What is High-Functioning Anxiety?

How to Know If You Have It and
What You Can Do About It

Anxiety can be plainly evident, like in the case of panic attacks, but it can also be a well-kept secret. The hidden form of anxiety is called high functioning anxiety. On the surface, the person can seem calm and pulled together. Inwardly, the person can be driven by fear, feels anxious and worries more often than not.

Many people who have high functioning anxiety become quite successful while they grapple with their worries and fears. Many don’t even realize they have high functioning anxiety. Let’s take a closer look at this disorder and how it’s closely related to generalized anxiety disorder.

What Is General Anxiety Disorder?

Generalized anxiety disorder in the United States affects 6.8 million adults (approximately 3% of the population). 1 Women are twice as likely to be affected by generalized anxiety disorder compared to men.

What Are the Symptoms of General Anxiety Disorder?

Generalized anxiety disorder symptoms can vary and include: 2

  • Constant anxiety or worrying about everyday issues
  • Overthinking solutions to include all potential worst-case scenarios
  • Overthinking plans to ensure the best outcomes are reached
  • Identifying events and situations as threatening, even when they are not
  • Finding it hard to handle uncertainty
  • Fear of making the wrong decision which leads to indecisiveness
  • Unable to put aside or forget a worry
  • Unable to relax
  • Restlessness much of the time
  • Feeling on edge frequently
  • Difficulty concentrating

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How Do General Anxiety Disorder and High Functioning Anxiety Differ?

High Functioning Anxiety Characteristics

If you’re living with high functioning anxiety, you may be experiencing many of the symptoms of generalized anxiety disorder, but you are able to keep a grip on yourself and not show any of your anxious or worried feelings to the people around you. Since you’re “stuffing” your feelings, you may experience a hazy sense of dread and have headaches as you worry internally – but you’ve come to accept these as a normal part of your life that can’t be avoided. Symptoms of anxiety, such as digestive issues, feeling tired all the time, and muscle aches can also be something you have to deal with frequently.

Even if your anxiety symptoms aren’t hampering your ability to be productive or are not negatively impacting your relationships, they can still be problematic if they strip away from your overall quality of life.

There are also other hidden ill-effects of being a high functioning anxiety sufferer. Since you are “white-knuckling” it through life and stuffing down anxious and worried feelings, you could be impacting your mental and physical health in the process.

With high functioning anxiety, you’ll experience some of the symptoms of general anxiety disorder, but at what is considered a subclinical level. Subclinical means the disorder isn’t severe enough to present definite or readily observable symptoms. 3 This will be especially true if your personal and professional lives function as always, but inside you live with anxiety and unhappiness most of the time.

Health Impacts of Anxiety

Mental Health

Anxiety increases the potential for developing other serious mental health issues. 2 Studies show anxiety affects mental processes such as memory, reasoning, and basic decision-making.4 Additionally, when someone has a chronic medical issue along with untreated anxiety, the risk of a medical issue worsening or becoming fatal also increases. Stress as a result of anxiety on the body can be significant, especially when it’s left untreated for a long period of time.

Physical Health

Common medical problems that can occur as a result of untreated anxiety include:

  • Gastrointestinal problems: A main symptom of anxiety is digestive system distress. Common issues include nausea and upset stomach. Untreated anxiety can make gastrointestinal distress worse. One study found a connection between high anxiety levels and irritable bowel syndrome.
  • Heart disease: Research studies show that people with high anxiety levels were more likely to have a heart attack, more likely to die from one, and had triple the risk of experiencing a coronary event or stroke. 5
  • Respiratory problems: For people who have asthma, COPD or other chronic respiratory disease, a high rate of anxiety is associated with more frequent hospitalizations and more severe distress regarding lung function.5

Anxiety and Substance Abuse Disorders

Anxiety (28.8%) and substance use disorders (14.6%) are among the most prevalent psychiatric problems in the US. 6 Research shows that having an anxiety or substance use disorder is also a risk factor for the development of the other disorder.

Research also has found that when anxiety and substance use disorders co-occur, they are interwoven in both the advancement and preservation of both illnesses. It is important to seek treatment for high functioning anxiety to help prevent the development or worsening of other medical, mental health, or substance abuse issues.

High Functioning Anxiety Treatment

Pharmacotherapy (medications) and psychotherapy are primary treatment approaches that have been shown to be most effective when treating anxiety disorders including high functioning anxiety.


