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High Functioning Anxiety & Perfectionism Healing With Dr. Carolyn Rubenstein

High functioning anxiety and perfectionism can often look like… Being well put together, being high achieving, being reliable, helpful, successful, organized, and the list goes on! But what’s actually going on on the inside can look much more like… Lots of overthinking, feeling anxious, needing to feel in control, having an immense fear of failure, not being able to say no, and not being able to relax without feeling a whole ton of guilt.

In this episode, I chatted with Dr. Carolyn Rubenstein, who is a licensed psychologist and someone who has a wealth of knowledge when it comes to high functioning anxiety and perfectionism. Her knowledge comes from her own personal experience, and also from her experiences in working with clients who struggle with high functioning anxiety, perfectionism, and burnout. She joins me to further dive into this topic, and she shares some more helpful tips and tools to help you create new and healthy habits to experience less anxiety and more peace. And her tips are so practical and actionable!


Although high functioning anxiety isn’t an actual clinical term, or a sub-type of anxiety, it’s something that’s really helpful to understand because it’s something that’s often missed. High functioning anxiety can look like experiencing symptoms of anxiety. Things like worry, overthinking, and physical symptoms such as difficulty with sleep and stomach issues. And why it’s often missed is because people who struggle with high functioning anxiety are often able to cover it up and use it in a way that allows them to be successful in certain areas, or to receive praise for certain things.

The behaviors associated with high functioning anxiety often get reinforced over and over, in a way that anxiety loves. Anxiety loves to be told that it’s doing a good job and that it’s helping you to be successful, and it also loves to get that praise. And by listening to anxiety and reinforcing the behaviors, you unfortunately get stuck in an unhealthy cycle of believing that you have to continue to do the things so that you can continue to be the best mom, or the best person in your job, or to be the best friend, or the best partner. It can be incredibly loud, and so you continue to listen to it and often think that it’s actually helping you to perform.


When you’re struggling with high functioning anxiety, you’re often in your head and thinking a lot. And one of the best cues to bypass this is to look at your body. This means looking at how your body is responding. Do you have butterflies? Is your stomach a little jittery? Are you noticing sleep issues or changes? Are you feeling stress in your neck or in another area? Getting connected to your body and using your body as a compass can be helpful to identify when anxiety is popping up rather than going into your brain and trying to take out all of your thoughts.

If you’re struggling with high functioning anxiety, it may look like being very detail oriented and structured. You may have plans, agendas, and schedules, and you appear to have it all together. You may also say yes a lot, and others see you as being loyal and reliable. You are hardworking. You can also appear very outgoing.

And on the flipside, often what people don’t see is…

  • Just as you’re detail-oriented, you’re spending a lot of time in your head, overthinking and over-planning.

  • Just as you are structured and creating agendas, you may be a little inflexible.

  • Just as you’re loyal, you may have issues with boundaries and saying no.

  • Just as you’re hardworking, you may have a huge fear of failure.

  • Just as you’re outgoing, you may have a strong urge to please others more so than yourself.

When you’re struggling with high functioning anxiety or perfectionism, things can appear one way, but what’s actually going on may be a deeper source of discomfort or desire. But it’s important to note that not all of these things aren’t bad, and some are actually quite natural and not associated with the flipside of these things. Meaning, it’s not all-or-nothing. But if you're noticing patterns, then it can definitely be helpful to get curious and dive a little deeper.


Carolyn is open in the fact that she “runs anxious,” but she doesn’t see it as a bad thing because it doesn’t run her life or dictate what she does. She says, “It’s like an accessory that I have and I kind of have it with me. And sometimes it’s louder than others. In the past, it was incredibly loud, and it kind of helped me to achieve really big things, and great success and all of that, but not really for the right reasons. It was more so from a place of anxiety than a true deep desire. That like, this is what I want and these are my values and from that deep core place. Versus like, anxiety is telling me that in order to please that person, I need to work 24/7 on this project. So I’ll just neglect my sleep and my eating.”

She explains that she wasn't really noticing that it was coming from a place of anxiety because she was getting great results and so she just kept going on what felt like an endless cycle. Until she realized, it wasn’t fun or enjoyable, and it ultimately led to burnout. Carolyn shares that you can allow anxiety, the feelings, and thoughts to be there and you don’t have to listen to what they’re telling you to do. And she personally found that once she began to do this, she then noticed that she began to connect more with people on a more raw and genuine level and it was more enjoyable.


Anxiety can impair your ability to connect with somebody, to be vulnerable, to be honest, because you’re so in your head and you’re often creating walls. You may be worried and scared of being seen as imperfect or being seen as not having it all together. And it’s a journey to be able to own this and to be okay with it, but it’s refreshing when you do the work and allow yourself to experience genuine connection with others.

