High-Functioning Anxiety: Signs, Symptoms & Treatment in New Braunfels, Texas

You’re the person who gets things done. You show up early, follow through, remember the details, and keep everything moving, even when life is hectic. People call you reliable, driven, and “so put together.”

But inside? It can feel like your brain never stops.

You replay conversations. You worry about what you forgot. You over-prepare. You struggle to relax without guilt. You look successful on the outside, yet feel tense, keyed up, and exhausted on the inside.

That pattern is often called high-functioning anxiety.

It’s important to know: “High-functioning anxiety” isn’t an official clinical diagnosis, but it’s a real experience. Clinically, many people who identify with high-functioning anxiety meet criteria for a diagnosable anxiety disorder (like Generalized Anxiety Disorder, panic disorder, or social anxiety), or have significant anxiety symptoms that still deserve treatment, even if they’re “high achieving.”

• The National Institute of Mental Health estimates 19.1% of U.S. adults had an anxiety disorder in the past year, and 31.1% experience one at some point in life.

• CDC data highlights how common “regular feelings of worry, nervousness, and anxiety” are in the U.S. adult population.

• In Texas, a Kaiser Family Foundation survey cited by the Texas Tribune reported 36.8% of adults in Texas experienced symptoms of anxiety and/or depressive disorder in early February 2023.

In this guide, we’ll cover what high-functioning anxiety looks like, common signs and symptoms, what causes it, how clinicians evaluate it, and the treatment options that actually help, especially for residents in New Braunfels, Texas and surrounding communities.

What Is High-Functioning Anxiety?

High-functioning anxiety describes a common “split-screen” experience:

• External: productive, capable, dependable, high-performing

• Internal: worried, tense, self-critical, restless, “always on,” afraid of falling behind

Many people with high-functioning anxiety are praised for traits that are actually anxiety-driven: perfectionism, people-pleasing, over-responsibility, and over-preparation. In the short term, those habits can create impressive results. In the long term, they often create chronic stress, sleep issues, irritability, and burnout.

Why it can be hard to spot

High-functioning anxiety doesn’t always look like panic attacks or avoidance. It can look like:

• Always being busy

• Always achieving

• Always “fine”

• Always the helper

• Always the one who handles it

But functioning well doesn’t mean you’re not suffering.

Signs of High-Functioning Anxiety

High-functioning anxiety tends to show up in three categories: thought patterns, behaviors, and physical symptoms.

1) Thought patterns (what’s happening internally)

• Constant “what if?” thinking

• Overthinking texts, conversations, and decisions

• Catastrophizing (jumping to worst-case scenarios)

• Fear of making mistakes or being judged

• Imposter syndrome: “I’m not really good enough”

• Harsh self-talk and constant self-evaluation

• Difficulty tolerating uncertainty

• Feeling guilty when you rest

2) Behaviors (what other people may notice)

• Over-preparing, over-researching, and over-checking

• Perfectionism (or “procrastination until it’s perfect”)

• People-pleasing and difficulty saying no

• Always staying busy, even when exhausted

• Micromanaging details to feel safe/in control

• Avoiding conflict; keeping the peace at any cost

• Being “high output,” but rarely feeling satisfied

3) Physical symptoms (your nervous system stays on)

Anxiety is not “just in your head.” It often shows up as real physical symptoms:

• Muscle tension (neck/shoulders/jaw clenching)

• Headaches, tight chest, shallow breathing

• Racing heart or palpitations

• Stomach upset (nausea, diarrhea, constipation)

• Fatigue—especially “tired but wired”

• Trouble falling asleep or waking up too early

• Restlessness, fidgeting

• Changes in appetite

• Irritability and feeling “on edge”

This is common because anxiety activates the body’s stress response. When that response stays “on” too often, it becomes harder to relax, even when you want to.

High-Functioning Anxiety vs. Generalized Anxiety Disorder (GAD)

Because “high-functioning anxiety” is not a formal diagnosis, clinicians typically assess whether symptoms align with an anxiety disorder such as:

• Generalized Anxiety Disorder (GAD) (persistent, excessive worry plus physical symptoms)

• Panic disorder (panic attacks + fear of future attacks)

• Social anxiety disorder (fear of judgment/embarrassment)

• Obsessive-compulsive disorder (OCD) (intrusive thoughts + compulsions)

• Trauma-related disorders (hypervigilance, nervous system stuck in “alert”)

• Depression (often overlaps with anxiety)

One reason high-functioning anxiety can persist is that it’s reinforced by success: you worry → you over-prepare → you perform well → your brain learns, “Overworking prevented failure.” This cycle is powerful—and exhausting.

What Causes High-Functioning Anxiety?

