You Don’t Look Anxious. You Just Never Stop.

Let’s break down what high functioning anxiety can look like in individuals who appear to have it all together and never stop moving.

When the presence of productivity, perfectionism, and having it all together is the most outward facing part of a person, the first thing I think about is how often they are thinking about the next task or what needs to be done. That is most likely all the time, and they never actually get a break.

So what does anxiety actually look like?

For some people, they think about the stereotype where people are always visibly struggling, crying often, or even having panic attacks that prevent them from doing the things that they want to do. Sometimes anxiety is that person that you wonder, "how do they do it all," and they are always working. It is the person who you know you will always receive a text back from. They respond immediately and put all their needs aside while their calendar is constantly full. They think about everyone else’s needs and often let theirs go unmet. They have plans mapped out in their mind all the time and know how to simply get things done. For most people, they view this person as really successful, reliable, and the one that they know is always moving. This is the person that you call when something needs to be handled efficiently and effectively.

That person is the go-to person because they are functional. A lot of the time, they are not asked the simple question that they hope to hear: "are you OK?"

You will likely get the response of "I’m fine," which is more likely an accurate representation of: "I’ve been keeping myself so busy that I don’t actually have the time to sit with, connect, or even know what I’m feeling in the moment."

Anxiety is not this black or white thing that we either have or we don’t. It can come on in different levels or look a little bit more like a spectrum, and someone can be very functional while having extremely severe anxiety. That is why so many of us know the term high functioning anxiety, because so many of us live with anxiety without the ability to slow down, or at least the perception that we can.

Let’s think about the symptoms. As a mental health provider, there are certain things that I look for when I meet with someone who may have anxiety that can give me information on how it exists in their day. Let’s start with the physical symptoms. You might experience a racing heart, muscle tension, headaches, restlessness, fatigue, trouble sleeping, GI issues, difficulty relaxing, having a change in appetite, and having the need to consistently be and feel "on." These are the aspects that I tend to notice people having an easier time identifying and labeling, because when we experience physical symptoms that cause discomfort, we want to get rid of them as quickly as possible.

Then there are some of the emotional or cognitive symptoms that somebody experiences. These are the ones that I feel people let build up for longer periods of time before taking action against them, because they can simply "just get through it." This often looks like constant worry or overthinking about every little thing in your life, and having difficulty slowing your brain down, which leads you to feeling irritable or overwhelmed. Anxiety can also present with difficulty concentrating, needing constant reassurance, or being worried that something might go wrong. For individuals with high anxiety, it can sometimes be difficult to be present because you feel you should always be doing something, and if you are not, then you are being "lazy."

And then there are behaviors. These are the behaviors that go on so long that you feel like that is simply your normal baseline rather than something being off. Avoidance is a big piece of this that we see because we inherently as humans do not like to approach things that make us uncomfortable. We will do literally anything else rather than the thing that we were thinking about that might take no time or energy at all. We can procrastinate projects or even over-prepare something that is coming up. For some people, this might look like people-pleasing and saying yes to a lot of things when the reality is that you do not have the time or energy for anything, and you need to be saying no in order to prioritize yourself. This over-functioning, where you are busy all the time to avoid uncomfortable thoughts or feelings, will show up, and the ability to rest without feeling an overwhelming sense of guilt is nonexistent.

And this is the point where anxiety can be really challenging, because not everyone with these symptoms appears to be anxious when you are looking at their outward presentation.

Let’s break this down into easy takeaway points for you to implement and notice in your daily life.

Number one: you stay busy because slowing down makes you uncomfortable.

