Anxiety is one of the most prevalent conditions in the US. Over 40 million Americans experience an anxiety disorder, though with more awareness, that figure could be much higher. Everyone is aware of worry that can consume you, as well as the sense of dread that you try to avoid at all costs. But these are only some signs of anxiety, and many more elements actually show up as physical symptoms of anxiety that we’re not as familiar with identifying. Here’s why it’s important to look out for all the ways anxiety can manifest in your body.
Anxiety is your body and mind’s reaction to perceived stressful situations. These situations can be mild, like worrying about the future, or intense, like those caused by an actual trauma. Everyone experiences anxiety at some point. Sometimes you get anxious before flying or doing a big presentation and these moments are natural and typically pass. Some people may experience a period of some extended anxiety caused by an unusually stressful time, like moving to a new city or starting a new job, which goes away in time. Then, there’s chronic and long-lasting anxiety lasting for more than 3 months, which can be a sign of generalized anxiety disorder.
It is important to note that there is a difference between anxiety and a panic attack. According to the National Institute of Mental Health , panic disorder is a type of anxiety disorder that presents as sudden, intense feelings of doom, as well as physical symptoms such as chest pains and hyperventilation. Panic attacks can be spontaneous or may have a specific trigger. Anxiety, on the other hand, often builds over time and is usually related to a real or perceived stressor. While anxiety can linger, a panic attack is typically short-lived.
Most people think of anxiety as something that’s only in your head—you may feel worried, have trouble concentrating, feel restless or irritable, or nervous. But the fact is, physical symptoms of anxiety happen too, and for some people, they may be the first sign that something is up.
Amy Coleman, MD, a functional medicine physician formerly with Parsley Health, has learned how to identify physical symptoms in a high anxiety environment, taking care of members of the military, often who had PTSD. “I took care of F16 pilots and Special Forces soldiers, and they wouldn’t tell you a thing,” says Dr. Coleman. “I used to call it veterinary medicine because they would hold back what was wrong with them for fear of not being able to do their job. So they would hide things just like animals hide their sicknesses or nervous tension.” She explains that anxiety would show up as high blood pressure spikes, an accelerated pulse, and rapid respiration. These are the ways she says, at the very minimum, survival mode shows up in the body.
These physical symptoms of anxiety are caused by your body going into fight-or-flight mode, which prepares you to take on an impending threat by releasing hormones like adrenaline and cortisol . These hormones in turn increase your breathing, heart rate, and blood pressure to provide more oxygen to working muscles.
This is not problematic if short-lived or infrequent. However, for people with prolonged anxiety or a diagnosed anxiety disorder, the constant release of stress hormones can have long-term impacts. Take Dr. Coleman’s patient with blood pressure spikes, which is a sign of increased cortisol levels.
The gut-brain connection is a powerful one. Symptoms like nausea, bloating , gas , constipation, loss of appetite, and stomach cramps can all be signs of anxiety. It can even cause ulcers and acid reflux.
As Dr. Coleman explains, shallow breathing caused by heightened anxiety impacts your blood chemistry, putting it in an alkaline state, which can impact your nervous system, causing fatigue and brain fog . She says, “People also don’t think about nerve impingement as being related to anxiety. However, your diaphragm acts as a bellows, and what runs through the diaphragm is the vagus nerve, which can be pinched when we breathe too shallow and fast.” This nerve is one of the largest, and it is a gateway for the parasympathetic nervous system, or as Dr. Coleman calls it, the “rest and digest” nervous system. So, this nerve needs to be released from any impingement conditions to work its best through breathwork.
The muscle tension can occur as a result of your body tensing from the hypervigilance of being in flight or fight mode.
Unfortunately, the relationship between sleep and anxiety can be cyclical. When you’re excessively worried or nervous, it can be more difficult to fall asleep, and these thoughts can also keep you from staying asleep. When sleepless nights start to become the norm, it can feed into anxiety about insomnia , and increase cortisol levels throughout the day that makes it even more difficult to fall asleep the next night.
If you’re not getting enough sleep or quality sleep due to anxiety, this can understandably lead to physical symptoms like daytime fatigue. But even if you aren’t having trouble sleeping, being anxious can be draining on your body. “If your body is in a heightened state of arousal from the stress hormones it’s pushing out, your system is actually doing a lot of work internally. That in itself can deplete your energy levels,” explains Dr. Coleman.
The immune system , which is mostly housed in the gut, can suffer if you have chronic anxiety. According to Dr. Coleman, “The body, just like any company, has limited resources. So it’s always going to siphon off some energies to where it feels like it’s needed the most. And when you’re in fight-or-flight, reactive survival mode, it takes a lot of energy to run that system. It’s like mobilizing for war.” This leaves the gut in a “low-power” mode, which can invite more unsavory gut flora that are able to survive and thrive in this unbalanced environment.
As a result, your body doesn’t have all the resources to fight off infections as well, like the cold or flu. A 2006 review of over 300 empirical studies found that chronic stressors have negative effects on almost all functional measures of the immune system. More specifically, one comparative study of older adults in the Archives of General Psychiatry found that participants with more depressive/anxiety symptoms had higher levels of interleukin 6, a pro-inflammatory cytokine, before and after receiving vaccination designed to provoke an immune response, than did those who reported fewer symptoms.
“Many physical manifestations of anxiety are frequently misdiagnosed as other conditions by conventional doctors who are not trained to look at the connections between the mind and body,” says Dr. Coleman. “At Parsley Health, providers spend ample time getting to know members and use advanced testing to really understand what’s going on with you both physically and emotionally.”
Beginning to manage symptoms of anxiety can result in an overall improved sense of mental and physical wellness. Dr. Coleman believes that it starts by balancing your nervous system. “That means allocating more energy to the side of the nervous system that rebuilds the city, which is you.”
She suggests recognizing what you can and cannot control. The pandemic by itself has caused an increase in anxiety diagnoses . Add election season, calls for justice, and personal stressors, and we are all anxious. The world can come in at every angle possible. The only thing we can control is our choice as to how we respond to it.”
Not only do our hypervigilant, obsessive thoughts need to change, but Dr. Coleman recommends deep breathing and meditation , walks in nature, or whatever can bring peace. For some, that means connecting to their higher power or spirituality.
Be aware, however, of using substances to bring you that peace. One study in the Journal of Caffeine Research calls caffeine and alcohol “the perfect storm.” The typical habits of drinking alcohol to calm anxiety, or using caffeine to combat the fatigue are actually counterproductive. This is because those who struggle with anxiety should also limit alcohol and caffeine consumption since both can trigger severe anxiety symptoms. More appropriate ways to handle this could be cognitive behavioral therapy, journaling, exposure therapy, meditation, acupuncture, herbal supplements , and breathwork.
Working with a doctor who understands both the mental and physical signs of anxiety can help you determine the best path for you in conjunction with a mental health professional.
The bottom line, Dr. Coleman says, is practicing self-care. “Be of the world but not in the world so much so that you can balance your state. And in doing that you’re putting the oxygen mask on yourself for balance, so that you can help others form a more balanced state in themselves too.”