Anti-anxiety medications help alleviate anxiety symptoms, such as fear, worry and panic attacks. 7 The most commonly prescribed anti-anxiety medications are benzodiazepines, and they are taken on an ‘as needed” basis. Common forms of benzodiazepines used to treat anxiety can include clonazepam, alprazolam and lorazepam. Also, SSRIs or other antidepressants may be used to treat anxiety.

People can quickly build a tolerance for or become dependent on benzodiazepines, so these types of drugs are usually only used for the short term. Individuals who have substance abuse problems or who become dependent on medication easily may be better suited to taking buspirone for anxiety.

Buspirone, which is not a benzodiazepine, can be used for the long-term treatment of chronic anxiety. 7 Buspirone must be taken daily for several weeks to reach its full effectiveness. Buspirone is intended as a long-term anxiety treatment, making it useful for chronic high functioning anxiety, but it’s not useful on an “as-needed” basis.


Psychotherapy, also known as “talk therapy“, can help people with anxiety disorders. 7 Psychotherapy is most effective when it’s directed at the person’s specific anxieties and unique needs.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy(CBT) is one form of psychotherapy that can help someone suffering from high functioning anxiety. Different ways of thinking, behaving, and reacting to situations that produce anxiety, fear and worry are taught. CBT also focuses on identifying and neutralizing unhelpful or distorted thinking. 7 Relaxation exercises and/or guided imagery is usually taught alongside CBT. CBT can be held in individual or group sessions.

Finding Help for High Functioning Anxiety

Approximately one-third of anxiety disorder sufferers go through life untreated. 5 If you believe you could be suffering from a form of anxiety, or if you have IBS, other digestive issues, asthma, COPD, or heart disease and you haven’t been checked to see if you have an anxiety disorder, talk to your doctor. Anxiety, even the high functioning type, could be a source of your unexplained physical symptoms.

If you have a substance abuse disorder and high functioning anxiety, a residential treatment program that offers psychotherapy and medication can help give you more positive outcomes for controlling anxiety and substance use. A residential treatment center offers 24/7 assistance as you undergo individualized treatment in a safe, comfortable and home-like setting, away from external stressors that can cause anxiety. Part-time programs on an outpatient basis are also available at treatment centers for co-occurring anxiety and substance abuse disorders.

It’s not easy to break the chain of high functioning anxiety even when substance abuse isn’t involved. Even if you think all your anxiety symptoms are “in your head” – it’s still affecting you in real ways. Remember that real symptoms can be healed by real treatments.

Dr. Venice Sanchez


Clinical Outreach Specialist, Europe Division

Dr. Sanchez works closely with Truvida Recovery patients regarding substance abuse and related mental illnesses and creates a supportive, cooperative and informed therapeutic environment. Her areas of expertise include Substance Dependence, Dual Diagnosis, Depression, Bipolar Disorder, Schizophrenia, Generalized anxiety disorder, Panic Disorder, Bereavement, Acute stress disorder, and more. Ms Sanchez has extensive training with experts in the field of Substance Abuse, and mood and thought disorders underlying the substance use. She received a Bachelor’s degree from University of California, Los Angeles and Medical Degree from Michigan State University College of Human Medicine. She continues training at the UC Irvine Psychiatry Residency Program and has been recognized with the Outstanding Resident of the Year Award.

Jaime Askew


Clinical Director

Ms. Askew is a Licensed Marriage and Family Therapist and Licensed Professional Clinical Counselor who has been working in the field treating substance abuse and mental health issues for over twenty years.  She obtained a Master’s degree in Clinical Psychology, with an emphasis in Marriage, Family, & Child Counseling from Pepperdine University and was among the first to obtain the LPCC license in the state of California.  She has been providing clinical supervision and training to interns, conducting workshops, and is a certified Trauma therapy trainer.  Her areas of expertise include working with legal issues, court ordered treatment, family preservation, trauma therapy, cognitive behavior therapy, family systems, social skills training, play therapy, and career/ vocational counseling.  Her passion is in advocating for at risk populations, holistic healing, and treating the underlying, core issues to help individuals achieve their maximum potential and happiness.  Jaime’s extensive experience and passionate leadership is of extreme importance to the overall TruVida clinical program, and her hands-on guidance of our clinical team insures that each patient is receiving optimal therapeutic treatment and care.

John Biroc

Consulting Psychologist

Dr. Biroc has a broad base of mental health and addiction recovery training and experience. He has supervised and taught therapists in various methodologies of effectively working with groups and individuals during therapy. He created and set up new group structures and trained staff in understanding the challenges of addiction recovery. He also helped develop curricula in Sociodrama and Psychodrama. Dr. Biroc is devoted to breaking paradigms that prevent progress in the path to lasting recovery. He is a member of the Nat’l Association of Marriage and Family therapists, and has a Ph.D. degree in Psychology, and a M.S. degree in Counseling from USC.