Now, vulnerability point here. I relate to this one pretty well. That sense of urgency that comes up when I don’t address something right away can be really challenging. Constant activity is the avoidance showing up and over-scheduling. And when it comes to children, we have to be very careful about the balance of keeping them active and involved versus overly booked and overly scheduled, but I will leave more of that information for our child mental health providers to address. It is not necessarily the busyness that is the problem or evidence of anxiety. It is the internal question of what happens when you are not busy. When you have time to rest, is it actually restful? Or is it that you are constantly thinking about all the things you feel you should be doing, so you feel guilty, restless, or just uncomfortable, which keeps your rest from being rejuvenating anyway? We know that sometimes those moments of productivity make you feel better and make the noise of anxiety quiet down, and it becomes a coping skill that you rely on until it is no longer functional.

Number two: you are the person that everyone can count on.

Anxiety presents itself here by taking on responsibility for things that you do not necessarily need to. The people-pleasing behaviors may often be connected to fear surrounding rejection, conflict, disappointing people, or being perceived negatively. This is a mask. The idea that you are actually seen as your true and authentic self is so daunting and intimidating that you would rather think about all the ways that somebody could potentially perceive you wrong and "fix" as much as you can before they actually know the real you. Sometimes that over-responsibility is simply because you are worried something will go wrong, and if you maintain control, it prevents things from being out of your control. Uncertainty feels uncomfortable, and anticipating those problems makes you feel better. Being a reliable person is not necessarily a problem. The concern is when you feel so inclined to take responsibility for everything that there is no flexibility in letting others take the lead or make decisions that you might be worried will go wrong if you don't do them. This leads to an overwhelming sense of perfectionism that can intensify anxiety symptoms.

Number three: this is where perfectionism starts to present itself.

Those unrealistically high standards that you have for yourself probably started when you were younger from expectations you learned from others, and they have only intensified as you have learned how to navigate the world. That fear of criticism or rejection is constantly heightened if you are in a world of work that revolves around productivity being a part of your job. This leads you to checking, re-checking, thinking about every possible scenario, and feeling as prepared as possible in any moment. The hard part about this is that perfectionism makes your actual accomplishments feel less satisfying, because instead of celebrating the wins as they show up, you are thinking about all the ways that you could have made it better or how you would change it for the next time.

Number four: anxiety and panic are not the same thing.

This is where a lot of people get confused, because anxiety can present itself at a lower level in your day-to-day, and though it might feel less distressing than a panic attack in the moment, it is persistent and leads you to feel run-down and overwhelmed constantly. For a lot of people, they can identify moments in their childhood where they noticed they leaned towards being a more habitual worrier. This isn’t just about what is going on in our brain, it is also about how our body feels it. If you have been thinking to yourself the constant phrases of "I can’t shut my brain off," "it’s hard for me to relax," "I always feel like I’m behind," or "everything is fine so how come I don’t feel fine," this is probably anxiety. Just because you are not having these intense, overwhelming panic attacks does not mean that it is not causing destruction and distress in your day-to-day.

For people with high functioning anxiety, it is often something you need to point out in therapy. Minimizing your anxiety because you are still functional does not mean that you do not have it. For certain individuals, highlighting that there is something wrong helps them to identify that life could be better, but it does not feel safe to trust that. Just because you are productive does not mean that there isn’t something wrong. Just because you can white-knuckle your way through your day-to-day life doesn’t mean that your mental health is in a good place. It is actually quite the opposite. You have got yourself so busy that you are not even aware of your own mental and physical reactions to what is going on in your mind and body.

You need to rest.

For many people I meet with who have high functioning anxiety, there is a running to-do list, and they are only allowed to have rest when that to-do list is done. Here is the thing: it is never done. Whether it is the list that you create yourself, the list that your boss creates for you, or the list the world is requiring of people, we were never supposed to be this busy. There is always a list. Understanding that a healthy coping skill includes letting that list sit to the side in order to rest and recharge is how you maintain functionality moving forward.

Anxiety presents in a lot of different ways, and if you have noticed that you are feeling burnt out, overwhelmed, and always on without the ability to turn off, it might be time for therapy to figure out how to address your high functioning anxiety to improve your day-to-day functioning.

