High-Functioning Anxiety: When You Look Fine But Feel Exhausted

Written by Laura Valentino, MSW, LISW-S (she/her)

As a therapist, I spend a lot of time talking with people about anxiety. But honestly ... I also know what high-functioning anxiety feels like personally. 

It can look like showing up for everyone else while your own brain feels like it never fully powers down.

You wake up in the middle of the night, suddenly convinced you forgot something important. (Happens to me regularly). Your brain constantly jumps between mental checklists, unfinished tasks, and responsibilities. (Yeah ... Speaking from personal experience here, too.) Sometimes you feel completely frozen by overwhelm… until suddenly you accomplish an entire week’s worth of tasks in one anxiety-fueled afternoon. (Who, me?! My team will laugh and say, "Yeah, YOU!")

Your texts and emails pile up because responding feels mentally exhausting, but the longer they sit there, the more anxious you feel about them. You feel overstimulated by noise, notifications, responsibilities, and people needing things from you all at once. (I've very intentionally made this personal. Ha!)

And from the outside? You probably still seem capable, productive, organized, and “on top of things.”

That’s one of the reasons high-functioning anxiety can be hard to recognize. While “high-functioning anxiety” is not an official mental health diagnosis, it’s a very real experience for many people.

Anxiety does not always look like falling apart externally. Sometimes it looks like over-functioning.

It looks like being the reliable person. The helper. The overthinker. The one who says yes too often. The one who keeps going even when exhausted.

High-functioning anxiety can show up as:

• constantly mentally planning ahead

• replaying conversations afterward

• difficulty relaxing, even during downtime

• feeling responsible for everyone else’s feelings

• perfectionism disguised as “just caring a lot”

• staying busy because slowing down feels uncomfortable

• overcommitting because saying “no” creates guilt

• appearing calm externally while internally feeling overwhelmed

  
  

For many busy parents, professionals, caregivers, and helping professionals, anxiety can become so normalized that it starts to feel like personality instead of stress.

“I’m just a worrier.”

“I just like being productive.”

“I’m better when I stay busy.”

And yes, sometimes those things may feel true. But that does not mean your nervous system isn’t overwhelmed. One of the tricky things about high-functioning anxiety is that Western society often rewards it.

Society praises the person who works nonstop. The person who remembers everything. The person who helps everyone else. The person who pushes through exhaustion and still gets things done. But functioning is not the same thing as feeling okay. A lot of people with high-functioning anxiety are carrying an enormous amount internally while still appearing successful externally.

For some people, especially those who grew up feeling pressure to perform, caretake, avoid conflict, or hold everything together, slowing down can even feel uncomfortable or unsafe.

Your nervous system gets used to staying alert. Scanning ahead. Preparing for the next thing. Trying not to drop the ball.

Over time, your body can start to operate as if there is always something urgent waiting around the corner.

There is an emotoinal cost of always holiding it together. Living in constant “go mode” is exhausting.

Even when life looks manageable from the outside, internally you may feel:

• emotionally drained

• mentally overloaded

• irritable

• disconnected

• unable to fully relax

• guilty when resting

  
  

You may also feel like your worth is tied to how much you accomplish or how much you do for other people. And many people do not seek support until they are completely burned out because they tell themselves: “But I’m still functioning.”

You deserve support long before it reaches that point.

Healing from high-functioning anxiety is not about becoming lazy, unmotivated, or suddenly never caring about anything again. It’s about learning that your worth is not dependent on constant productivity. (Admittedly, I'm still working on this.)

Therapy can help people:

• better understand anxiety patterns

• regulate their nervous system

• set healthier boundaries

• challenge perfectionism

• practice self-compassion

• and learn how to rest without guilt

  
  

Most importantly, it can help people stop living in survival mode all the time.

You don't have to earn rest. You do not have to earn support. And you do not have to wait until you completely fall apart before you are allowed to slow down.

