You pride yourself on your productivity and are vigilant about meeting work deadlines. You always show up for your friends at social gatherings, and even keep up with hobbies. On the outside you appear organized and successful, while on the inside you are feeling overly worried and stressed. Experts call this high-functioning anxiety—when the constant hustle masks symptoms of generalized anxiety.

While not an official diagnosis under the DSM-5, the classification of mental health disorders, high-functioning anxiety refers to a more subtle and less obvious form of anxiety. You may have heard the phrase used to describe people who function at a high level despite having anxiety symptoms.

People with high-functioning anxiety are typically high-achievers, perfectionists, and “type A,” whose symptoms of generalized anxiety are less visible and, therefore, harder to treat.

“They might still excel in their careers, have many friends, and have strong relationships,” says Dr. Neha Chaudhary, child, adolescent, and adult psychiatrist at Massachusetts General Hospital and Harvard Medical School and the chief medical officer at Modern Health. “But inside, they might be struggling with common symptoms of anxiety like restlessness, excessive worrying, trouble sleeping, or fatigue.”

People with high-functioning anxiety may cope by engaging in behavior that makes them appear more productive or accomplished.

“The same personality traits that drive individuals to perform at the highest level often fuel the symptoms of anxiety,” says Dr. Michael Louwers, associate medical director at Reset Medical and Wellness Center. “It often begins with good intentions, such as goal-setting and rigorous planning. However, those experiencing this type of anxiety usually establish incredibly high and unrealistic goals, resulting in procrastination or constant worry.”

Managing anxiety by appearing more productive is more common for women and minority groups, who “are acculturated to ignore their pain and discomfort to be there for others,” says Dr. Judith Joseph, psychiatrist and author of the book High Functioning. “Women are often acculturated to push through physical pain of periods, postpartum and menopause and this puts them at risk for [high-functioning anxiety] because they feel that they have to show up in spite of what they are going through physiologically.”

Many of the particular signs of high-functioning anxiety are synonymous with burnout, which is no coincidence as those who overexert themselves are at a higher risk of burnout.

Subtle signs of high functioning anxiety, according to mental health experts

Overworking and a reluctance to take breaks
Trouble slowing down or taking days off
Feeling of guilt or shame for minor failures or setbacks
A resistance to delegate tasks
Easily irritable
Negative self-talk
Micromanaging
Trouble sleeping

How to manage high functioning anxiety

It’s essential to take high-functioning anxiety seriously before it leads to other conditions—and to not see overperforming as the only way to calm the physical and mental symptoms of anxiety.

“People with high functioning anxiety and depression will have the symptoms but may actually overextend themselves to appear functioning,” Joseph says. “If we wait until these people lose their functioning, we could be too late. Many of them burn out, develop clinical depression or anxiety, abuse substances or develop medical problems if untreated and unsupported.”

Some people may benefit from talk therapy, medication, or a combination of both. There are also everyday tools that may help.

5 tools to manage high functioning anxiety

Give yourself some grace that it won’t all get done every day. “Recognizing when the anxiety is heightened and taking breaks can be really helpful, whether it’s from work or even from social commitments,” says Chaudhary.
Practice diaphragmatic deep breathing daily: Breathe in for four seconds, hold for four seconds, and breath out for four seconds
Eat brain-fueling foods, which include those rich in omega 3 fatty acids, B12, Vitamin D, and magnesium. Brain foods not only reduce inflammation but can improve mood by helping to sustain energy. Consider adding berries, nuts, and fish to your diet.
Set aside 30 minutes each day just for you. Experts recommend that taking a break—walking, listening to music, calling a friend—will help calm the nervous system and slow down the spiral of worrisome thoughts. It’s all about an intentional reset to shift your attention to something else.
Learn the art of delegating and saying no. Being a collaborative, human-centered leader will give you more time to care for yourself and partake in other things that bring joy.

“If you recognize the signs and symptoms and are struggling, know you’re not alone, and resources are available,” Louwers says.

8 surprising, subtle signs you have high-functioning anxiety