Carolyn goes on to share that if you’re saying yes to everything, you’re lacking boundaries which can cause burnout. And you’re also setting yourself up to be very let down, because when people don’t reciprocate in the same way that you do, it can really hurt. And this can really set up an imbalance in relationships.

It can also lead to needing a lot of reassurance in relationships. It may look like saying to others, “You’re okay with everything I’m doing right? Everything is good? You’re happy with me?” And then an hour later, you find yourself asking the person the same questions again because you feel you need their reassurance. Or if somebody gets frustrated with you and you’re not pleasing them, you may jump to questioning if the relationship is over. But the reality is that relationships have ups and downs and twists and turns and it doesn’t mean that the relationship is over. It’s really about practicing getting comfortable with the unknowns, which is something that anxiety doesn’t enjoy.


A big reason why people struggle with high functioning anxiety and perfectionism is because of the rewards that come along with the behaviors that are often reinforced. Carolyn says, “Think about when kids are in school. You get points off if you’re not detail oriented. If you don’t capitalize, if you don’t put a period, if you don’t dot your ‘i.’ While if you do everything perfectly, you get a star or a sticker. All of this is very much reinforced from a young age and can be very addicting.” It all goes back to the reward and praise. Because it feels so good to get the recognition and praise, you keep doing the behaviors.


Take back your power with your actions!

  • Recognizing when the thoughts come up and bringing light to them is hugely important. Asking yourself, “Why am I feeling this way?” And being able to name the thought and name what’s going on. For example, I’m doing this because I'm afraid that they’re not going to like me if I say no. Maybe it looks like writing the thought down so that you can better understand how you’re feeling and why.

  • Recognize that thoughts are thoughts and nothing more, it’s really what you do with the thoughts and how much power you give them.

  • Approach yourself with compassion. For example, telling yourself… This is hard. This kind of sucks. It’s scary and I don’t like this feeling. It’s important to validate yourself, what you’re feeling, and what you’re up against.

  • Challenge the thoughts with your actions. You may say to yourself… Anxiety is telling me to do this, but what do I actually want to do? And you may land on… I’m going to try saying no and see what happens and see how I feel. And note that when you do this, you’re going to feel uncomfortable and it’s not going to immediately get better. And this is okay and is a part of the process. On the other hand, sometimes you may land on following the thought and doing whatever anxiety is telling you to do, and this is also okay. When you do, don’t beat yourself up for it.

  • Take small steps! Maybe this week try challenging your thoughts and behaviors once or twice a week, and then work yourself up to challenging yourself more and in different ways. Here’s an example of what challenging yourself might look like - If you’re a list person, instead of aiming to accomplish everything on your list, instead identify one or two things on your list that you’re not going to accomplish. Giving yourself permission to not do things that don't need your attention right now (or maybe even at all) is huge.

  • Track your wins. Write down when anxiety told you to do something and you chose to do something different instead. It’s so powerful to see that your whole world doesn’t fall apart when you don’t listen to anxiety.


With high functioning anxiety, it’s really helpful to look at where your perfectionism really comes from. Because the reality is that it’s often coming from a place of trying to do something good and help you in some way. This can look like asking yourself… What was this trying to do for me at some point? And really looking at it in a positive way. What was this trying to do for me in a positive way? Almost recognizing it and thanking it for what it’s given you so that you can then move beyond it. And what can help you to move beyond it is asking yourself questions like…

  • In my life now, what is it doing for me?

  • What is it taking away? How is it hurting me possibly?

  • Is it doing much good now, or is it hurting me more?

Being able to look at it head on can be really empowering and informative. With perfectionism, it’s important to open the hood and really see what’s underneath so that you can give yourself the permission and allowance to develop new and healthier responses and behaviors. And when it pops up, it can look like saying to yourself, I know you want to help me (perfectionism), but I don’t really need you right now.

Carolyn shares that something she sees a lot is people wanting to overcome high functioning anxiety and perfectionism with high functioning anxiety and perfectionism. But overcoming it isn’t going to be perfect and doing it perfectly is not the goal. As Carolyn says, “Messing up is success!”


Therapy services, newsletter, book, all the things:

On Instagram: @carolynrubensteinphd


Ways to work with me...

Driving Anxiety Masterclass

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Panic to Peace

(10-week live course)

A 10-week live course that will teach you the tools that will help you to overcome your anxious thoughts, the symptoms, panic, and fears (no matter where and in what situations you experience them), and start living a life that is full of lots more peace, joy, freedom, and adventure!

Symptoms & Panic Attacks


A 90 minute masterclass that teaches you how to start approaching the symptoms and panic attacks in a healthy way so that you can finally find freedom from them!

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