Dr. Nader Siahdohoni

Consulting Psychologist


Dr. Nader is one our esteemed consulting Psychologists who provides our Clients with various breakthrough therapy’s that focus the functional systems including neurons, neurotransmitters, and certain brain waves that enable the way we think, behave, move, feel, and maintain homeostasis. Such therapy’s include NeuroMax neurofeedback, the state of art integrated technology in Neurofeedback, combinations of wireless Electroencephalogram (EEG), real time brain mapping and a unique and exceptional neuropathway therapy called “Visual Concentration Attention Therapy (VCAT)”. Dr Nader graduated from Walden University.

Tiffany Agra


LMFT #103693

Ms. Agra is a Cognitive Behavioral Therapist, who has been working with individuals, couples, families, and groups for the past seven years. Her other therapeutic approaches include Narrative Therapy, Family Systems Theory, Psychodynamic dream interpretation, and Gestalt Psychology. She has also been a Guest Speaker at other organizations. This unique background has made her effective at helping clients overcome the grip of substance addiction. Tiffany obtained two Bachelor’s degrees from the University of California, Davis, and her Master’s degree from the California State University, Long Beach. She has worked for both the county of Orange and Riverside, helping those who struggle with addiction and mental illness. In addition to providing evidenced-based approaches to the clinical program at Truvida Recovery, she brings her compassion as a fellow addict in recovery; living proof that we do get better!

Deborah Wieland


MS, LMFT #96864

Ms. Wieland is an Eclectic EMDR Therapist, using R-TEP and G-TEP, and specializes in several modalities in treating Substance Use issues, Dual Diagnosis, Complex Trauma, and Severe Mental illness. Deborah also provides several types of therapy such as Psychodynamic, Rogerian, CBT, DBT, IFS, PICT, MI, Grief Recovery, Sand Tray, and Attachment Theory to help her patients achieve mental wellness and a sober lifestyle.

She has worked with Psychiatric Hospitals providing crisis interventions and psychotherapy to those struggling with substance abuse issues, mental health issues, and domestic violence. She completed her undergraduate and graduate studies at Vanguard University of Southern California. She has a Bachelor of Arts in Psychology, Summa Cum Laude and a Master of Science in Clinical Psychology. She is currently completing her Doctoral studies in Clinical Psychology at Cal Southern University. Deborah is an active member of EMDRIA, California Association Marriage Family Therapist (CAMFT), American Association of Christian Counselors (AACC), and Psi Chi International Honors Society of Psychology.

Ashley McLaughlin



Ms. McLaughlin is a Licensed Marriage and Family Therapist specializing in EMDR therapy. She brings over ten years of experience working in the field of addiction to the Truvida Team. She obtained a Master’s degree in Clinical Psychology, with an emphasis in Marriage and Family Therapy from Pepperdine University and has two Bachelor’s degrees in Psychology and Economics from University of California, San Diego. Ms. McLaughlin was trained in EMDR in 2013 and since has been helping individuals process through past traumatic experiences that have contributed to current struggles with substance abuse and mental health symptoms. Her extensive experience and passion for this field has helped guide individuals through the process of recovery in order to experience freedom from their past and a hope for their future.

Travis Taylor



Mr. Taylor is a Licensed Marriage and Family Therapist specializing in  Drug Abuse & Addiction,  PTSD, Anxiety, Bipolar Disorder, Borderline Personality, Codependency, Coping Skills, Depression, Dual Diagnosis. Taylor uses an integrative approach geared towards understanding self, specifically what drives one’s thoughts and behaviors. He excels in helping patients identify automatic thoughts that lead to specific feelings and undesired actions. Another useful approach stems from understanding how thoughts and behaviors are fueled by former messages that have been consistently reinforced. Travis has over 6 years of therapeutic practice and obtained a Master’s degree at Vanguard University.

Kat Johnson

AOD Counselor, Group Facilitator

With almost 10 years experience working at treatment centers, Kat Johnson shares her wisdom and passion for balanced living, creative writing, and meditation and how each plays a role in early recovery and beyond. Certified as a CADC II, and supported by a bachelors in psychology, Kat’s infectious energy brings her groups to life. She is grateful for every opportunity to spread health and wellness.

