By Charletta Dennis, M.D., CCHP | Medical director of behavioral health at Priority Health with Board Certification in Psychiatry and Forensic Psychiatry
Having a physical response to anxiety is normal. Knowing how the body reacts can help you determine when to call for help.
Whether you’re having a panic attack, are experiencing long-term anxiety or you’re just feeling anxious because of recent worries or an upcoming event, your body is likely to react to anxiety with physical symptoms. Those symptoms can range from dilated pupils, muscle tension, increased sweating and a quickened heart rate to digestive issues, chronic fatigue, hyperventilation and chest pain.
When you’re already feeling anxious, the physical symptoms and manifestations can heighten your anxiety and cause new or worsening symptoms. While physical reactions to anxiety are common, it’s important that you’re able to differentiate between anxiety symptoms and serious health concerns so you can navigate the situation appropriately and seek help if needed.
Can anxiety cause physical symptoms? Yes, here’s why
Think of the common phrase “butterflies in the stomach.” That feeling you get in your stomach when you’re excited to surprise your friend or when you’re about to do public speaking is the body’s way of processing stress, both good and bad. Anxiety and even anticipation can trigger the body’s fight, flight or freeze (fight-or-flight) response, which can have an immediate impact on how you feel. In cases of intense, momentary anxiety or chronic anxiety, the effect on the body is amplified.
The fight-or-flight response is the body’s way of preparing you for quick action when faced with danger, whether that danger is real or perceived. When you encounter stress, it triggers your sympathetic nervous system. Signals are sent to different parts of your brain that then communicate with your body immediately.
Having a physical response to anxiety is not only common, but it’s also important for survival. However, some people’s fight-or-flight response can be overactive because the brain associates certain thoughts or situations with danger, leading to more pronounced physical symptoms or panic attacks.
Chronic anxiety or stress means your body is consistently in a fight-or-flight state, causing strain over time that can have serious health effects.
How the body responds to anxiety
According to Harvard Health Publishing, when someone is stressed, the brain sounds an alarm that signals the adrenal glands to pump adrenaline into the bloodstream.
This has many possible effects, including:
- Faster heart rate
- Rapid breathing
- A rise in blood pressure and blood sugar
- Blood vessels tightening
- Sharper senses
The goal is to make sure the body is immediately ready to respond to the stressor and keep you safe. After that initial stress response is complete, the body moves on to phase two: maintaining the stress response. Cortisol levels rise to keep the body on high alert past that initial moment of fear or anxiety. Once the danger passes, the body’s hormone levels return to normal.
“Physical symptoms of anxiety can range anywhere from the top of your head to the bottom of your feet,” says Dr. Charletta Dennis, medical director of behavioral health at Priority Health and a practicing psychiatrist and forensic psychiatrist. “It really depends on how nervous you are and what the situation is.”
Anxiety and chest pain: Telling it apart from a heart problem
Feeling pain in your chest is scary. For many people, their mind immediately questions whether they’re having a heart attack and need to call an ambulance. The combination of chest pain and fear can make the pain worse and further increase the concern. Luckily, there are some key differences between chest pain caused by anxiety and chest pain caused by a heart problem such as cardiac arrest or a heart attack.
Chest pain caused by anxiety presents as a sharp or stabbing pain, according to Cleveland Clinic. The hormones released during the fight-or-flight response can increase your heart rate, quicken your breathing (which can lead to hyperventilation in rare cases) and cause spasms of the muscles between your ribs. It also causes blood vessels to tighten. These sensations combined can create a feeling of panic that intensifies the anxiety and, as a result, the painful feeling in your chest.
If you’re experiencing sharp chest pain, especially if you just experienced something that could bring on anxiety, or if you’ve been anxious a lot recently, then the chest pain could be caused by anxiety.
“Anxiety attacks typically peak in about 15 or 20 minutes, then they will level off and start to decline,” Dennis says.
While anxiety chest pain is not necessarily an emergency, it’s still a good idea to see a doctor. A healthcare provider can run tests to confirm whether your heart is healthy. And if it turns out that the pain is an anxiety symptom, they can connect you with the mental health support you need.
