Here’s Why High-Functioning Anxiety Can Feel Like the Mental Health Version of ‘No Pain, No Gain,’ According to Therapists

I remember pulling up my pant leg so my doctor could get a better look at the rash on my shin. His eyes widened each time I answered “no” to questions about possible causes from insect bites to chemical sensitivities. I’m not a medical expert but I knew the culprit behind my rash because it happened every time I graduated from school. First, while crossing the stage for my high school diploma, I had bobby pins holding my hair in place to hide the rash on my neck. Once again, with my skin swollen and blistered, I knew that completing a PhD would mean grappling with and figuring out how to manage my high-functioning anxiety.

You might be familiar with this term. If you search #highfunctioninganxiety on TikTok, you’ll find videos with over 114 million views. But even if you don’t break out in rashes, you probably know what it feels like to go into the fight-or-flight response where your heart rate goes up and your thoughts start racing. When this happens, your first instinct might be to avoid whatever situation is causing you anxiety such as getting on an airplane or giving a presentation.

It’s important to note that, although high-functioning anxiety isn’t a disorder, the distress individuals (like me) experience is very real. We often struggle with overthinking, dwelling on past mistakes, expecting the worst, and needing reassurance from others. But instead of trying to escape from stressful situations, we push back against our anxiety, managing to “succeed despite persistent feelings of fear, dread, and uneasiness,” says Tonya Lester, LCSW,  a therapist who practices in Brooklyn, New York. “The high-functioning, anxious person believes that if they don’t feel nervous and agitated most of the time, they’re letting themselves off the hook or they’re on the verge of becoming a total slacker.”

Why do we get stuck thinking that anxiety helps us succeed?

Growing up in an Indo-Caribbean family taught me that pursuing an education was the best way to honor my culture and earn my loved ones’ approval. I learned to cope with loss by channeling my anxiety into schoolwork. At 7 years old, I couldn’t stop my dad from dying nor could I, at 17 years old, ease the suffering my grandma endured from dementia. But I could control my anxiety long enough to get good grades in spite of my deteriorating mental health.

From the outside, someone with high-functioning anxiety can appear as though they have a blueprint for success. They tend to be high achievers, appearing calm, organized, and attentive to detail. Since they don’t want to risk failing or disappointing anyone, they often view anxiety as “fuel for accomplishing tasks,” says  Daryl Appleton, EdD, MEd, psychotherapist, and Fortune 500 Executive Coach. “While this can have some obvious upsides like improved performance and productivity, the downsides include perfectionism, imposter syndrome, and basing our worth on what we do vs. who we are.”

Being high functioning is almost like the anxiety version of “no pain, no gain.” In striving for perfectionism, we can get caught up in a cycle of procrastinating, then feeling overwhelmed while still managing to meet deadlines. This cycle, which Dr. Appleton refers to as a “type of success delusion,” further reinforces that we need to be in a state of turmoil to achieve our goals. As a society, because we often celebrate achievements like winning gold medals, reaching the top of the music charts, or getting into an Ivy League school, it can be hard to let go of high-functioning anxiety even while pushing ourselves to the brink of fatigue and burnout.

Why it’s important to change your relationship with anxiety

Typically, high-functioning anxiety is rooted in perfectionism and low self-esteem, leading us to believe that our only option in life is to be an anxious super-achiever or a go-with-the-flow failure. This kind of thinking doesn’t serve us well and, too often we’re not even aware of it. An example from Lester shows this thought process in action: Imagine starting a job, and your new boss tells you that their goal is to make you feel scared and unhappy all the time. Your boss constantly tells you that you’re a failure, diminishes your ideas, berates you, and overlooks your accomplishments. “The high-functioning anxious person allows that boss to live inside their head,” she adds.

With high-functioning anxiety, we can grow accustomed to thinking that it’s normal, and perhaps beneficial, to feel jittery and overwhelmed all the time. But this isn’t true. “When our minds are clouded by fear, we’re more likely to make careless mistakes and ignore innovative ideas,” Lester says. “Anxiety cuts us off from traits that are responsible for high achievement, like conscientiousness, creativity, and passion.”

How to manage high-functioning anxiety without losing passion or drive

Even though high-functioning anxiety isn’t a clinical disorder, you can still benefit from mental health support, especially if anxiety is interfering with your enjoyment of life. For example, if your goal is to switch careers and you’ve been doing just about everything except sending out resumes, it’s easy to double down on procrastination by overscheduling yourself with work or social engagements to avoid your job search. In that case, Dr. Appleton recommends asking yourself, “Am I feeling pressured to achieve because this is a goal I want? Or am I trying to win someone else’s approval?”

Once you have a clear sense of the motivation behind your goals, you can determine what steps are needed to move forward. Start by tracking your mood, looking for patterns such as when minor stressors are becoming more intense or prolonged, Dr. Appleton says. Take steps to reduce anxiety such as going for a walk, making sure you’re getting enough sleep and saying no to things you can’t accommodate in your schedule. As you consider your next career move, be sure to separate who you are from what you do, she adds, since your self-worth can become intertwined with your job title.

In addition to self-care, consider reaching out to a mental health professional who can help you challenge unhelpful thought patterns and develop new ways of approaching stress. For instance, they might suggest breathing exercises for anxiety, or trying what’s called “reality testing” by asking yourself, “Is what I’m telling myself true or is there another way to look at this situation?” Lester says.

Remember it’s okay to feel anxious during difficult times. A reasonable amount of “pressure can sharpen our focus and help us respond appropriately to the issues at hand,” Lester says. Learning to manage anxiety isn’t about being carefree in the face of stress. Instead, it’s about practicing self-compassion by recognizing mistakes as part of your growth and taking time to celebrate your accomplishments.

“High achievers who are motivated by passion, purpose, and curiosity are just as successful as those inspired by anxiety, and they also enjoy their lives,” she says.