Early in my career, I worked in a healthcare training setting. Medical, nursing, and dental students would come through my door, and they all had something in common.

They were exceptional. Cream of the crop. Top of their classes. The kind of people you want holding the scalpel or reading your chart.

And most of them were anxious.

Not the falling-apart kind. The quiet kind. The kind that hides behind a perfect GPA and a calm exterior and a to-do list that never ends.

Here is what I learned watching them: High achievement and anxiety often grow from the same root.

When you have spent your whole life being praised for performance, your nervous system starts to believe the praise is the point. Slipping up does not feel like a normal part of learning. It feels like a threat. So the brain stays on alert, scanning for the next thing that could go wrong.

That is low-level anxiety. And in small doses, it can actually fuel people. It makes them prepared, thorough, conscientious.

The problem is that low-level does not always stay low.

Under enough pressure, the dial turns up. Preparation becomes over-preparation. Thoroughness becomes the inability to ever feel finished. The student who used to study hard now cannot sleep, cannot delegate, cannot turn the work off in their head.

I see the same pattern now in the leaders I work with. Different setting, same wiring.

So how do you spot it before it escalates?

Watch for the high performer who never seems satisfied with their own work.

Watch for the person who says yes to everything because saying no feels dangerous.

Watch for the one who is always busy but rarely seems present.

Watch for irritability and exhaustion in someone who used to have plenty of energy.

These are not signs that someone is weak. They are usually signs that someone is trying very hard to hold it all together.

The kindest thing a workplace can do is notice early. A leader who asks a real question, who normalizes rest, who makes it safe to be human instead of flawless, changes the trajectory.

Anxiety in high achievers does not always announce itself. It often looks like someone who has it all together.

The skill is learning to tell the difference.

It is Mental Health Awareness Month. If you lead people, this is a good week to look a little closer, dear readers.

And if you are one of those high achievers reading this, quietly recognizing yourself in it, you are not alone. I bring together a group of like-minded women who are done holding it all together by themselves. If that is you, send me a DM.

Cristina “I see you, high achiever” Filippo