A psychologist has highlighted seven subtle indicators of mental health issues that could lead to severe burnout. According to the National Institute of Mental Health, around 40 million people in the United States are diagnosed with some form of anxiety disorder.
Anxiety doesn’t always show up in the most obvious ways. Some individuals suffering from anxiety might appear calm, well-organized, and even highly successful on the outside.
However, beneath that composed exterior is often a relentless worry and an unyielding quest for perfection that can become exhausting. This often leads to burnout due to its often unnoticed presence.
The particular form of anxiety being described is known as high-functioning anxiety. Dr. Bijal Chheda, a Consultant Psychologist and Founder of Nos Curare, a clinic specializing in inclusive mental health care, outlines seven subtle yet impactful ways high-functioning anxiety manifests in daily life along with expert tips to manage them.
Individuals with high-functioning anxiety frequently feel physically exhausted while their minds remain in overdrive, constantly worrying or picturing worst-case scenarios.
This perpetual state of alertness is often linked to anxiety-related conditions like obsessive-compulsive disorder (OCD). It keeps individuals perpetually prepared for the next challenge, whether or not the challenge actually arises.
Over time, this can result in stress, irritability, burnout, and disrupted sleep, which can perpetuate the cycle.
Dr. Chheda suggests that taking brief breaks to breathe or meditate, even for just five minutes an hour, can help quiet the mental noise and recharge one’s focus.
Despite feeling physically drained, individuals with high-functioning anxiety often find relaxation or sleep elusive. Mentally, they may remain in overdrive, ruminating over concerns or imagining worst-case scenarios.
This constant mental activity can lead to sleep disturbances such as insomnia or delayed sleep phase disorder, where anxiety postpones the body’s natural ability to relax and initiate sleep.
At bedtime, Dr. Chheda advises using techniques such as progressive muscle relaxation (systematically tensing and releasing muscle groups to alleviate physical tension) or guided imagery (visualizing calming scenes or experiences). Should sleep issues persist, consulting a mental health professional for personalized guidance is recommended.
High-functioning anxiety frequently shows up as replaying conversations and incessantly worrying about what was said or how one was perceived.
This mental replay can make even brief social interactions feel exhausting as every detail, from facial expressions to tone of voice, is meticulously scrutinized. Dr. Chheda points out that this is particularly true for those on the autism spectrum who ‘mask’ to fit in.
Cognitive behavioral therapy (CBT) can assist in challenging these negative thoughts and alleviating post-interaction anxiety, according to the doctor.
A common way people with high-functioning anxiety try to control outcomes is through striving for perfection.
This drive for perfectionism is prevalent in those with attention-deficit hyperactivity disorder (ADHD), who may have been told they ‘lacked discipline’ growing up. In response, they often overcompensate by setting excessively high standards to avoid further criticism.
“Instead of hyperfixating on past mistakes, try reframing them as learning opportunities. Set realistic, flexible goals and celebrate progress, whether big or small,” Dr. Chheda advises.
“Growth isn’t linear. I recommend scheduling a cognitive talk therapy session to address the roots of this issue and establish healthier expectations moving forward.”
Despite social media’s emphasis on hustle culture, chronic ‘overproductivity’ is often a sign of high-functioning anxiety.
Tasks such as work, hobbies, and chores can become means of disconnecting from emotions or silencing racing thoughts, making it challenging to recognize when help is needed. Downtime might trigger guilt, even when rest is crucial.
“Remember that rest is a necessity, not a luxury,” Dr. Chheda cautions. “Lack of rest can lead to increased irritability, difficulty concentrating, and even a weakened immune system, hindering productivity when needed.”
Prioritizing boundaries around work and scheduling rest is essential.
High-functioning anxiety can result in ‘people pleasing’ tendencies and difficulty establishing boundaries. Due to a fear of disappointing others, individuals might overcommit to plans and requests, regardless of their current capacity.
This behavior can lead to both mental and physical exhaustion, ultimately exacerbating anxiety symptoms.
“Practicing assertiveness may be challenging initially, but you must recognize that saying ‘no’ is an act of self-care, not selfishness,” Dr. Chheda advises.
“Develop scripts in advance to politely decline requests. By evaluating your capacity before agreeing to tasks, you ensure you’re taking on new responsibilities intentionally, without guilt or pressure.”
Many individuals with high-functioning anxiety appear confident and successful outwardly while concealing an ongoing inner turmoil.
This disparity often results in feelings of isolation, as others may be unaware of the individual’s silent struggles.
The need to maintain a certain appearance can leave them feeling as if there is no safe outlet, leading to the suppression of emotions.
Over time, this suppression can contribute to major depressive disorder. Dr. Chheda emphasizes the importance of building a trusted support system where you can express your true feelings without fear of judgment.
“Counseling or local peer support groups can offer non-judgmental spaces for honesty and connection. Remember, acknowledging your emotions and seeking help demonstrates real strength,” Dr. Chheda concludes.
If you or someone you know is in crisis or struggling, support is available through Mental Health America. Call or text 988 to connect with a 24-hour crisis center, or visit 988lifeline.org for webchat support. The Crisis Text Line is also available by texting MHA to 741741.