You’re the person everyone counts on. You meet deadlines, exceed expectations, and maintain a polished exterior that makes it look like you have it all together. But inside, you’re running on anxious thoughts that never stop. The worry that something will go wrong. The fear that people will discover you’re not as capable as you appear. The exhaustion of always being “on.”

This is high-functioning anxiety—and it rarely gets recognized because from the outside, it looks like success.

People with high-functioning anxiety don’t fit the typical picture of an anxiety disorder. You’re not paralyzed or unable to function. In fact, you might be the model employee, the reliable friend, the person who seems to have it all figured out. But beneath that exterior, you struggle internally with self-doubt, perfectionism, and a nervous energy that never fully quiets.

At Therapy Group of DC, our therapists specialize in helping high-achieving professionals manage high-functioning anxiety. We understand that your anxiety isn’t obvious to others—and that’s part of what makes it so isolating. Our approach addresses both the symptoms you’re experiencing and the underlying patterns keeping you stuck in chronic stress.

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Is High-Functioning Anxiety Therapy Right for You?

You might benefit from high-functioning anxiety therapy if you:

• Feel anxious before meetings, deadlines, or social events—even ones you’re prepared for
• Replay conversations and worry about how you came across
• Have difficulty relaxing even when you have time off
• Experience physical symptoms like muscle tension, a pounding heart, or sleep disturbances that your doctor can’t fully explain
• Set impossibly high standards for yourself and feel like a failure when you don’t meet them
• Overthink decisions and second-guess yourself constantly
• Say yes to everything because you fear disappointing people
• Appear calm and competent while feeling overwhelmed inside
• Struggle with self-criticism that feels relentless
• Keep telling yourself you’ll slow down “after this project” but never do

What to know:

• High-functioning anxiety is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, but the symptoms are real and significantly affect people’s lives
• High-functioning anxiety often coexists with generalized anxiety disorder and shares many of its features
• Research shows that cognitive behavioral therapy and other evidence-based approaches effectively treat high-functioning anxiety symptoms
• Seeking professional help is important if anxiety symptoms are overwhelming or interfere with daily life
• With professional support, you can reduce ongoing anxiety while maintaining the drive and capability you value

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Understanding High-Functioning Anxiety

High-functioning anxiety describes a pattern where anxiety drives achievement rather than preventing it. Unlike other anxiety disorders where symptoms interfere with daily activities, people with high-functioning anxiety use their anxious energy to fuel productivity, preparation, and performance. The problem is that this comes at a significant cost to mental health and well-being.

High-functioning anxiety isn’t recognized as a distinct mental health condition in the Diagnostic and Statistical Manual. However, mental health professionals increasingly recognize it as a meaningful pattern that deserves attention. Many people with high-functioning anxiety mirror the criteria for generalized anxiety disorder—excessive worry, difficulty controlling anxious thoughts, and physical symptoms—but they’ve developed strategies to keep functioning despite these symptoms.

The term “high-functioning” can be misleading. It implies you’re coping well, when in reality you may be struggling silently. You might appear outwardly successful but feel empty and unfulfilled inside. High-functioning anxiety also often coexists with other conditions, such as depression. For some people, the perfectionism and checking behaviors cross into obsessive-compulsive disorder—the constant internal struggle takes a toll over time.

What Causes High-Functioning Anxiety?

Perfectionism and fear of failure. Many people with high-functioning anxiety developed early beliefs that their worth depends on achievement. This creates intense fear around making mistakes or falling short of expectations.

Environmental pressure. Washington DC’s professional culture rewards overwork and constant availability. When everyone around you is striving, it normalizes the relentless pace that feeds anxiety.

Genetic predisposition. Anxiety disorders have a hereditary component. If family members experience anxiety, you may be more susceptible to developing it yourself.

Early experiences. Childhood environments where love felt conditional on performance, or where unpredictability created hypervigilance, can set the stage for high-functioning anxiety in adulthood.

Risk factors include: high-pressure careers, Type A personality traits, history of anxiety in the family, traumatic experiences, and chronic stress exposure.

In our DC practice, we work with many professionals who’ve spent years channeling their anxiety into successful careers without recognizing how much it’s costing them. The same drive that helped you succeed is often what brings you to therapy when it becomes unsustainable.

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Common Signs of High-Functioning Anxiety

High-functioning anxiety symptoms affect your mind, body, and relationships—even when they’re invisible to others. Common signs of high-functioning anxiety include constant worrying, perfectionism, overthinking, and difficulty relaxing.

Emotional and Cognitive Symptoms

Persistent feelings of worry. Your mind generates worst-case scenarios that feel impossible to turn off. Even when things go well, you’re waiting for something to go wrong.

