High functioning anxiety: why the people who look fine are often struggling most

“High functioning anxiety” is a phrase some people use for performance driven worry that can sit behind competence, productivity and a calm appearance. It is not a formal diagnosis, and it cannot establish why someone is distressed. People who look capable may still experience restless thinking, fear of mistakes, difficulty switching off or physical tension. Physical symptoms should not automatically be attributed to anxiety, particularly when they are new, severe, changing or worrying. An assessment can consider health, sleep, work, relationships, safety, support and the practical circumstances around a person’s distress. CBT based support may be relevant for some people, but a blog cannot decide what treatment is suitable or predict an outcome. If behavioural experiments are considered, their rationale, pace and suitability should be agreed individually with an appropriate clinician. There is no requirement to use an online reflection as a self directed exercise. For related education, see the anxiety therapy page, panic resources and the Clinical Guides library. The Lyceum offers CBT based support in Chiswick, Ealing and the Richmond venue, as well as online where clinically appropriate. If there is immediate danger, a risk of harm or urgent medical or mental health need, use an appropriate emergency, crisis or healthcare service.