If you recognize these patterns in yourself, here are some local resources, tools, and practical strategies to help you start navigating high-functioning anxiety today.

Resources for High-Functioning Anxiety

Therapy for Anxiety with a Kansas City Therapist

If you are constantly working, overthinking, planning, accomplishing, and trying to stay one step ahead of everything, therapy for anxiety may be worth considering, even if you do not feel like your anxiety is "bad enough."

As a Kansas City therapist, I work with adults experiencing anxiety, high-functioning anxiety, perfectionism, chronic stress, burnout, and the pressure to constantly have it all together. You may look successful and put-together from the outside while internally feeling overwhelmed, exhausted, restless, or like you can never quite turn your brain off.

Anxiety therapy is not about making you stop caring, stop achieving, or become a completely different person. It is about understanding what is underneath the constant need to do more and learning how to manage anxiety without letting it dictate your entire life.

In individual therapy, we can work on anxious thoughts, perfectionism, people pleasing, difficulty resting, boundaries, stress management, burnout, and the fear that something will go wrong if you are not constantly in control.

If you are looking for a therapist for anxiety in Kansas City or throughout Missouri, head over to lifeyourway.org and send me a message to get connected for individual therapy.

Please note: I am located in Kansas City, MO, and provide therapy services to clients located in Missouri.

Resources for Managing Anxiety and Stress

How We Feel

If you are someone who automatically says "I'm fine" and then immediately gets back to work, How We Feel can be a helpful place to start paying attention to what is actually happening emotionally.

This free app helps you identify and name your emotions, which can be surprisingly difficult when you are used to pushing through stress and anxiety instead of stopping to check in with yourself.

Insight Timer

If anxiety makes it difficult to slow your brain down, Insight Timer offers a large library of free guided meditations and mindfulness exercises.

You do not have to become a meditation person. Start with five minutes. The goal is simply to practice slowing down without immediately reaching for another task, problem, or distraction.

Books for Anxiety, Perfectionism, and High Achievement

The Anxiety and Phobia Workbook by Edmund J. Bourne

If you are looking for a practical resource for understanding anxiety, this is a solid place to start. It covers anxious thoughts, physical symptoms of anxiety, avoidance, worry, and strategies for managing anxiety.

The Perfectionist's Guide to Losing Control by Katherine Morgan Schafler

If your anxiety tends to show up as perfectionism, overachievement, control, or constantly feeling like you should be doing more, this book is especially relevant.

It explores the different ways perfectionism can show up and challenges the idea that you simply need to stop being a perfectionist. Instead, it looks at how you can understand your perfectionism and make sure it is working for you rather than running your life.

Coping Skills for High-Functioning Anxiety

Ask Yourself: "Do I Actually Need to Do This?"

Before automatically adding another task to your list, pause and ask yourself:

"Does this actually need to happen right now, or am I doing it because being productive makes me feel less anxious?"

You might be surprised by how often productivity has become your coping mechanism for anxiety.

Practice Doing Nothing on Purpose

For people with high-functioning anxiety, rest can feel uncomfortable. You may feel guilty sitting on the couch when there are emails to answer, laundry to fold, or something else you could be accomplishing.

Start small. Give yourself five minutes where you are not accomplishing anything.

Notice the urge to get up and do something. You do not have to immediately act on it.

Learning to tolerate the discomfort of resting is a skill, too.

Change "What If?" to "What Is?"

Anxiety loves hypothetical problems.

What if I mess this up? What if they are upset with me? What if something goes wrong? What if I forgot something?

When you notice yourself getting pulled into the future, bring yourself back to the present.

Ask yourself:

What is happening right now? What do I actually know? What needs my attention today?

You do not have to solve every possible future problem before it happens.

If you are looking for a Kansas City therapist for anxiety, stress, burnout, perfectionism, or high-functioning anxiety, learn more about therapy with me at lifeyourway.org.