Most people develop high-functioning anxiety from a combination of:

Biology & temperament

• Family history of anxiety

• A sensitive nervous system that reacts quickly to stress

• A tendency toward high conscientiousness or perfectionism

Life experience

• Growing up with high expectations or criticism

• Conditional approval (“You’re loved when you achieve”)

• Early responsibility (having to be the “adult” too soon)

• Trauma or chronic unpredictability

Modern pressure

• Work overload, constant connectivity, and information overload

• Financial stress and uncertainty

• Social media comparison

• Sleep deprivation (which worsens anxiety symptoms)

The American Psychiatric Association has reported rising anxiety levels in U.S. adults in recent years, reflecting how widespread these stressors have become.

When “High Functioning” Becomes Burnout

High-functioning anxiety can “work” until it doesn’t.

Common long-term costs include:

• Burnout and emotional exhaustion

• Sleep issues that worsen anxiety and mood

• Irritability, lower patience, and feeling easily overwhelmed

• Reduced enjoyment (you’re present physically but not mentally)

• Relationship strain (resentment, withdrawal, conflict avoidance)

• Increased risk of depression

• Coping habits that backfire (excess caffeine, doomscrolling, alcohol to unwind)

If you’re thinking, “I’m doing everything right, why do I still feel like this?” that’s often a sign your nervous system needs support, not more effort.

When to Seek Help

Consider a professional evaluation if:

• Anxiety is present most days even when life is going “fine”

• You can’t relax without guilt, restlessness, or worry

• Sleep, focus, appetite, or relationships are affected

• You rely on overworking, avoidance, or substances to cope

• You feel stuck in constant tension or dread

• You’re having panic symptoms or intrusive thoughts

If you ever feel unsafe or have thoughts of self-harm, call/text 988 (U.S. Suicide & Crisis Lifeline).

How a Psychiatric Evaluation Can Help

A psychiatric evaluation is about understanding what’s really going on and building a plan that fits your life.

During an evaluation, your provider may explore:

• Your main symptoms (worry, panic, irritability, insomnia, racing thoughts)

• How long symptoms have been present and what triggers them

• Medical factors that can mimic anxiety (thyroid issues, medication effects, sleep disorders, etc.)

• Co-occurring conditions (ADHD, depression, OCD, trauma, substance use)

• Prior treatment history (therapy, medications, lifestyle changes)

• Your goals (sleep better, stop overthinking, feel calm, improve focus, reduce panic)

At Affective Mental Wellness, providers include Board Certified Psychiatric Mental Health Nurse Practitioners in New Braunfels. The practice also notes that psychiatric evaluations and personalized treatment planning are part of care.

Evidence-Based Treatment Options for High-Functioning Anxiety

The most effective plans usually include a combination of therapy skills, medication when appropriate, and targeted lifestyle supports.

1) Therapy (highly effective for anxiety)

Cognitive Behavioral Therapy (CBT) is one of the most studied, evidence-based treatments for anxiety disorders and has demonstrated effectiveness across many anxiety conditions.

CBT helps you:

• Identify anxious thought patterns (catastrophizing, perfectionism, mind-reading)

• Reduce “safety behaviors” (over-checking, reassurance seeking, over-preparing)

• Build tolerance for uncertainty

• Replace fear-driven habits with healthier coping strategies

Acceptance and Commitment Therapy (ACT) can also be very helpful for high-functioning anxiety because it focuses on:

• Reducing the struggle with anxious thoughts

• Increasing psychological flexibility

• Building a life based on values (not fear)

If your anxiety is rooted in trauma or chronic hypervigilance, trauma-informed approaches may be recommended.

2) Medication management (when appropriate)

Medication can be helpful if anxiety is persistent, significantly distressing, or affecting sleep and functioning.

Common first-line medication options for anxiety disorders often include SSRIs and SNRIs, which are widely recommended as first-line pharmacotherapy for GAD and panic disorder.

A thoughtful medication plan considers:

• Your symptom profile (worry vs. panic vs. insomnia vs. irritability)

• Side effects you want to avoid

• Co-occurring conditions (like depression, ADHD, trauma symptoms)

• Past medication response

• Safety considerations and long-term goals

Clinical guidance commonly cautions that benzodiazepines are not recommended as first-line or long-term therapy due to risks such as dependence and adverse effects.

At Affective Mental Wellness, medication management is listed as a core service.

3) Telehealth visits (access + continuity)

If your schedule is packed (work, kids, commuting, caregiving), telehealth can reduce barriers to consistent care. Research reviews generally find high patient satisfaction with telepsychiatry and outcomes that are often comparable to in-person care for many needs.

Affective Mental Wellness offers telehealth services, noting visits may include support from a case manager to help with access and treatment support.

4) Lifestyle supports that actually matter (and don’t require perfection)

Lifestyle changes aren’t a replacement for clinical care when anxiety is significant—but they can make treatment work better:

Sleep basics

• Consistent wake time

• Wind-down routine

• Reduce late-night screens/news

Stimulant check

• Caffeine can worsen anxiety for many people (especially when sleep-deprived)

Movement

• Exercise may help reduce worry symptoms and improve sleep for people with anxiety.