Paige A. Chastain

AOD Counselor, Case Manager

Ms. Chastain has dedicated her life to helping the suffering addict/alcoholic, bringing personal experience to both individual substance abuse and group counseling settings. She has worked in the field of addiction for several years, currently working as an addiction counselor and case manager.  Paige too, is a collaborative member of the multi-disciplinary team providing excellence in addiction services, working with clients from detox to intensive outpatient levels of care. She holds a strong skill-set in Psychoeducation, Motivational Interviewing and Dialectical Behavior Therapy.  She also has extensive experience with 12-step recovery programs. Paige is passionate about treating the client with empathy, compassion and respect throughout the client’s journey.  Paige holds an AA from Saddleback College, a BA from the University of California of Irvine and is a certified CADC-I holding memberships with CCAPP and NAADAC.

Lesley Richards

AOD Counselor, Interventionist

Ms. Richards began in this field of healthcare as a volunteer for substance abuse treatment centers and worked her way up from there. Lesley has dedicated her life to helping the suffering addict. it is here strong belief that everyone deserves to have the opportunity to have a safe and sober life.  She is very compassionate about her work as an addiction counselor, and has a strong commitment in helping patients struggling with addiction in developing healthy coping mechanisms, and developing new positive behavioral habits.  Her Group counseling sessions are highly sought after within the TruVida program.  Lesley is a Certified Alcohol and Drug Counselor (CADC), National Certified Intervention Professional (NCIP), Nationally Certified Recovery Coach (NCRC), and is a member of the California Consortium of Addiction programs (CCAP), as well as the International Association of Addiction Professionals.

Christine Green

Treatment Facilitator

Christine Green is a certified personal trainer, and yoga instructor. Ms. Green is dedicated to helping patients struggling with substance abuse transform their lives through a consciousness-based approach to body-in-motion fitness.

Christine passionately shares her 18 years experience with our clients by sharing her specialized Yoga & Energy Healing Program, which she has developed over the past 8 years of working directly with addicts and alcoholics. Her Yoga program facilitates integration of all the layers of life – environmental, physical, emotional, psychological, and spiritual with the primary initial goal of overcoming withdrawal symptoms and cravings from drug and alcohol dependency. TruVida is fortunate to have her as part of the team.

Allison Goode

Art in Recovery Counselor

Allison Goode is a lifelong resident of Laguna Beach and professional artist for over 15 years, and has developed a very successful and trans-formative Art in Recovery program in treatment facilities through out California. Her passion for the fine arts and helping others recover from substance abuse addiction is contagious. Allison has a unique ability to connect with clients through the creative process helping clients set positive goals for their recovery. Ms. Goode has studied Fine Art and Graphic Design at Laguna College of Art and Design, is a certified RADT1 technician, and is currently completing her CCAPP certification program.

Thomas Mladinich

Admissions Manager

Mr. Mladinich hard work ethic and dedication make him a key part of the TruVida team. Tom’s ability to connect and relate with others have allowed him to excel as admissions manager. His personal experience has allowed him to proudly serve those in need of recovery from addiction. Tom is eager to work with our clients and provide the experience, strength and hope that they need to find success in recovery.

Willie Sanchez

Operations Manager

Mr. Sanchez is a self-motivated professional with a positive attitude. He is actively involved in a 12 step fellowship. He effectively contributes to each Patient with their struggles with addiction. Willie is RADT1 certified counselor and has been educated at Long Beach City College.

Jose Flores

Program Manager

Mr. Flores is a highly motivated and hardworking team member with TruVida. He has several years of experience working in treatment helping individuals get back on track, achieving a lot of great results. He brings problem solving skills and experience to use everyday, and is proud and passionate about his profession as a RADT-I program manager.

Dr. Andrew Morrow

MD, Psychiatrist


Dr Morrow is a member of the American Board of Psychiatry and Neurology Psychiatry, who specializes in the treatment of depression, anxiety, bipolar disorder, thought disorders, other mental health issues, and substance abuse addictions. Having undergone extensive training in medical school, psychiatric residency and over 15 years of psychiatric practice, he is well trained in both psychotherapy and medication management of mental problems. Dr Morrow integrates psychological, and social characteristics with biological therapy to treat the whole person; mind, body, and soul, and it is with great humility that he pursues the goal of freedom from substance abuse addictions.

Dr DeSanto conducted his undergraduate education at St. Louis University with a B.S. in Chemistry graduating summa cum laude. He then attended medical school at St. Louis University School of Medicine, and completed his residency training and served as chief resident at University of California, Irvine Medical Center.