The View From The Exam Room
Bethesda Women’s Mental Health
In my practice, I’m seeing more women who don’t “look” like they’re struggling because by most external measures, they’re not. They’re working efficiently, caregiving with a smile, and showing up for their children. Underneath that, though, there’s a steady hum of anxiety, poor sleep, irritability and/or physical symptoms that don’t quite fit a single diagnosis. This scenario often gets missed, not just by clinicians, but by patients themselves.
When someone is still functioning at a high level, it’s normal to equate the outcomes with “normal” distress. Many women describe being unable to relax without guilt and feel like they are always doing something. They start to become numb and keep checking the boxes. Others present in primary care with headaches, GI symptoms, or fatigue, without initially identifying anxiety as the driver. Part of the challenge is that being high functioning works against women in recognizing when they are suffering.
Let me be clear that the impact is real: disrupted sleep, strained relationships, work issues and chronic medical issues. What I’ve come to appreciate is how often this gets dismissed as “just stress” by patients and clinicians alike. We have an opportunity to shift that. By recognizing these patterns early and encouraging women to seek support before things escalate, we can help prevent a slow progression into more significant impairment.
Holding everything together shouldn’t come at the cost of someone’s well-being, and it’s worth saying that clearly in the exam room.