Boundary skills

• Learning to say no

• Building buffer time

• Scheduling real recovery (not just collapsing)

For high-functioning anxiety, the goal isn’t becoming less capable. It’s becoming less driven by fear.

Advanced Options: Ketamine and Spravato (When Depression Is Part of the Picture)

Many people with high-functioning anxiety also have depression, or they experience anxiety that is closely tied to mood symptoms (low motivation, hopelessness, emotional numbness, poor sleep, or burnout that turns into depression). That’s where advanced interventions may be considered—based on a full psychiatric evaluation.

Spravato (esketamine): what it is (and what it’s approved for)

Spravato® (esketamine) is an FDA-approved nasal spray with specific indications, including treatment-resistant depression (TRD) in adults and depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, administered under strict safety requirements.

It is only given in a certified healthcare setting and requires monitoring for at least 2 hours after administration due to risks like sedation and dissociation.

Affective Mental Wellness offers Esketamine/Spravato treatments in New Braunfels.

Important note: Spravato is not FDA-approved specifically for “anxiety.” It may be considered when depression is the primary concern (especially TRD), and anxiety symptoms may co-occur.

IV ketamine: what to know

IV ketamine is commonly used off-label in psychiatry (meaning it is not FDA-approved specifically for depression in this form), and research has shown rapid antidepressant effects in some patients with depression, including treatment-resistant depression.

Medical monitoring is an important part of safe administration. Guidance and clinical literature emphasize monitoring vital signs (like blood pressure, heart rate, oxygen saturation) during ketamine administration and after treatment.

Affective Mental Wellness lists ketamine treatment and “IV Ketamine & Spravato” as services in New Braunfels.

As with any advanced treatment, candidacy depends on your diagnosis, history, safety factors, and goals—this is where a psychiatric evaluation is essential.

Practical “High-Functioning Anxiety” Patterns That Treatment Targets

High-functioning anxiety often has predictable loops. A good treatment plan helps you disrupt them.

Pattern 1: Over-preparing to feel safe

Treatment focus: gradually reduce over-checking and perfectionistic rituals while building tolerance for uncertainty (often via CBT skills and behavioral experiments).

Pattern 2: People-pleasing to avoid rejection

Treatment focus: boundary setting, assertiveness, values-based choices, and tolerating discomfort.

Pattern 3: “Rest = lazy”

Treatment focus: reframe rest as a performance skill (nervous system recovery) and practice guilt-free recovery intentionally.

Pattern 4: “If I slow down, everything will fall apart”

Treatment focus: test that belief safely and gradually, often a huge breakthrough for high-functioners.

What You Can Do This Week (Small, realistic changes)

If you want to start shifting your anxiety now, try one of these:

1. Pick one task to do at 80% (not 110%).

2. Stop one reassurance habit (re-reading a text, re-checking an email) once per day.

3. Schedule 15 minutes of decompression (no phone, no chores).

4. Brain dump worries → write the most likely outcome (not worst-case).

5. Book an evaluation so you don’t have to self-diagnose or white-knuckle it.

High-Functioning Anxiety Treatment in New Braunfels, TX (and Telehealth Across Texas)

If you’re in New Braunfels or nearby communities, Seguin, Canyon Lake, Bulverde, Schertz, San Marcos, or the greater San Antonio area—support is available.

Affective Mental Wellness offers a range of mental health services, including:

• Psychiatric evaluations 

• Medication management 

• Telehealth services 

• Esketamine/Spravato treatments 

• Ketamine treatment / IV ketamine

Location: 705 Landa St E, New Braunfels, TX 78130 Scheduling phone: (210) 360-1590

If you’re not sure what you need, a psychiatric evaluation can help clarify whether you’re experiencing an anxiety disorder, burnout, depression, ADHD, trauma-related symptoms, or a combination—and what treatment plan fits best.

FAQs: High-Functioning Anxiety

Is high-functioning anxiety “real” if it’s not a diagnosis?

Yes. The term isn’t an official DSM diagnosis, but it describes a common pattern of anxiety symptoms that can still meet criteria for an anxiety disorder—or cause significant distress that deserves treatment.

Can I have anxiety even if I’m successful?

Absolutely. Anxiety is about internal distress and symptoms—not how impressive you look from the outside.

What treatment works best?

Evidence supports therapy approaches like CBT for many anxiety disorders, and SSRIs/SNRIs are commonly recommended first-line medications for conditions like GAD and panic disorder. The best plan is individualized.

Does telehealth work for anxiety care?

Many studies and reviews show telepsychiatry can be effective and is often well-accepted by patients, especially when it reduces access barriers.

Medical disclaimer

This article is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. If you think you may be experiencing anxiety or another mental health condition, a licensed clinician can help.