Man staring anxiously into the distanceAnxiety is a mental health condition, so it may seem logical to assume it primarily involves mental or emotional symptoms, not physical ones. But anxiety often also involves somatic symptoms, or symptoms felt in the body. In fact, some people may experience more physical symptoms than emotional ones.

Anyone who’s ever felt nervous can likely name many common physical symptoms, including:

But people living with chronic anxiety issues, including panic, phobias, general anxiety, or social anxiety, may experience more persistent symptoms, even when they don’t have any reason to feel nervous.

These symptoms can resemble those of serious health conditions, and some people may not recognize the nature of their distress. They may worry instead they have heart trouble, chronic migraines, or other health issues. Accordingly, these physical symptoms may not only cause immediate distress, they also often contribute to long-term confusion and stress around the true cause of symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Seven Physical Symptoms of Anxiety

Anxiety can cause plenty of physical complaints, so people living with anxiety could notice the following physical signs, in addition to mental health symptoms.

1. Anxiety and dizziness

Dizziness often arises as a symptom of anxiety. You might feel:

The relationship between anxiety and dizziness can go both ways, creating a feedback loop. People who worry about losing their balance, falling, or losing control in a public place may become anxious whenever they feel dizzy, and one symptom may worsen the other.

Research from the Academy of Neurologic Physical Therapy suggests this happens when the vestibular system, which helps regulate sensations of movement in your environment and the position of your body, interacts with the limbic system, which helps regulate emotional experiences.

These fears can lead many to cope by avoiding activities likely to cause one or both symptoms, including physical activity or experiences likely to provoke anxiety or stress. This can have a negative impact on quality of life over time.

2. Anxiety and chest pain

Chest pain is one anxiety symptom that often causes alarm, especially when pain accompanies a rapid increase in heart rate and shortness of breath. These symptoms, of course, can also suggest a heart attack, so many people who experience chest pain worry their symptoms are life-threatening. When seeking emergency medical care, they may feel frustrated and distressed when there’s no medical explanation for their pain and heart palpitations.

But according to one study of 151 patients reporting chest pain, 59 percent had symptoms of anxiety. Research from 2006 supports the finding that people who seek emergency care for chest pain often have anxiety rather than a cardiac condition. Panic attacks, in particular, may share many similarities with an oncoming heart attack.

Someone having a heart attack, however, will most likely experience a squeezing pain that may radiate toward the jaw or left arm. Women often notice pain in their upper back or shoulders.

3. Anxiety and headaches

Experts have linked anxiety to both tension headaches and migraines. Headaches can develop as a symptom of anxiety for many reasons, including the following:

4. Anxiety and digestive issues

Persistent gastrointestinal distress often occurs as a physical symptom of anxiety. Medical research suggests this happens because of the connection between the brain and the gut. Nerves shared by the gut and the brain can interact with each other and have a negative impact on normal bodily processes.

Most people have experienced stomach “butterflies” or nausea when nervous or worried about something. But people living with chronic anxiety might notice more serious issues, such as:

Worries about experiencing things like vomiting or diarrhea in public can contribute to increased anxiety and emotional distress. Long-term GI distress can even make it difficult for some people to function as they usually would, which can lead to significant negative consequences for their quality of life.

5. Anxiety and breathing difficulties

Many people experience breathing problems when feeling anxious. Breathing troubles can range from hyperventilation, or very rapid breathing, to sensations of choking or feeling unable to draw a breath.

These symptoms don’t typically persist over time. They generally happen whenever a situation becomes tense or involves some fear or nervousness. Panic attacks often involve choking sensations, and it’s not uncommon to feel as if you can’t breathe. These feelings can be very frightening, and they often worsen anxiety’s emotional symptoms.

6. Anxiety and numbness

Numbness or tingling can also occur as a physical sign of anxiety. People with anxiety tend to experience this sensation, often described as pins and needles, in the hands, arms, legs, or feet.

