High-Functioning Anxiety in Women: Calm Outside, Chaos Inside

Calm on the Outside, But a Hummingbird on Espresso Inside

The other day, a client told me she was lying awake at 2 a.m., replaying a conversation she feared she’d fumbled — while also mentally rehearsing her to-do list for the next day.

I see this in so many women I work with in my Seattle practice.

On the outside, everything seems fine. You’re productive, responsive, probably praised for being “driven” or “on top of it.”

But inside? It feels like living with a motor that won’t shut off. You’re run down, fragile, and operating from pure adrenaline.

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What Is High-Functioning Anxiety, Really?

High-functioning anxiety isn’t something you’ll find in the DSM — but that doesn’t make it any less real.

Clinically, it’s often an anxiety disorder hiding in plain sight. Generalized anxiety. Panic. Sometimes OCD. But dressed up in perfectionism, people-pleasing, and relentless achievement.

You’re working. Parenting. Holding it all together. But internally, your nervous system is running on overdrive. In fact, research suggests women are nearly twice as likely as men to be diagnosed with anxiety disorders (ADAA).

One meta-analysis found that women are significantly more prone to internalizing disorders like anxiety and depression due to both biological and sociocultural factors (Salk et al., 2017).

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5 Subtle Signs You Might Be Living with High-Functioning Anxiety

1. You’re Always Doing — But Rest Feels… Wrong

You finally sit down to relax. Five minutes later, you’re folding laundry or checking your inbox.

Your brain confuses stillness with danger. Movement becomes safety.

2. You Plan for Everything — Yet Still Feel Unprepared

You rehearse conversations. Triple-check the calendar. Rewrite the same email three times.

But no matter how much you prep, your nervous system doesn’t believe you’re ready.

3. You Say “Yes” When You Want to Say “No”

Even when you’re overwhelmed, you agree to help. Saying no feels selfish — or dangerous.

One woman I worked with started practicing soft no’s over text: “I’d love to, but I don’t have capacity right now.”

At first it felt terrifying. But within a few weeks, she noticed something powerful: her world didn’t fall apart. Her nervous system learned that boundaries could feel safe.

4. Your Inner Critic Never Quiets

You brush off compliments. Obsess over slip-ups. You hit a goal — and instantly move the bar.

That voice isn’t just self-doubt. It’s anxiety in disguise — pushing, pressuring, never letting you land in “enough.”

5. You Feel “Fine” — But Your Body Tells a Different Story

No panic attacks. No breakdowns. But your body holds the tension: tight jaw, shallow breathing, stomach issues, constant headaches.

Studies show that chronic anxiety often manifests in physical symptoms long before we notice the mental toll (Mayo Clinic).

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Do a Quick Self-Check

If you say yes to even 2–3 of these, you may be experiencing high-functioning anxiety:

• Do you feel unsettled when you try to rest?
• Do you replay conversations in your head?
• Do you say yes when you want to say no?
• Do you dismiss compliments but obsess over mistakes?
• Do you over-prepare but still feel unsure?
• Does your mind keep going long after your body is tired?

You’re not broken. You’re exhausted. Your nervous system is trying to protect you — but it’s stuck in high-alert mode.

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What Can Actually Help When You Feel Like You Can’t Stop?

1. Soften the Inner Critic

• Place a hand on your heart and say: “I’m doing the best I can.”
• Ask yourself gently: “What do I need right now?”
• Try a Self-Compassion Break by Dr. Kristin Neff

Why this works: Self-compassion interrupts the brain’s threat mode and activates the care system, releasing calming hormones like oxytocin. It helps shift your inner voice from harsh to supportive, which lowers stress and builds emotional resilience.

2. Reset Your Nervous System (Daily, Briefly)

• Box breathing: Inhale 4 – Hold 4 – Exhale 4 – Hold 4
• Grounding: Sit with feet flat and notice sensations
• Gentle touch: Hand on chest + slow breath for 2 minutes

Why this works: These practices signal to your body that you’re safe, shifting you from “fight or flight” into a calmer parasympathetic state. Even short, consistent resets can lower baseline anxiety and help you think more clearly.

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3. Try the Two-Minute Permission Pause

Set a timer. Place your hand over your belly. Say aloud or silently:

“I have permission to pause. I don’t need to fix or prove anything right now.”

Just breathe. Let that be enough.

Why this works: Giving yourself explicit permission to stop disrupts the cycle of overdoing. It retrains your nervous system to see stillness as safe, not dangerous, which over time makes rest easier to accept.

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4. Practice Saying No — Gently

• “Thanks for thinking of me — I can’t say yes this time.”
• “That sounds like a great event. I’m choosing rest this week.”

Therapist Tip: Start small — celebrate the little wins. Boundaries, even the tiniest ones, build momentum. Only the wins count.

Why this works: Each time you say no, you teach your brain that your worth isn’t tied to constant giving or performing. Boundaries protect your energy, reduce overwhelm, and create space for what truly matters.

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When Therapy Might Be the Next Gentle Step

Sometimes the weight you’ve been quietly carrying becomes too much to keep holding on your own. Therapy offers a safe, steady place to set it down—where your story is heard, your pace is honored, and you don’t have to keep pretending you’re “fine.”

• Anxiety feels constant or exhausting
• You can’t relax even when you try
• You’re navigating pregnancy, postpartum, or birth-related overwhelm
• You’re “fine” on the outside, but unraveling inside

Evidence-Based Therapies That Can Help

These approaches are well-researched, trusted by therapists, and adaptable to each woman’s needs. They’re especially powerful for high-functioning anxiety—meeting you where you are, capable and composed on the outside, but longing for more ease and breathing room inside.

• • CBT: You’ll learn to identify and reframe anxious thought loops like catastrophizing or perfectionism. For example, replacing the “worst case” rehearsal before a meeting with a more balanced, supportive perspective.

  • ACT: You’ll practice making space for uncomfortable feelings without letting them run the show. That might mean choosing small, values-based actions—like resting without guilt—to help you live in alignment with what matters most.

  • EMDR: You’ll process stored overwhelm from past experiences—often without needing to retell the entire story. This can help release the body’s “always on” response after years of burnout or a difficult birth experience.

Helpful Resources

You don’t have to do this work all at once—sometimes the smallest daily practice can begin to shift how you feel. These tools offer gentle, accessible ways to pause, breathe, and reconnect with yourself, even on the busiest days.

• Tara Brach’s RAIN Meditation
• Kristin Neff’s Self-Compassion Tools
• Greater Good Science Center
• Insight Timer App

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You Deserve to Exhale

It’s okay to want a slower pace. It’s okay to exhale. It’s okay to ask for support.

👉 Schedule a Free Consultation if you’re ready to feel less frazzled and more grounded.

PS: If you’ve been holding your breath for too long, this is your gentle nudge — you don’t have to do it alone.