Smiling on the Outside, Struggling on the Inside: The Hidden Truth About My Anxiety

Outwardly, people with high-functioning anxiety appear fine. They go to work, raise families, and contribute to society. But inwardly, they wage a constant battle against crippling anxiety that threatens to derail their lives. Approximately 40 million persons in the United States are impacted by anxiety disorders annually.  Symptoms like excessive worry, muscle tension, panic attacks, and compulsions can interfere with daily activities. But many hide their struggles to function normally.

Those with high-functioning anxiety have developed coping strategies to present a capable face to the world. However, they still endure the same relentless fears and distress as anyone with an anxiety disorder. Their mental health issues remain invisible, which can lead to misunderstandings. Four people living with high-functioning anxiety opened up about their daily reality. They aim to dispel misconceptions and evoke compassion for the secret turmoil bubbling under their surface.

Lynda, 35, seems outgoing and accomplished to casual acquaintances. But routine worries continually snowball into paralyzing what-ifs inside her mind. "Living with high-functioning anxiety is likely comparable to living with other conditions, but the challenge with anxiety is that it is not visible," she stated. "I might inform someone about my concerns, but this is frequently perceived as a characteristic of mine." You know, 'Oh, she's an anxious person.' No, I am not. I’m fighting a disease.” Alex, 27, also resents when others minimize her anxiety as a personality quirk. Her irritation and anger stem from an underlying condition, though it’s not visually obvious. "I had never fully grasped that anxiety could be diagnosed as a medical condition," she clarified. "I was under the impression during my childhood that I was considered a 'baby' who would become upset over unconventional matters."

Outward signs of inner turmoil like compulsive behaviors or panic attacks are absent for many with high-functioning anxiety. They force themselves to confront situations and settings that trigger anxiety. But maintaining a facade of normalcy requires immense effort. Dana, 42, admits hiding her struggles to preserve her family and career. “Just because you can’t see my illness doesn’t mean it’s not there,” she said.I continue to experience sleepless and restless evenings due to excessive rumination. I continue to learn on a daily basis about how a 'average' individual is expected to respond to specific situations. It is more challenging to discuss it when it is not visibly apparent that you are experiencing distress. Steve, 35, also presented an outgoing, accomplished exterior for years. But his anxious thoughts remained a constant presence. "I believe there are misunderstandings that high-functioning anxiety is similar to mania," he stated. However, in my case, that statement is not accurate. The majority of my anxiety is internal. I do a very good job of keeping it buried, because I have a family (and a brand) to protect. I want others to believe that I am managing it in a positive manner. And that's mainly true. However, there is a significant distinction between experiencing mania and feeling nervous.

Dana’s anxiety requires daily holistic self-care like therapy, meditation, balanced eating, and physical activity. Her coping strategies help minimize but can’t permanently eliminate her underlying condition."I truly need to actively handle my stress level by recognizing what contributes to or reduces my energy," she clarified. "I have made significant life adjustments to prioritize my mental well-being." She said, "At times, I feel a strong sense of resentment and anger towards the amount of effort I have to put in to take care of my health." I believe some of it is determined by genetics, some of it is influenced by my family background, and some of it is a result of my lifestyle. Lynda has gone through the demoralizing process of trying medication after medication seeking relief. “There are days when I feel like a scientific test, experimenting with each medication that my doctor recommends, hoping that one of them will restore normalcy to my life," she added. Occasionally, the medication is effective for a period of time and then loses its effectiveness. A recent medication significantly decreased my sexual desire for a few months. At 35, no longer being able to have a sexual connection with my wife brings a lot of humiliation on top of the guilt I already feel. Even effective treatments only help manage anxiety day-to-day. There is no quick fix to permanently eliminate it.

During high-functioning periods, anxiety remains under the surface. But its symptoms inevitably resurface without warning. For Lynda, mystery terror plagues her worst days. You feel fearful, but you are unsure of the cause or the specific object of your fear. It's not something logical. You just have fear, concern, and unease over something that you are unable to identify. Steve talked about his usual difficult days: I experience panic attacks, fear, persistent anxious thoughts, and find it difficult to rest for extended periods of time. This is how my mind remains in a perpetual state of anxiety. Anxiety to me seems like a continuous rubbing or scraping on my brain. On those days, he has had to avoid people and activities altogether when anxiety becomes overwhelming. Dana also admitted needing to abruptly cancel plans when unable to manage her symptoms. Their coping strategies aim to minimize bad days. But the battle remains ongoing, with anxious thoughts constantly threatening to regain control.

At the end of the day, those with high-functioning anxiety don't want to be summed up as unstable "worrywarts." Nor do they want unsolicited advice about how to "get over" their lifelong condition. They ask simply for others to meet them with empathy, compassion and understanding. Anxiety compels behaviors they don't fully control. Maintaining relationships and employment despite the turbulence requires immense strength. "I’d love for people to treat me with understanding and compassion. Those are the only things I really need," said Lynda. "If you let me know I am seen and heard, it changes my whole outlook." Steve echoed the desire for patience from loved ones. Although my anxiety may tire them, it has an even greater impact on me. Occasionally, my hands tremble without any apparent cause, and it may be rather humiliating. However, I am not mentally unstable. I'm simply having difficulty.  No one would tell someone with diabetes or cancer to “snap out of it.” Yet anxiety is often dismissed as a choice, not an illness. Accepting anxiety’s medical reality is the critical first step toward compassion.

In sum, high-functioning anxiety means constantly battling to appear "normal." Coping strategies minimize but don't eliminate the underlying condition. Bad days inevitably emerge without warning. Yet those who live with hidden anxiety aren't looking for pity or excuses. They seek only empathy for the intense struggles outsiders can neither see nor truly comprehend.