Experts believe it happens in response to bodily arousal. Anxiety symptoms develop when the body feels threatened. In response to this perceived threat, the body redirects its resources, like blood, away from the extremities and to the more essential organs, such as the heart.

Hyperventilation can also contribute to numbness and tingling. When you hyperventilate, you end up with an excess of oxygen in your blood. This excess of oxygen means the body doesn’t have enough carbon dioxide to maintain typical processes. As a result, blood vessels constrict, and blood doesn’t flow to areas the body considers less essential, like hands and feet. Other symptoms, including head pain, increased heart rate, and dizziness can also happen in response to this lack of carbon dioxide.

7. Anxiety and chronic pain

There’s plenty of scientific evidence supporting the connection between chronic pain and anxiety.

Results of one study from 2013 found that, among 250 people living with chronic pain, 45 percent of them also had symptoms of at least one type of anxiety. The chronic pain patients who also had anxiety tended to experience greater pain and lower quality of life than those who did not have anxiety symptoms.

People with both chronic pain and anxiety often have a lower tolerance for pain and become trapped in a distressing cycle of symptoms.

People constantly in pain may:

Long-term chronic pain has also been linked to depression. It’s not uncommon for people living with anxiety and chronic pain to also have symptoms of depression.

Long Term Effects of Anxiety

Anxiety symptoms develop because the body mistakenly believes it’s about to face a serious threat. Physical and emotional symptoms result from bodily changes known as the “fight-or-flight” response. Once the body engages in this mode, hormones enter the bloodstream at higher levels than usual, triggering those well-known symptoms of anxiety.

So, although anxiety serves an important purpose—to prepare the body to face threats in the environment—problems can develop when anxiety sends the body into fight-or-flight mode too often or the body remains in fight-or-flight mode for a long period of time, which can happen when you have trouble coping with anxiety symptoms.

Medical research has found evidence to suggest links between long-term anxiety and the following conditions:

To sum up, people with anxiety, especially untreated anxiety, don’t only experience immediate physical and emotional symptoms of anxiety. They may also see a decline in overall health over time.

Can Therapy Help with the Physical Effects of Anxiety?

Just as therapy can help address the emotional impact of anxiety, it can also help people manage physical symptoms. Addressing anxiety causes and triggers will generally lead to improvement of all symptoms, physical or mental.

People who experience physical symptoms of anxiety will typically work with a therapist who helps them identify and address possible causes or triggers of anxiety. Specific types of therapy, including cognitive behavioral therapy (CBT) or exposure therapy, can help people learn to address anxiety in the moment and learn potential methods of reducing anxiety in daily life.

But therapists can also offer guidance on specific ways to address physical symptoms. These might include:

Because many physical signs of anxiety do resemble symptoms of serious health conditions, it’s always wise (and highly recommended) to talk to a doctor about any concerning physical symptoms, especially if you have any doubt about what’s causing the symptom.

This is particularly important with chest pain. Since chest pain occurs during heart attacks as well as panic attacks, it’s often best to talk to a medical professional even when you feel certain anxiety has caused the pain. Once they’ve ruled out a heart attack or similar issues, talking to a therapist can be a helpful next step.

Find a compassionate, skilled therapist at GoodTherapy today.

References:

