18 common physical symptoms of anxiety (and why we get them)

by Dr. Melissa Shepard, MD

by Dr. Melissa Shepard, MD

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We tend to think of anxiety as “all in our heads.” And yes, worry might be a big part of your anxiety. But many people with significant anxiety disorders struggle with a lot of physical symptoms too. Sometimes, the physical symptoms are more bothersome than the mental symptoms of anxiety and can lead the person to see doctor after doctor to try and figure out the cause.

Most of the physical symptoms of anxiety are due to the changes that occur in our body when our “fight-or-flight” or sympathetic nervous system is activated, and our “rest-and-digest” or parasympathetic nervous system is shut down. While these physical symptoms can be helpful if you have to run away from a bear, they can become upsetting if they happen out of the blue or in response to something that doesn’t require fighting or running away.

Here are some of the most common physical symptoms of anxiety that I see in my patients:

1. Fatigue and weakness.

Being anxious is exhausting, mentally and physically. When we are dealing with an anxiety disorder, we spend so much energy worrying that it adds up to make us feel tired, slowed down, and even physically weak no matter how much sleep (or coffee) we get.

2. Muscle tension.

When we are anxious, we are constantly on edge and ready to react. The constant strain on our muscles leads to tension, especially in our necks and backs. Muscle tension is worsened by poor posture and lack of exercise, which are also common in people with anxiety.

3. Headaches.

Stress and anxiety cause the release of certain hormones and other chemicals that can cause changes in our blood vessels, leading to headaches. Poor sleep, neck and back tightness, and clenching the teeth are also common contributors to headaches in those with anxiety.

4. Dry mouth.

Dry mouth occurs when anxiety tells our “rest-and-digest” or parasympathetic nervous system to take a back seat. Normally, our parasympathetic nervous system causes our salivary glands to produce the saliva that helps us break down food. But when we are anxious, our brains decide that it’s not time to eat, it’s time to run, so there is no need to make saliva.

5. Shortness of breath.

When we are stressed and anxious, our brains tell our bodies that we need to take shorter, faster breaths to take in more oxygen so that we can fight or run away from the threat.

6. Chest pain and chest tightness.

Many people with anxiety develop significant chest pain and tightness. Chest discomfort can be related to chest muscle strain, faster heartbeat, more rapid breathing, and even issues with digestion and the movement of our esophagus due to stress.

7. Memory problems and confusion.

When we are anxious, our minds are often spinning, trying to keep track of a million things at once and constantly attending to threats. These distractions make it harder for us to take in and retain new information, making us feel more confused and forgetful.

8. Fast heartbeat, palpitations, and pounding heart.

When we are anxious, our sympathetic nervous systems tell our hearts to pump more blood so that our muscles will have the oxygen they need for a “fight-or-flight” response. These signals can cause us to feel a faster, stronger, or even irregular heartbeat.

9. Nausea, vomiting, stomachaches, and heartburn.

When we are anxious, our sympathetic nervous system takes over, and our parasympathetic nervous system takes a step back, signaling to our bodies that it’s time to run, not time to eat. Blood flow gets shunted away from the stomach and intestines and towards our heart, lungs, and muscles. When prolonged, this can cause problems with digestion. Anxiety can also cause spasms or other problems with coordinating the muscles involved in digestion.

10. Diarrhea.

Although the “fight-or-flight” response generally tells our digestive system to slow down, there is one exception: our large intestine (or colon). Our brains tell our large intestines to speed up and expel waste because we want to get rid of anything that isn’t going to help us fight or run away (including poop).

11. Shaking, tremors, and twitching.

If you think about the last time you did something intense or scary, or the last time you were in a lot of pain, you may remember feeling shaky. Shakiness is due to the release of stress hormones and other physiological changes that prepare our muscles for a fight. All of this extra energy can cause us to feel unsteady, shaky, or tremulous.

12. Sweating, flushing, and temperature fluctuations.

Anxiety can cause significant temperature fluctuations, including hot flashes and flushing, due to changes in blood flow meant to prepare us to run away or fight. When we become stressed and overheated, our body then sends a signal to our brain to move in the opposite direction and start sweating to cool things down. These fluctuations can happen quickly with anxiety, causing us to vacillate between hot flashes and cold chills.

13. Urge to urinate.

Feeling the urge to urinate more frequently or urgently is common in anxiety. Our kidneys may produce more urine when we are anxious, and we also release stress hormones that cause the bladder to squeeze (making us feel like we have to pee, or in some cases, even causing us to lose bladder control).

14. Tingling/numbness.

The shortness of breath that occurs when we are anxious can lead us to hyperventilate. When we hyperventilate, the level of carbon dioxide in our blood decreases. While we typically think of carbon dioxide as a bad thing, we need a certain amount in our blood for normal functioning. When carbon dioxide levels drop too low, there are changes in calcium and potassium levels and changes in the blood vessels that change the blood flow to our fingers, toes, and lips, leading to tingling and numbness.

15. Dizziness.

Dizziness can also be related to hyperventilation in anxiety. When we breathe too quickly, and our carbon dioxide levels drop, our brains try to restore this balance by narrowing the blood vessels that lead to our brains. Decreased blood flow to the brain can make us feel dizzy or lightheaded.

16. Acne and blemishes.

Increased anxiety leads to the production of stress hormones that can cause acne. When we are anxious, we also tend to sweat more and are more likely to touch our faces as a nervous habit. All of these factors can contribute to worsening acne and other skin problems.

17. Blurry vision and tunnel vision.

When our sympathetic nervous system takes over, our brains try to focus our attention on the threat and the potential escape by blocking out irrelevant things in our peripheral vision. Fear and anxiety also causes our pupils to dilate to allow more light in, but all of this extra light can overwhelm us and cause blurred vision.

18. Throat tightness, feeling of choking, or a lump in the throat.

Dry mouth alone can cause a feeling of choking or tightness in the throat. People with anxiety also tend to have tight muscles in their necks, leading to a sense of tightness. Sometimes stress can even contribute to spasms or other problems with the esophagus, leading to tightness and discomfort.

You may have noticed that many of these symptoms are due (at least in part) to hyperventilation. This is why breathing exercises may help some people. If you can slow down your breathing and reset your nervous system, your anxiety may start to wane. Please note, if you find yourself dealing with these symptoms, it is essential to see your doctor to ensure that other potential causes are ruled out before the symptoms are attributed to anxiety.

If you need help with anxiety, check out my YouTube channel for lots more info. You can also find all my tips in one place in the Anxiety Bootcamp Course.

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