Demystifying OCD

Written by Dylan Crum, MSW, LSW

(he/him/his)

In this short blog post, I will be clarifying some common misconceptions about obsessive-compulsive disorder (OCD), describing how it presents, and how it can be treated. OCD is a condition in which individuals experience intense, unwanted, and often distressing obsessions which are then either avoided or neutralized with compulsory behaviors. Obsessions are often experienced as intrusive thoughts, whereas compulsions can take the form of physical actions or thoughts. 

The OCD Cycle

For all individuals with OCD, and even those who display some OCD tendencies but do not meet full criteria for an OCD diagnosis, their symptoms present in a predictable, but not always visible, cycle. This is referred to as the “OCD Cycle”, and consists of 4 phases. 

1. Fear-Inducing Stimulus

The first step in the OCD cycle is experiencing an intrusive, obsessive thought or fear, often when triggered by something in our environment. The focus of obsessive fears tend to revolve around aspects of our identity that they prioritize or highly value (e.g., our cleanliness, safety, morality, piety, etc.). As a result, these fears symbolize more than just an unwanted environmental condition or feeling - they often feel like an existential threat to our identity. 

It is highly important to consider that a fear-inducing stimulus can vary greatly from person to person. OCD-based fears are more than just needing our surroundings to be clean and orderly, as is commonly depicted in media or used in our everyday lexicon. 

1. Anxiety and Distress

Following the activation of OCD-based fears by an intrusive thought or environmental factor, individuals with OCD will experience intense distress. In the brain, this is caused by quick and involuntary activation of our amygdala, which serves as the “threat detector" of the nervous system. Individuals with OCD have an overactive amygdala, leading to greater and more common distress when the focus of obsessions are touched upon. An additional layer causing distress is the aforementioned existential threat to one’s identity, as someone’s obsessive fears becoming true would likely have dire consequences for their self-perception. In OCD, this distress is so intense that it needs to be “neutralized” through physical or mental actions.

1. Compulsory Behavior

Compulsory behaviors within OCD fulfill the function of “neutralizing” obsessive fears mentioned above. These behaviors resolve the internal conflict triggered by an intrusive fear or, in other cases, provide a level of certainty that is undermined by the fear response. While in many situations these behaviors are directly and obviously linked to the source of the fear (e.g., excessive hand washing for those with contamination OCD), they do not have to be. In many cases, there is an element of “magical thinking” involved in compulsory behaviors, in which the compulsion is only loosely tied to the obsessive fear. In some situations, rituals are performed or actions are repeated a certain number of times until it just feels “right”. These types of compulsions can be harder to properly identify as symptoms of OCD due to their loose connections to the source of fears, but can be accurately labeled by viewing them in the context of the OCD cycle.

1. Temporary Relief

The last step in the OCD cycle is the temporary relief that is elicited by compulsory behaviors. This relief is often immediate and may vary in length depending on the source of the fear and the intensity of OCD symptoms. In my opinion, this stage in the OCD cycle is the most crucial to understanding why it is just that - a cycle. When someone with OCD experiences this relief, it has two primary effects: first, it validates the source and extent of the intrusive fear and second, it reinforces the effectiveness and perceived necessity of the compulsory behavior. This has the total effect of reinforcing the overall OCD cycle, while also just feeling good in comparison to the distress felt at earlier points in the cycle. Invariably, however, for those with OCD, this relief will fade. Typically, this relief will slowly fade over time until a new stimulus retriggers one’s obsessive fears, restarting the whole cycle.

How Do We Treat It?

Now that you have a better understanding of the OCD cycle, you may be wondering: what can be done about it? The gold standard treatment for OCD is known as Exposure and Response Prevention (ERP), and is an offshoot of Cognitive Behavioral Therapy (CBT) mixed with elements of exposure therapy. ERP achieves change through what are known as in-vivo exposures. These are planned exercises in which one will intentionally expose themselves to the source of their obsessive fears while abstaining from their typical compulsive behaviors. If done systematically and consistently, these exposures will break down the OCD cycle by weakening the automatic connection between fears and compulsions. Over time, this will gradually improve one’s ability to tolerate uncertainty, which is typically the true fear underlying obsessive fears. ERP teaches people that they can tolerate distress and fear caused by this uncertainty without needing to engage in their compulsions to achieve a state of psychological safety. While ERP may not fully cure OCD for most, it can certainly make this condition more manageable and less impactful on day-to-day life.