  1. Anxiety and physical illness. (2018, May 9). Harvard Women’s Health Watch. Retrieved from https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness
  2. Calm your anxious heart. (2019, October 1). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/calm-your-anxious-heart
  3. Chronic pain. (2016). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain
  4. Chronic pain sufferers likely to have anxiety. (2013, May 8). Health Behavior News Service. Retrieved from https://www.sciencedaily.com/releases/2013/05/130508213112.htm
  5. Demiryoguran, N. S., Karcioglu, O., Topacoglu, H., Kiyan, S., Ozbay, D., Onur, E., Korkmaz, T., & Demir, O. F. (2006). Anxiety disorder in patients with non-specific chest pain in the emergency setting. Emergency Medicine Journal, 23(2), 99–102. doi: 10.1136/emj.2005.025163
  6. Goodman, K. (n.d.). How to calm an anxious stomach: The gut-brain connection. Anxiety and Depression Association of America. Retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/how-calm-anxious-stomach-brain-gut-connection
  7. Komaroff, A. L. (n.d.). The gut-brain connection. Healthbeat. Retrieved from https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection
  8. Marksberry, K. (2012, August 10). Take a deep breath. The American Institute of Stress. Retrieved from https://www.stress.org/take-a-deep-breath
  9. Morris, L. O. (2015). Dizziness related to anxiety and stress. Retrieved from http://neuropt.org/docs/default-source/vsig-english-pt-fact-sheets/anxiety-and-stress-dizziness4ca035a5390366a68a96ff00001fc240.pdf?sfvrsn=80a35343_0
  10. Peres, M., Mercante, J., Tobo, P. R., Kamei, H., & Bigal, M. E. (2017). Anxiety and depression symptoms and migraine: A symptom-based approach research. The Journal of Headache and Pain, 18(1), 37. doi: 10.1186/s10194-017-0742-1
  11. Rajagopalan, A., Jinu, K. V., Sailesh, K. S., Mishra, S., Reddy, U. K., & Mukkadan, J. K. (2017). Understanding the links between vestibular and limbic systems regulating emotions. Journal of Natural Science, Biology, and Medicine, 8(1), 11–15. doi: 10.4103/0976-9668.198350
  12. Raymond, V. (2018, February 23). Is your chest pain a heart attack or anxiety? Right as Rain by UW Medicine. Retrieved from https://rightasrain.uwmedicine.org/well/health/your-chest-pain-heart-attack-or-anxiety
  13. Schwarz, J., Prashad, A., & Winchester, D. E. (2015). Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients. Critical Pathways in Cardiology, 14(1), 44–47. doi: 10.1097/HPC.0000000000000038
  14. Woo, A. K. (2010). Depression and anxiety in pain. British Journal of Pain, 4(1), 8–12. doi: 10.1177/204946371000400103
  15. Yoder, W. M. (2018, October 27). Anxiety and numbness—A typical reaction. Calm Clinic. Retrieved from https://www.calmclinic.com/anxiety/symptoms/numbness
  16. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018, September 7). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353. doi: 10.3389/fnhum.2018.00353

Person sits at table with laptop, looking distracted by pain in head“If we could somehow end child abuse and neglect, the eight hundred pages of the Diagnostic and Statistical Manual of Mental Disorders (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician’s Guide to Diagnosis) would be shrunk to a pamphlet in two generations.” —John Briere

Conversion disorder is not one of the better known mental health conditions. Google search inquiries, perhaps the most reliable way of measuring public interest in the internet age, show only a fraction of the interest generated by bipolar, OCD, or schizophrenia. The DSM-5 uses a more explanatory name: “functional neurological symptom disorder.” But this name is even less known. Ironically, conversion disorder is the modern term for one of the oldest and most famous—though now rather taboo—concepts in mental health: hysteria.

Over two thousand years ago, the cultures most interested in medical knowledge—ancient Egypt and Greece—observed that a person’s physical symptoms sometimes seemed unconnected to the usual causes. Of course, it must be said that the ancient Greek theory of illness and health, based on imbalances in the “four humors,” did not provide the most solid basis for identifying what was and wasn’t a “normal” symptom. Nevertheless, Greek scientists were correct in observing that symptoms like shortness of breath, partial paralysis, and pain were sometimes not prompted by a physical injury or illness and would recede when the patient calmed, even without medical treatment.

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However, this accurate observation was taken on a walk down a blind alley—something common in the premodern age. Doctors observed that these “phantom” symptoms were far more common in women. (This has been repeatedly confirmed by modern studies.) But doctors at the time used the observation to make the factually inaccurate inference that the symptoms must be specific to women. If these mysterious symptoms were peculiar to women, the next step in the logic ran, they must be caused by something specific to women, or the womb, known in Greek as the hyster. Thus the concept of hysteria was born. In one of intellectual history’s odder chapters, bizarre theories of the wandering uterus playing havoc by pressing against internal organs were formulated and debated by some of the greatest minds of premodern medicine. Even stranger was the long-running medical debate on whether masturbation should be prescribed as a cure for hysterical symptoms or whether marriage was the proper prescription.

