Many people in high-profile positions have gotten there through their anxiety. If you feel like this describes you, reach out to Flourish Psychology, today.