Chest pain caused by a heart problem often presents as uncomfortable pressure in the chest, according to the American Heart Association. If someone is having a heart attack, chest pain is typically, though not always, accompanied by pain that radiates down to the arm or even up to the shoulder or jaw. They also might experience shortness of breath, dizziness, nausea and cold sweating. While heart attack pain is often sudden, it can come and go, building gradually over several hours from a feeling of tightness, fullness or squeezing to a feeling of intense pressure.
“If you have chest pain symptoms that worsen over time, it’s likely related to a heart issue,” Dennis says. “If you don’t know your heart risk and you have that sense of impending doom, then you always want to seek help immediately.”
If you’re having sudden, unexplained pain in your chest that feels like it’s being crushed by a heavy weight, especially if it’s accompanied by radiating pain, dizziness or nausea, then it’s time to call 911. It’s important to see a doctor as soon as possible if you’re experiencing a medical emergency.
Shortness of breath and anxiety
When anxiety triggers the release of stress hormones, a person’s breathing quickens in preparation for perceived danger. While this is a common response, in instances of extreme fear and emotional distress, someone could take in more air than needed. This is hyperventilation.
According to Cleveland Clinic, the over-breathing leads to the exhalation of too much carbon dioxide, which then lowers the blood’s carbon dioxide levels. The result is dizziness, tingling and a feeling of not getting enough air — which further exacerbates the feeling of terror and anxiety.
That’s why it’s recommended that someone who is hyperventilating breathe into a paper bag. The bag traps the exhaled carbon dioxide and allows the person to easily breathe it back in to restore the blood’s levels.
People with respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD) or an infection like pneumonia are more at risk of experiencing shortness of breath or hyperventilating when stressed. Breathing into a bag is not recommended for people with some lung conditions. Check with your health care provider for guidance.
The feeling of chest tightness caused by a constriction of blood vessels and the muscles between the ribs can also lead to shortness of breath. This should cease as the anxiety fades.
If you experience shortness of breath combined with anxiety, you should take deep breaths to increase oxygen intake and slow your heart rate.
Can anxiety cause dizziness, nausea or stomach issues?
The simple answer is yes, anxiety can cause dizziness, nausea and stomach issues. Here’s how anxiety causes each of those symptoms:
Dizziness
Anxiety can cause dizziness in a few ways. As your breath becomes quick and shallow, it lowers the levels of carbon dioxide in your blood, which can lead to lightheadedness. The rush of adrenaline can shift blood flow away from the brain and toward the muscles to enable quick action, causing an onset of dizziness.
If you experience dizziness coupled with anxiety, it’s important to sit down and take slow, deep breaths.
Nausea
Hormones are released during the fight-or-flight response that can disrupt digestion, tighten stomach muscles and make the gut more sensitive. Extreme anxiety can lead to nausea or even vomiting, especially if you already have a GI condition. If you experience nausea coupled with anxiety, you should try drinking water, resting and, if possible, eating something light to settle your stomach.
Stomach issues
Nausea is just one digestive symptom caused by anxiety. Other ways anxiety impacts the gut include:
- Stomachache
- Acid reflux or heartburn
- Loss of appetite
- Increased hunger
- Gas and bloating
- Diarrhea
- Constipation
- Bowel spasms
- Flare-ups of existing GI conditions such as irritable bowel syndrome
- Gut microbiome imbalance caused by chronic anxiety
Most of these symptoms are not long-lasting and should go away once the danger has passed or the stressful situation ends. If these symptoms persist, it’s important to see a doctor to rule out other causes.
Anxiety and blood pressure: What’s the connection?
When the body initiates its fight-or-flight response, the heart pumps faster and blood vessels constrict, causing a spike in blood pressure. The spike is temporary, and blood pressure should return to baseline levels once the anxiety ends.