Conversion Disorder Today

Fast-forward to the 19th century. The new science of psychiatry at last produced the insight that these symptoms were caused by brain disturbances, not reproductive system issues. The broad category of hysteria was divided into several more defined categories. The most extreme of these became known as hysterical neurosis, conversion type. Finally, after decades of limping along without any particular reason, “hysterical” was dropped. The diagnostic name became “conversion disorder.” The condition was characterized by the presence of neurological symptoms without an identifiable organic cause.

Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

The symptoms of conversion disorder are diverse. They include pain, paralysis, numbness, fits, and even temporary blindness. One of the most interesting features of this condition is that before diagnosis, all other possible reasons for the pain must be ruled out. Doctors must confirm that a patient is not feigning or deliberately inducing the symptoms. They must also make certain the symptoms do not stem from a neurological disease. Practically speaking, this is extremely difficult. As a result, conversion disorder is one of the hardest mental health concerns to diagnose, often leading to vigorous debate on the rate of misdiagnosis.

Conversion disorder also raises an interesting philosophical issue about the nature of pain and other unpleasant physical symptoms. We tend to distinguish between “real” and “imaginary” pain. If a rock falls on your foot and you experience a sharp pain, then that is real pain. But if you experience the same sensation in the absence of any outside stimulus, you might consider that pain imaginary.

The reality, however, is that all pain exists within the nervous system. The sensation of feeling pain, in any part of your body, is an illusion the nervous system creates to make you respond in a certain way. Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

Now, this is not to suggest that there is no point in distinguishing between different forms of pain. In fact, identifying what causes the nervous system to act in a certain way is a critically important step toward effective treatment. I do want to suggest, however, that we consider changing our attitude about what constitutes an injury.

Everyone would agree that a parent who caused their child a serious physical injury was guilty of inflicting an injury. But what about emotional wounds, such as those resulting from trauma? Children who experience abuse, frequent conflict in the home, neglect, or other trauma may experience physical symptoms that last a lifetime and are no less “real” for being indirectly caused.

A growing body of research indicates conversion disorder may be strongly linked to childhood trauma. Indeed, it may be the case that many diagnosed cases of conversion disorder are really symptoms of underlying C-PTSD, which can manifest itself in a variety of ways. Future research may help shed more light on the interesting phenomenon of conversion disorder.

If you experience symptoms that have no clear cause, I encourage you to seek support from a medical and/or mental health professional.

References:

  1. Akyüz, F., Gökalp, P. G., Erdiman, S., Oflaz, S., Karşıdağ, C. (2017). Conversion disorder comorbidity and childhood trauma. Archives of Neuropsychiatry, 54(1), 15–20. Retrieved from http://www.noropsikiyatriarsivi.com/en_makaleOzet?id=829
  2. Ali, S., Jabeen, S., Pate, R. J., Shahid, M., Chinala, S., Nathani, M., & Shah, R. (2015). Conversion disorder— Mind versus body: A review. Innovations in Clinical Neuroscience, 12(5-6), 27–33.
  3. Allin, M., Streeruwitz, A., & Curtis, V. (2005). Progress in understanding conversion disorder. Neuropsychiatric Disease and Treatment, 1(3), 205–209.
  4. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. http://doi.org/10.1186/2051-6673-1-9
  5. Stone, J., Smyth, R., Carson, A., Lewis, S., Prescott, R., Warlow, C., & Sharpe, M. (2005, October 27). Systematic review of misdiagnosis of conversion symptoms and “hysteria.” British Medical Journal, 331(7523), 989. Retrieved from https://www.bmj.com/content/331/7523/989
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