Self-doubt and impostor feelings. Despite evidence of competence, you feel anxious you’re not actually qualified. The relentless pursuit of perfection and fear of failure can erode self-esteem over time, leading to feelings of inadequacy.

Excessive worry about others’ perceptions. You analyze social interactions and replay conversations. The fear of judgment drives much of your behavior.

Self-criticism and harsh inner voice. You hold yourself to standards you’d never apply to others. Self-criticism is swift and severe. Practicing self-compassion feels foreign or even dangerous.

Physical Symptoms

Muscle tension in your shoulders, jaw, or back—often without realizing it until it becomes pain.

Sleep disturbances. Difficulty falling asleep or waking with anxious thoughts. Good sleep becomes elusive, yet establishing good sleep habits is crucial for overall well-being.

Restlessness. Inability to sit still, feeling like you always need to be doing something.

Fatigue from chronic stress. The constant vigilance is exhausting.

Pounding heart, gastrointestinal issues, shortness of breath—physical symptoms doctors can’t fully explain.

How It Affects Your Life

Work. Successful careers built on unsustainable hours and stress that follows you home.

Relationships. People-pleasing, difficulty relaxing into connection, emotional unavailability.

Self-care. People with high-functioning anxiety tend to neglect self-care like sleep, exercise, and nutrition—leading to physical health problems associated with chronic stress.

Daily lives. Simple decisions feel overwhelming. Rest feels impossible.

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How We Treat High-Functioning Anxiety

Effective anxiety treatment addresses both the symptoms and the deeper patterns driving them. Effective treatment for high-functioning anxiety focuses on building awareness, self-compassion, and changing unhelpful thought patterns and behaviors. Our therapists use evidence-based approaches tailored to high-achieving individuals.

Psychodynamic Therapy

Psychodynamic therapy explores how past experiences and unconscious patterns shape your current anxiety. For high-functioning anxiety, this approach helps you understand why achievement became tied to self-worth, how early relationships influence your need for control, and what drives the fear beneath the perfectionism. This deeper work creates lasting change.

Acceptance and Commitment Therapy (ACT)

ACT helps you change your relationship with anxious thoughts rather than fighting them. You’ll learn to notice anxiety without being controlled by it, clarify your values, and take action aligned with what matters. This approach builds psychological flexibility, helping you function effectively without anxiety driving everything.

Mindfulness-Based Approaches

Practicing mindfulness helps you return to the present moment rather than living in anxious thoughts. For high-functioning anxiety, mindfulness addresses the tendency to always think ahead, always prepare, never rest.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy helps you identify and change thought patterns fueling your anxiety. You’ll learn to recognize cognitive distortions—like catastrophizing—and develop more balanced perspectives. For people with high-functioning anxiety, CBT provides concrete tools you can apply in stressful situations.

Somatic Therapy

Somatic therapy addresses the mind-body connection and helps process intense emotions manifesting physically. For people who carry anxiety in their bodies—muscle tension, stomach issues, racing heart—somatic approaches help release what talk therapy alone may not reach.

Internal Family Systems (IFS)

Internal Family Systems therapy helps integrate different parts of oneself to reduce internal conflict. This approach is particularly beneficial for perfectionism in high-functioning anxiety, helping you understand and work with the “inner critic” driving your relentless standards.

Talk Therapy and Deeper Work

Understanding where your patterns originated creates lasting change. Therapy explores how early experiences and core beliefs contribute to current anxiety.

What About Medications?

Some people benefit from medication alongside therapy. Selective serotonin reuptake inhibitors (SSRIs) can help ease anxiety symptoms while you develop new strategies. Our therapists can discuss whether a psychiatry referral might help.

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What to Expect in Therapy

Getting Started

Your therapist will want to understand your specific anxiety symptoms, triggers, and what you hope to change. Early sessions focus on building trust—creating space where you can be honest about what’s happening beneath the successful exterior.

Ongoing Treatment

Skill building. You’ll learn techniques to manage stress and anxious feelings in real-time—strategies for when anxiety spikes before presentations or when overthinking takes over.

Pattern exploration. Where did beliefs about needing to be perfect come from? What are you afraid will happen if you let go of control?

Behavioral experiments. Therapy means trying new ways of being—setting boundaries, tolerating imperfection, taking breaks without guilt.

Timeline

Many people notice shifts within the first few months. Treatment typically continues 6-12 months, though depth varies by goals. You control the pace.

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Our High-Functioning Anxiety Therapists

Our therapists understand the unique challenges faced by high-achieving professionals with anxiety. They bring specialized training in anxiety disorders and experience working with DC’s professional population.

Dr. Paul Rizzo, Psy.D.