Putting It All Together

Through explaining the OCD cycle and describing its primary treatment, I hope to draw a distinction between OCD and other mental health disorders, primarily anxiety. OCD is commonly confused for anxiety because this is often the primary symptom, and in many cases one’s compulsions can seem like justified, natural steps taken to resolve this anxiety. It is only through observing one’s symptoms in comparison to the OCD cycle that a true distinction can be made. OCD is not just anxiety; it represents a complex cycle of behavior that interferes with our quality of life and causes regular, distressing threats to our perceived safety and identity. If you feel that you or someone you know suffers from OCD, contact a mental health professional with experience treating this condition.

Why Do I Shut Down During Conflict? Understanding the Freeze Response

Written by Rocco Contini, MA, LPCC-S

(he/him/his)

Picture it: You and your partner are going along your normal day when something happens and someone gets upset. They begin to express frustration toward you or your behavior, something you did or said, and you also begin to get upset when suddenly…you shut down.

Your eyes drop, your shoulders roll forward, you disengage verbally and emotionally, and you feel yourself trying to escape the situation. What is this? Why is this happening?

Shutdown is a state of dysregulation, a “down regulated” nervous system state akin to playing possum. It’s a natural state all human brains are capable of slipping into during moments of conflict, stress, or any other strong emotional trigger. Although not loud and boisterous, it is still dysregulation. 

When conflict occurs, many things start to happen and get triggered at once. Your fight/flight/freeze/fawn system activates, old habits and safety mechanisms turn on, and any unresolved attachment wounds may jump to the surface. When this happens, your brain automatically starts scrolling through its files and begins to look for ways to keep you safe.

Which is the ACTUAL job of the shutdown state: It is your nervous system doing the best it can in that moment to keep you safe. Just like playing possum, it’s your nervous system trying to protect you, not work against you.

Where does this come from? As any good therapist will answer…it depends. First and foremost, as stated earlier, shutdown is a natural response built into the human brain. We’re all capable of it and probably all do it from time to time, but some more than others. Those who get into a pattern of shutdown, shutting down during most periods of conflict, stress, etc., probably have a range of life experiences wherein shutting down kept you physically and emotionally safe. It may have been the best (or even only) way your nervous system learned to navigate scary, stressful, or even traumatic moments of conflict. 

Shutdown can show up in a variety of ways. You may go silent during arguments, forget what you wanted to say or just say “I don’t know” when asked a question, cry unexpectedly, or try to find ways to make the conversation end, such as agreeing in order to end the conflict. Shutdown can also appear as becoming emotionally distant and disengaged. Not necessarily combative, but cold, distant, and overly logical rather than tapped into your emotions or the emotions of those around you.

As difficult as shutdown can be to experience, there are ways to navigate it and work through it. 

• Learn to notice the cues in your body. Slower breathing, less eye contact, slouching posture, feeling cold, heavy limbs, emotionally disconnected, etc.

• Use skills to regulate. Grounding techniques to help remain in the present moment, gross motor movement to help re-activate your nervous system, change the pace of your speech, breathing techniques focused on cold/fast air (like blowing out a candle)

• Notice the pattern between yourself and whoever you are in conflict with. Non-judgementally own your part of the pattern, then communicate an emotional need or boundary

• Therapeutic support, either individual or relational. Both individual and relationship therapy (not just couple relationships, but parent-child, siblings, etc) can help people realize what gets triggered for them during conflict, their behaviors, and how to change up their part of the pattern for a better, more connected outcome.

  
  

Shutting down is genuinely more common than many people who do it realize. It’s a natural thing that can become a problematic pattern for ourselves and our relationships. It is not a sign that something is inherently “wrong” with you, that you’re weak or uncaring, it comes from a place of needing to feel safe. Healing involves learning where it comes from and how to feel safer and more connected during difficult moments.