Anxiety can lead to a variety of different physical symptoms, including things like chest pains, changes in heart rate, dizziness, GI distress, and headaches, among other things. It is important to understand how anxiety can contribute to and exacerbate physical symptoms, as well as what steps you take to ensure that there are not underlying physical causes for your discomfort. This guide covers the most typical ways that anxiety can present physically, what studies say about those connections, and what steps you should take if you begin experiencing uncharacteristic physical symptoms.
There is that moment when you suddenly feel a pressure in your chest at 2am and your instincts begin screaming dire things at you before you’ve even stopped to think. It’s that feeling where you spend months waffling between doctors checking for all the possible physical causes of your symptoms before it even occurs to you that anxiety could be the reason. I speak from personal experience when I say that the journey to understanding the root of your symptoms can be long and grueling.
Medical Issues Should Be Ruled Out First
It is essential that any physical symptoms you are experiencing are properly diagnosed by a medical doctor before trying to chalk them up to anxiety, especially if your symptoms include any kind of chest discomfort, heart palpitations, or dizziness since these can be signs of a number of different medical conditions that may need urgent care. Anxiety can contribute to a number of physical symptoms but is typically a diagnosis of exclusion (meaning that it is often considered only after other physical causes have been ruled out).
How Does Anxiety Affect the Body?
Anxiety symptoms are primarily produced through the body’s endogenous stress response system, also called the fight-flight-freeze response. When the brain senses danger in any form (actual or perceived), it signals the adrenal glands to release stress hormones like adrenaline and cortisol. Adrenaline is responsible for a number of the immediate physical symptoms of anxiety like increased heart rate, redirecting blood flow away from non-essential muscles towards bigger muscles like the legs and arms, and increased breathing. While adrenaline has short duration, cortisol is released for longer-term stress and helps to sustain the body’s stress response to danger. The thing to note here is that these physical anxiety symptoms are the body’s fear response to danger or perceived danger; that perceived danger can be a physical threat, but it can also be a mental or even imagined threat.
[insert diagram on stress response pathway]
Can Anxiety Cause Chest Pain?
Anxiety can absolutely be a cause of chest pain, and not just indirectly through increased heart rate or risk of heart issues. In fact, a study on non-cardiac chest pain found that anxiety was a significant predictor of developing the condition, with an odds ratio of 3.27, and found that worry, tension, and feelings of being frightened were most closely linked to the pain itself (Smeijers et al., 2014). A later prospective clinical trial study on patients with existing coronary heart disease found that the association went both ways, with chest pain predicting higher levels of anxiety and depression in the future, while anxiety predicted higher levels of future chest pain only in the short term, with the association disappearing after about 18 months (de Heer et al., 2020).
Chest pain from anxiety can take a number of forms, but it is most common for people to describe it as being either tight or squeezing, or as a dull ache; it is less common for people to describe sudden sharp pains or pressure in the chest area. Chest pain caused by anxiety tends to be intermittent, coming and going throughout the day and being triggered by stressful events, and typically disappears when the person is otherwise occupied or distracted. It is often accompanied by other anxiety symptoms like rapid heartbeat or shortness of breath.
Can Anxiety Cause Heart Palpitations?
Many people with anxiety find that they experience heart palpitations, which are feelings of a racing or pounding heart. They are caused by the same adrenaline surges that drive other physical anxiety symptoms like rapid heartbeat and shallow breathing. Heart palpitations from anxiety often appear without warning, although they may also be linked to intrusive thoughts or stress as the body’s fight-or-flight response kicks in to deal with the sudden adrenaline rush, and persistent palpitations with associated chest pain or dizziness should be checked out by a medical doctor to make sure they are not a sign of a cardiac issue.
Can Anxiety Cause Dizziness?
Dizziness is another common physical symptom of anxiety, frequently caused by shallow breathing or rapid breathing patterns that cause a drop in blood CO2 levels. This is also sometimes called hyperventilation, and it can lead to feelings of lightheadedness or derealization during periods of intense stress or panic. Dizziness during a panic attack can be severe enough to make people feel as though they are about to faint, although actual fainting is rare.
Can Anxiety Cause Stomach Pain or GI Issues?
Anxiety has a fascinating connection to the digestive system, as stress is known to affect digestion and contribute to a number of gastrointestinal issues like stomach cramps, nausea, indigestion, acid reflux, and diarrhea. Stomach pain related to anxiety tends to occur alongside other GI issues as irregularities in digestion are caused by the same adrenaline surges that lead to other physical anxiety symptoms
Stomach pain due to anxiety often manifests as:
- A tight or balled-up feeling in stomach area
- Cramps that come and go
- A burning discomfort behind the breastbone or upper abdominal area
- Increased urge to use the bathroom, sometimes including diarrhea
Can Anxiety Cause Nausea?
Nausea is also strongly connected to anxiety as a physical symptom, and it appears to be one of the strongest predictors of anxiety in terms of GI issues. One large population study found that, compared to heartburn, diarrhea, or constipation, anxiety disorders were overall more strongly connected to nausea with an odds ratio of 3.42 (Haug, Mykletun, & Dahl, 2009). Many people with anxiety find that they have nausea as a symptom before big anxiety-inducing events as a result of anticipatory anxiety.
Can Anxiety Cause Headaches?
Anxiety can also frequently contribute to tension-type headaches, and people with chronic anxiety often report experiencing these headaches as a daily occurrence. They are typically a dull pressure around the head or at the back of the neck that occur as a result of constant tense muscles during periods of chronic stress. Migraine sufferers may also find that their migraines are more frequent or severe as a result of anxiety.
Seeking Therapy Can Help
If you find that physical symptoms related to anxiety are interfering with your quality of life, you may want to consider working with a therapist to help identify and address the root causes of these symptoms.