However, if someone is anxious or stressed all the time, then there’s a risk of those constant blood pressure spikes damaging blood vessels and vital organs like the heart. That’s why it’s important to take anxiety disorders seriously. Long-term anxiety can have a negative impact on your health down the road.
In some cases, the body reacts to extreme stress with a vasovagal response (an overreaction of the vagus nerve — a key part of the body’s parasympathetic nervous system), which causes blood pressure to drop and can result in lightheadedness or fainting. While these episodes are typically harmless in the grand scheme of your health, falling injuries or fainting while operating heavy machinery are a concern. Laying or sitting down and taking a break from activities that require careful attention are crucial in the event of a vasovagal episode. Always seek medical attention if you’ve experienced a fainting episode.
When physical symptoms mean you should seek care now
Seek medical attention immediately if you experience any of these symptoms for the first time with no clear explanation:
- Chest pain
- Chest tightness
- Shortness of breath
- Dizziness or fainting
Anxiety, stress and fear can cause a variety of different symptoms. While typically those symptoms are mild and resolve quickly, extreme anxiety can exacerbate your body’s physical response, leading to an anxiety or panic attack. Those moderate or severe symptoms can overlap with the symptoms of serious health conditions such as a heart attack or asthma, which are cause for concern.
If you’re experiencing anxiety, emotional distress or fear coupled with any of these symptoms, then there’s a good chance they are caused by anxiety, especially if they are mild and the symptoms stop when your anxiety resolves.
Monitor less concerning symptoms such as nausea, diarrhea and other new digestive issues. If they don’t go away within a day or two, then talk to a doctor.
However, Dennis points out that if you’ve experienced an anxiety attack for the first time no matter the symptoms, or if those symptoms have never been assessed by a doctor or mental health professional, she recommends seeking out professional assistance.
“You really won’t know what is happening until it has been assessed by a professional,” she says.
Managing anxiety symptoms and where to get support
When you’re experiencing the physical symptoms of anxiety, there are a few things you can do to help in the moment.
- Take slow, deep breaths using the 1-2-3 method: Breathe in while counting to three, breathe out while counting to three and repeat.
- Try a grounding technique like counting backward from 100 or performing the 5-4-3-2-1 method: Name five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste.
- Practice progressive muscle relaxation: While sitting or lying down, breathe in and tightly squeeze your toes and feet for five seconds before breathing out and relaxing. Wait 10 seconds before moving up to the next muscle group. Repeat this all the way up your body’s muscle groups until you end with the face.
- Other quick things you can do to reduce anxiety symptoms include splashing cool water on your face and soaking tense muscles in hot water.
“In the moment, breathing and counting techniques are always amazing. Taking those physical symptoms and refocusing on how you can moderate them is helpful,” Dennis explains. “Focus on slowing down to try to alleviate your symptoms. Techniques that calm you down also help to slow your breathing when you’re hyperventilating and to slow your heart rate and stop sweating. Breathing techniques are typically the first line.”
Methods to ease the physical symptoms and manifestations of anxiety in daily life include:
- Exercising
- Eating healthy
- Reducing alcohol and caffeine intake
- Prioritizing sleep
- Practicing consistent meditation
- Writing in a journal
- Understanding your triggers
- Getting involved in your community
- Spending time with family and friends
- Seeing a mental health professionalTaking medications as prescribed
Where to get support for anxiety
If you’re experiencing consistent anxiety that interferes with your life — regardless of symptoms — then it could be beneficial to speak with a mental health professional. A psychiatrist, psychologist or therapist can help you to reduce your anxiety and find healthy coping habits and grounding techniques to improve your ability to navigate difficult situations and the anxiety attacks that follow.Priority Health offers mental health coverage and resources to connect with mental health providers. Information about Priority Health’s mental health services can be found here. You can call 800.673.8043 (TTY 711) to chat with Priority Health staff and gain a better understanding of your benefits and treatment options.
If you’re experiencing suicidal thoughts or thoughts of harming yourself or others, always seek immediate emergency help. If you live in the U.S., call or text 988 to contact the 988 Suicide & Crisis Lifeline. You can find their chat function here.