Physical Manifestations of Anxiety

Introduction to Anxiety Symptoms

The American Academy of Child and Adolescent Psychiatry guidelines recognize that anxiety can cause physical/physiological pathology secondary to anxiety symptoms 1, 2, 3
Anxiety produces genuine physical symptoms through physiological pathways, not merely imagined complaints 1, 2, 3

Cardiovascular symptoms, such as racing heart rate, chest pain or discomfort, and palpitations, are associated with anxiety 4
Respiratory symptoms, including shortness of breath and feeling of choking, can occur in individuals with anxiety 4
Gastrointestinal symptoms, such as nausea and abdominal distress, are common in anxiety disorders 4
Neurological symptoms, including dizziness, paresthesias, and feeling lightheaded, can be experienced by individuals with anxiety 4
Thermoregulatory symptoms, such as sweating, chills, or hot flushes, are associated with anxiety 4
Musculoskeletal symptoms, including muscle tension and trembling, can occur in individuals with anxiety 4, 6
Systemic symptoms, such as fatigue, restlessness, and sleep disturbance, are common in anxiety disorders 4, 6

The American Society of Clinical Oncology guidelines document that heightened anxiety is directly associated with increased adverse effects, more physical symptoms, and poorer physical functioning 7
Health anxiety patients often experience restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbance 6
These symptoms can persist for at least 6 months and are disproportionate to actual medical risk 6

The relationship between anxiety and physical symptoms is bidirectional, meaning anxiety can contribute to physical illness, result from physical illness, or be a reaction to physical illness and/or treatment 1, 2, 3
Before attributing physical symptoms to anxiety, it is essential to rule out medical conditions, such as hyperthyroidism, cardiac arrhythmias, and valvular disease 1, 2, 3
Laboratory testing, including thyroid function and glucose tests, should be completed if suggested by signs and symptoms 1, 2, 3

The Hospital Anxiety and Depression Scale (HADS) is a useful instrument for assessing anxiety, as it excludes somatic symptoms that may be confounded by medical illness 8
The GAD-7 is recommended for assessing generalized anxiety, with scores ≥10 indicating moderate anxiety requiring comprehensive evaluation 8

SSRIs, such as sertraline, and cognitive behavioral therapy are first-line treatments for anxiety disorders with physical manifestations 5
Occupational therapy guidelines recommend education about the physiological process of anxiety, breathing techniques, progressive muscle relaxation, grounding strategies, and regular cardiovascular exercise 4

Do not dismiss physical symptoms as "just anxiety" without proper medical workup, as real medical conditions can coexist with anxiety 5
Approximately 31% of patients with anxiety disorders also have major depressive disorder, so it is essential to screen for both conditions using validated instruments 5, 6
Many patients with anxiety report hypersensitivity to touch, light, sound, and movement, which can become a maintaining factor resulting in avoidant behaviors 4