Dr. Rizzo uses client-centered, existential, and humanistic approaches to help clients navigate anxiety and life transitions. His work helps high-functioning professionals reconnect with what matters beyond achievement. View Dr. Rizzo’s full profile →

Dr. Jessica Hilbert, Psy.D.

Dr. Hilbert uses Internal Family Systems (IFS) and relational therapy to help clients understand the different “parts” driving their anxiety—including the inner critic and the perfectionist. IFS is particularly effective for high-functioning anxiety where internal conflict keeps people stuck. View Dr. Hilbert’s full profile →

Dr. Tyler Miles, Psy.D.

Dr. Miles specializes in anxiety, stress, and burnout using ACT, client-centered therapy, and CBT. Her expertise helps clients understand how thought patterns maintain anxiety and build more effective responses. View Dr. Miles’s full profile →

Dominique Harrington, MA.Ed., LPC, NCC

Dominique uses relational and narrative therapy approaches to help clients explore the experiences that shape their anxiety patterns. She helps high-achieving professionals rewrite the stories driving their self-doubt. View Dominique’s full profile →

Dr. Dana Treistman, Ph.D.

Dr. Treistman uses Cognitive Behavioral Therapy and mindfulness practices to help adults manage anxiety. Her warm, collaborative approach creates space for addressing the thought patterns and behaviors that keep high-functioning professionals stuck. View Dr. Treistman’s full profile →

Dr. Rose Medcalf, Psy.D.

Dr. Medcalf integrates client-centered, feminist, and psychodynamic approaches. Her engaging style helps clients uncover the patterns driving their anxiety while building self-compassion alongside practical coping skills. View Dr. Medcalf’s full profile →

Xihlovo Mabunda, MS, LPC

Xihlovo integrates EMDR and psychodynamic therapy. When past experiences fuel current anxiety patterns, her training helps address root causes. She brings a culturally responsive approach that honors each client’s unique experience. View Xihlovo’s full profile →

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Begin High-Functioning Anxiety Therapy in Washington DC

You’ve spent years managing everything—including your anxiety. You’ve developed workarounds, pushed through, and made it look easy. But the exhaustion of constantly performing is catching up.

Therapy offers something different: a place where you don’t have to be fine. Where you can address the ongoing anxiety that’s been running in the background of your life. Where you can build a more fulfilling life that doesn’t depend on fear to keep you moving.

At Therapy Group of DC, we help high-functioning professionals move from surviving to thriving—without losing the ambition and capability you value.

Schedule an Appointment →

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Frequently Asked Questions

Is high-functioning anxiety in the DSM?

High-functioning anxiety is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. However, many people with high-functioning anxiety meet criteria for generalized anxiety disorder. The term describes anxiety that fuels achievement rather than preventing it—a pattern mental health professionals increasingly recognize and treat.

What is the best therapy for high-functioning anxiety?

Cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) are among the most effective approaches. CBT changes anxious thought patterns, while ACT builds psychological flexibility. Many people also benefit from mindfulness and talk therapy exploring underlying patterns.

How to improve high-functioning anxiety?

Managing high-functioning anxiety involves therapy, self-care, and lifestyle changes. Deep breathing and mindfulness help manage stress in the moment. Journaling can provide an outlet for stress and help identify triggers and patterns. Developing personal boundaries can improve relationships and prevent overextending yourself. Building a support network helps you feel less isolated. Setting realistic expectations and engaging in regular physical exercise also help manage anxiety levels. Working with a mental health professional provides personalized strategies.

What’s the 3-3-3 rule for anxiety?

The 3-3-3 rule is a grounding technique to relieve anxiety. Name three things you see, three sounds you hear, and move three body parts. This brings attention to the present moment and can ease anxiety when it spikes.

How is high-functioning anxiety different from generalized anxiety disorder?

Both involve excessive worry and physical symptoms. The difference is manifestation: people with high-functioning anxiety appear successful and in control, using anxiety as fuel. This delays seeking professional help because the anxiety seems to “work.” Generalized anxiety is a clinical diagnosis; high-functioning anxiety describes a pattern.

How long does therapy take?

Most people notice changes within months. Treatment typically continues 6-12 months depending on goals and depth of work desired.

Can high-functioning anxiety affect people at any age?

Yes. High-functioning anxiety can affect people of any age. Children and teenagers can experience high-functioning anxiety, often manifesting as excessive worries about performance and social pressures. It often develops when achievement becomes linked to self-worth. Many adults don’t seek professional support until the cumulative effects of chronic stress become unsustainable.

Do I need a diagnosis to start therapy?

No. If you’re experiencing anxiety that affects your well-being, therapy can help—whether or not it meets formal criteria for an anxiety disorder. Therapists help you identify and build on your strengths while developing new coping strategies.