Seven hidden signs of mental health condition that can lead to total burnout

A psychologist has warned of the seven quiet signs of a mental health issue that can lead to total burnout.

Some 40 million people in the US are diagnosed with some form of anxiety disorder, as per the National Institute of Mental Health.

But one manifestation of anxiety doesn't manifest in the way you'd expect.

In fact, many people with this form of anxiety typically appear calm, organized and even highly successful.

But beneath the surface, there’s often a constant undercurrent of worry and need for perfection that’s hard to switch off. It can result in exhaustion and complete burnout, especially as it's so under-recognized.

The anxiety in question is called high-functioning anxiety and Dr Bijal Chheda, Consultant Psychologist and Founder of Nos Curare, a clinic specialising in inclusive mental health care, has shared the seven subtle but powerful ways high-functioning anxiety shows up in daily life, plus some expert-backed tips on how to manage each one.

You’re ‘always on’

Being constantly 'on' and can a red flag on high-functioning anxiety (D3sign/Getty Images)

People with high-functioning anxiety often feel physically tired but mentally stuck in overdrive, worrying or imagining worst-case scenarios.

Commonly associated with anxiety-related conditions like obsessive-compulsive disorder (OCD), this persistent ‘on’ state means the person is always on high alert, constantly preparing for the next challenge, regardless of whether this new potential problem actually exists.

Over time, it leads to stress, irritability and burnout - and disrupts sleep, which can keep you in the cycle.

Taking short breaks to breathe or meditate, even just five minutes an hour, can quiet the noise and recharge your focus, Dr Chheda says.

Exhausted yet restless

Despite feeling tired, people with high-functioning anxiety often find it hard to truly relax or fall asleep. They may feel physically drained, but mentally they’re stuck in overdrive, spiraling over worries or imagining worst-case scenarios.

This persistent cognitive stimulation can lead to sleep disturbances such as insomnia or delayed sleep phase disorder, a condition where anxiety delays the body’s natural ability to wind down and initiate sleep.

At bedtime, Dr Chheda recommends incorporating techniques like progressive muscle relaxation (systematically tensing and releasing muscle groups to reduce physical tension) or guided imagery (visualising calming scenes or experiences). If sleep problems persist, it's advised that you consult with a mental health professional for more tailored support.

Overthinking social interactions

Replaying that awkward moment all over again? (Catherine Falls Commercial/Getty Images)

High-functioning anxiety often manifests as replaying conversations and constantly worrying about what you said or how you came across.

This mental loop can make even the briefest social interactions feel draining as they analyse every detail of the interaction, from facial expression to tone of voice. Dr Chheda notes that this is especially the case for individuals on the autism spectrum who ‘mask' to fit in.

Cognitive behavioral therapy (CBT) can help challenge these negative thoughts and reduce post-interaction anxiety, the doctor adds.

Perfectionism as a coping mechanism

Striving for perfection is a common way people with high-functioning anxiety try to control outcomes.

This type of perfectionism is common in those with attention-deficit hyperactivity disorder (ADHD), who may have grown up being told they 'lacked discipline'. In response, they often overcompensate by setting extremely high standards for themselves in order to avoid further criticism.

"Instead of hyperfixating on past mistakes, try reframing them as learning opportunities instead. Set realistic, flexible goals and learn to celebrate progress, whether big or small," Dr Chheda says.

"After all, growth isn’t linear. I suggest booking a cognitive talk therapy session to help unpack the roots of this issue and build healthier self-expectations going forward."

Constant productivity

Hustle culture could be a crutch for something else (Maria Korneeva/Getty Images)

Despite social media's love of hustle culture, chronic 'overproductivity' can actually be a trademark of high-functioning anxiety.

Work, hobbies, and even chores can become ways of disconnecting with emotions or silence racing thoughts, making it harder to recognise when you really need help. Any downtime can trigger guilt, even when rest is desperately needed.

"But you must remember that rest isn’t a luxury, but a necessity," Dr Chheda warns. "Without enough of it, you can experience increased irritability, difficulty concentrating, and even a weakened immune function, making it even more difficult to be productive when needed."

Make creating boundaries around work and scheduling rest a priority.

Struggling to say no

High-functioning anxiety can lead to ‘people pleasing’ habits and difficulty setting boundaries. Because the person fears disappointing others, they may have the tendency to overcommit to plans and requests, regardless of whether they can handle these tasks at the moment.

This can result in both mental and physical overexertion, eventually leading to resentment that worsens anxiety symptoms.

"While practicing assertiveness can be hard at first, you must recognise that saying ‘no’ is also an act of self-care, not selfishness," Dr Chheda says.

"I suggest developing scripts at the ready to politely decline requests. By evaluating your capacity before agreeing to anything, you’re also ensuring you’re taking on new tasks intentionally, without guilt or pressure."

It can lead to ‘people pleasing’ habits and struggling to say no (JulPo/Getty Images)

Outward confidence, inner tension

Many with high-functioning anxiety seem confident and successful on the outside while hiding a relentless inner turmoil.

This discrepancy often leads to feelings of isolation, as others may not realise the person is silently struggling beneath the surface.

Because they feel the need to appear a certain way, they may feel as though they have no safe outlet and end up keeping their emotions bottled up.

Over time, this suppression can contribute to major depressive disorder. Dr Chedda explains that's why it’s important to build a well-trusted support system where you can share your true feelings without fear of judgment.

"Counseling or local peer support groups can offer non-judgmental spaces for honesty and connection. Remember, no matter how difficult it may seem, there’s real strength in acknowledging your emotions and reaching out for help," Dr Chedda adds.

If you or someone you know is struggling or in crisis, help is available through Mental Health America. Call or text 988 to reach a 24-hour crisis center or you can webchat at 988lifeline.org. You can also reach the Crisis Text Line by texting MHA to 741741.