The physical symptoms of anxiety don’t get as much attention as the mental and emotional effects. Which, understandable. The overwhelming worry and fear that characterize anxiety can be debilitating. But anxiety can wreak just as much havoc on the body as it can the mind. “From head to toe, almost every system can be impacted just by nature of your body releasing a lot of stress hormones,” Mona Potter, M.D., medical director at McLean Anxiety Mastery Program in Boston, tells SELF.
You have your fight-or-flight response to thank for your physical anxiety symptoms. Typically, it’s supposed to help you survive a threat by escaping or fending it off. In way-back-then, cavepeople days, that threat might have been something along the lines of a lion. If you have anxiety, though, your fear and worry are that threat, prompting your sympathetic nervous system, which controls involuntary processes like your breathing and heart rate, to kick into high gear. This leads your adrenal glands to release hormones such as adrenaline and cortisol, according to the Mayo Clinic. This domino effect is behind anxiety’s physical symptoms.
“When a person experiences anxiety, it’s essentially the fight-or-flight system kicking in and saying, ‘Danger!’” Neda Gould, Ph.D., a clinical psychologist and associate director of the Johns Hopkins Bayview Anxiety Disorders Clinic, tells SELF.
All told, it’s important to recognize these physical symptoms for what they are because if you don’t know what you’re dealing with, it is difficult to seek out the treatment you need to feel better. Here are some of the biggest physical symptoms of anxiety, plus when they could actually be signaling a panic attack.
1. Your heart is racing.
This is a classic sign of anxiety, according to the National Institute of Mental Health (NIMH). So remember how we just mentioned that your sympathetic nervous system controls your heart rate? When you’re dealing with something stressful and your adrenal glands churn out hormones like adrenaline and cortisol, receptors in your heart react by speeding up your heartbeat. This enables you to pump more blood to your big muscles so you could theoretically flee or combat a threat, Gould explains. But if you’re dealing with anxiety, that racing heart could just make you feel more nervous in a vicious cycle.
2. You’re short of breath.
Your blood circulates oxygen around your body. (It also transports carbon dioxide, a waste product, to your lungs so you can breathe it out.) When your stress response boosts how quickly you’re sending blood around your body, your breathing might increase to provide you with more oxygen.
If you breathe too quickly (also known as hyperventilation), you can actually enhance a lot of the physical anxiety symptoms on this list because your oxygen–carbon dioxide balance gets out of whack, according to the U.S. National Library of Medicine.
“That’s why we often talk about belly breathing, or diaphragmatic breathing,” says Dr. Potter. This is essentially breathing slowly and deeply by really using your diaphragm. (Tucked underneath your lungs, this is the main muscle involved in breathing.) By slowing down how quickly you’re breathing, you have more of a chance to get the oxygen you need, Dr. Potter explains.
3. You’re constantly exhausted.
A persistent feeling of fatigue is a common sign of anxiety, according to the NIMH. The reasons are twofold. For starters, that anxiety-activated uptick in stress hormones can keep you revved up on high alert, which can be seriously draining, says Dr. Potter. But there’s an additional complicating factor: Sleep and anxiety have a complicated relationship, which brings us to another typical physical side effect of anxiety…
4. Your sleep is all screwed up.
A person with anxiety might have a tough time falling asleep and/or staying asleep, or might have restless and unsatisfying sleep, according to the NIMH. Elevated levels of hormones like cortisol and adrenaline make it hard to get a good night’s sleep, since your buzzing body may not be able to relax enough to rest. The racing thoughts that can come with anxiety are no recipe for great sleep, either.
It’s not just that anxiety contributes to sleep problems. Sleep issues such as insomnia can make you more prone to anxiety too, the Mayo Clinic explains.
5. Your muscles ache.
Your muscles tense up as part of your stress response. Holding parts of your body so rigidly for prolonged periods can lead to pain, says Dr. Potter, who notes that many people with anxiety report feeling tight in their neck, back, or shoulders. You might also clench your jaw or feel muscle tension all the way up into your head, leading to headaches, says Dr. Potter.
6. Your stomach is all sorts of messed up.
A lot of this may boil down to what experts call the gut-brain axis, which is a communication system between your brain and the enteric nervous system, that governs your digestion. This connection is why stress can so easily mess with your poop. There’s also the fact that anxiety-induced lifestyle choices like eating foods that don’t agree with you or not exercising can affect your digestion as well.
7. You’re sweating up a storm.
If you’re already grappling with anxiety, the thought of sweating profusely may just make it worse. Who wants to worry about pit stains or wiping their palms when they’re already totally anxious? Unfortunately, sweating is a common side effect of anxiety disorders, according to the NIMH.
When your sympathetic nervous system gets activated, it can influence the sweat glands basically all over your body. You have two kinds, according to the Mayo Clinic: eccrine, which cover most of your skin, and apocrine, which are only on body parts that have a lot of hair follicles. Both types of sweat glands can cause anxiety-induced perspiration, but it’s the milky fluid from your apocrine glands in particular that may make it smell bad.
8. You’re shaky.
If you’ve ever found yourself trembling with fear before a big event, you know how your body reacts under pressure. Turns out, it doesn’t need an external trigger like a scary presentation or an important meeting to start shivering like a leaf; shaking and trembling can be a by-product of anxiety-induced hormone surges, according to the NIMH.
9. You’re easily startled.
Trying to anticipate unknown threats is a common feature of anxiety. Constantly being on guard has been linked with an increased “startle response,” which could be why you practically jump out of your shoes if someone taps you on the shoulder on an anxious day.
10. You have a hard time swallowing.
Anxiety can cause some people to feel tightness in their throat or even like something is stuck in there, according to the U.S. National Library of Medicine. This is called globus sensation, and although the exact reason why this happens is unclear, it can definitely make anxiety even worse. “You feel like you can’t get enough air,” says Dr. Potter.
11. You come down with a lot of colds.
Some people tend to get sick more often in periods of high anxiety, says Dr. Potter. Your immune system doesn’t function as well when your fight-or-flight response is operating for too long, according to the Mayo Clinic. This could mean that you’re more susceptible to issues such as the common cold, although a lot of other factors come into play here as well, like how robust your immune system is in general and how vigilant you are about hand hygiene.
When do these physical symptoms signal a panic attack?
Some of the physical symptoms of anxiety and panic attacks overlap, like sweating, trembling, and a fast heart rate. But there’s one major difference: Panic attacks cause an extreme sensation of fear that strikes out of nowhere. That terror is an integral part of having a panic attack. Beyond that, panic attacks include at least four of the following symptoms, some of which you just read about as physical effects of anxiety:
Palpitations, a pounding heart, or an accelerated heart rate
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Chills or heat sensations
Numbness or tingling
Derealization (feeling like reality is confusing) or depersonalization (feeling detached from yourself)
Fear of losing control or “going crazy”
Here’s how to get help.
Now for a bright side: It’s totally possible to treat anxiety and panic attacks. Anxiety can feel overwhelming to the point that it seems completely beyond your control. But there are things you can do to manage it and start to feel better. Therapy is often a crucial part of treatment, especially methods like cognitive behavioral therapy, to help you retrain your brain’s anxious thoughts. If you don’t know where to start, this guide to affordable therapy might help.
Medications like anti-anxiety drugs may help too, according to the NIMH, as can lifestyle changes, including joining a support group or picking up some stress-management techniques. The best course of treatment is different for everyone and will depend on your specific symptoms. For many people, a blend of techniques will work best.
If these symptoms are getting in the way of your life—or are just making you feel like crap, TBH—it can’t hurt to check with your doctor or make an appointment with a therapist.