Physical Symptoms of Anxiety
Barbara Heffernan • June 12, 2025

Can these symptoms really be anxiety?!

Physical Symptoms of Anxiety: Understanding Your Body's Response
If you're experiencing physical symptoms from anxiety, these can be very strong and very scary. You're probably wondering: could these really be anxiety?
Maybe you weren't particularly worried and you're still having these very strong physical reactions. Or perhaps you weren't worrying at all and the physical reactions just hit you out of the blue.
Maybe you weren't particularly worried and you're still having these very strong physical reactions. Or perhaps you weren't worrying at all and the physical reactions just hit you out of the blue.
This can be very confusing, and many people wonder: is this anxiety or is it something else? In this article, I'm going to cover physical symptoms of anxiety in detail, explain why your body responds this way (understanding this can really help you calm yourself about the symptoms you're having), and discuss what you can do about it.
First Things First: See a Doctor
If you're having serious symptoms, you always want to see a doctor and get everything checked out. There are a number of conditions that can look similar to anxiety symptoms. However, if you've been given a clean bill of health, this blog will help you understand why these symptoms arise from anxiety and confirm that they are from anxiety!
Now, I want to reiterate: **anxiety is not all in your head.** Even if a doctor says there's "nothing wrong with you and these symptoms are anxiety," know that anxiety does cause real physical symptoms.
They are uncomfortable, they can be very scary, and they are real. You are really physically feeling something.
How Anxiety Affects Your Entire Body
Anxiety can impact almost every one of our major physiological systems. Anxiety can impact our:
- Cardiovascular system
- Respiratory system
- Gastrointestinal system
- Muscular skeletal system
- Other parts of our nervous system
Cardiovascular Symptoms include:
- Increased heart rate
- Pounding heart or racing heart
- Palpitations (sometimes fluttering or a skipped beat)
- Chest pain
- Lightheadedness or dizziness
- Feeling faint or unsteady
As I mentioned earlier, if you're having these symptoms, have them checked out by a doctor. However, if they're tied to anxiety, you can then begin to treat them as anxiety.
Gastrointestinal Symptoms include:
- Difficulty swallowing
- Change in appetite (some people when they get very anxious can't eat at all, while other people just want to do nothing but eat - it really can impact you either way)
- Upset stomach
- Nausea
- Diarrhea
- Other digestive problems
- Constipation
Respiratory Symptoms include:
- Shortness of breath
- Hyperventilation
Muscular Skeletal Symptoms include:
- Muscle tension (very common)
- Tremors or shaking
- Tics (for example, a little pulse in your eye, which is pretty common, or in your hand - it can happen in different places)
- Headaches (very common with anxiety)
- Muscle aches, pains, and cramps
Other Symptoms include:
- Numbness or tingling in your extremities
- Sweating
- Dry mouth
- Fatigue
- Insomnia
You can really see how the physical symptoms of anxiety can impact your whole body.
Understanding the Adrenaline and Cortisol Cycle
Let me explain briefly about the adrenaline and cortisol cycle, because all of these symptoms actually have a common cause when they're caused by anxiety.
When you have a stressor, your adrenaline begins to spike. This isn't necessarily a bad thing - if you have a saber tooth tiger you need to run away from, you want your adrenaline to kick in. Sometimes a small amount of adrenaline can be motivating to study for an exam, prepare for a big work meeting, or motivate yourself to get off the couch and do what you need to do. A certain amount of adrenaline helps us get up in the morning, so a little bit can be helpful. Too much can be problematic.
When adrenaline kicks in, shortly thereafter a hormone called cortisol kicks in and begins to rise. As cortisol peaks, the adrenaline starts to drop. So the cycle goes: stressor → adrenaline goes up → cortisol goes up → then they both drop, hopefully followed by a period with no stressors. When another stressor hits, it happens again. Our bodies are built to deal with this.
If your stressors are happening and your adrenaline is spiking once in a while, often you won't have major physical symptoms. However, if you have continual stressors, how you manage your stressors will impact this cycle as well. And this is not to minimize stressors. Some are very serious, some can be minor. The more you can make sure you aren't overreacting to the minor stressors, the more energy and wherewithall you will have to deal with the serious ones. And many serious ones require planning, which is more effective when you are not in the middle of an adrenaline-cortisol spike.
If we respond to minor stressors with a lot of anxiety and worry (which is really what an anxiety disorder is), we're continually responding to every stressor, whether it's big or not, with adrenaline. Then cortisol kicks in. With continual stressors and the way we respond, the cortisol never gets a chance to come down. Cortisol can remain elevated chronically on an ongoing basis, and that has actually been implicated in a number of major diseases.
I'm not saying this to frighten you, but to give you motivation that you can have agency over your anxiety. Anxiety is very treatable. When I worked with people as a therapist for over 20 years, working with anxiety was very satisfying for me as a therapist, and it was satisfying for the client because people could make major progress. So I want to give you that hope.
The Health Impact of Chronic Stress:
Continually elevated cortisol levels are tied to:
- Diabetes
- Osteoporosis
- Cardiovascular disease
- Weakened immune system
- High blood pressure
- Impact on sexual desire and libido
- Reproductive functions
Why This Happens: Your Body's Design
Your body is designed to deal with dangerous situations. Our brains evolved this way. We have an amygdala and a fight, flight, and freeze response. If we're actually being chased by a dinosaur or a scary dog, we're designed so that our fear response will kick in:
- Our adrenaline will spike
- Our muscles will tense
- Our heart rate goes up
- We have digestive issues (you don't need to be digesting your food if you're being chased by a wild animal - you need to not digest that food and just run)
- We get a very single-minded focus
I want to come back to that single-minded focus because I think it's quite important and we don't always talk about that being an impact of this fear response.
We need this fear response - we want it in some situations. The problem is when we think about that dinosaur, when we think about that scary thing happening, our body has the same response.
Simply thinking about being attacked by whatever the danger is produces the same response: our adrenaline spikes, our muscles tense, our heart rate goes up, we have digestive issues, we get a single-minded focus.
That single-minded focus is problematic because most of the problems we face today really need our whole brain online. We need to be able to think creatively, pull in solutions, and be aware of what we can do right now and what we want to do to be prepared to face problems in the future.
You want the whole brain working, not just that overactive amygdala, and you want to be thinking creatively. That's not what happens when you have to run away from a wild animal.
How All Physical Symptoms Connect
All the physical symptoms of anxiety have a common thread - they can all be tied to a fight, flight, or freeze response:
- Your inability to swallow or eat: if you have to fight, flee, or freeze, you're not eating a meal
- Digestive issues: if you have to fight, flee, or freeze, you're not digesting your food - in fact, the opposite
- Constipation can be tied to the fight or flight response
- Diarrhea is more tied to the freeze response
The freeze response kicks in when we can't fight and we can't flee. You'll see this with animals - if an animal is being attacked by a larger animal and can't run away, it will go into a freeze state. A number of symptoms that you might not think were anxiety-related are actually freeze state related, such as dizziness, lightheadedness, and passing out.
The opposite - heart rate going way up and heart palpitations - is part of the fight or flight response.
What You Can Do About This
**Identify Your Symptoms as Anxiety**
If you've had everything checked out and you are having these symptoms, or if you know that these are tied to anxiety, you can begin to treat them that way. As you begin to try to relax your physiological being, you will probably see an improvement in your symptoms.
Treating the symptoms as anxiety allows you to take care of them, and then they won't be making you more anxious. You won't be worrying about the symptoms, which is what tends to happen and why they tend to worsen your anxiety cycle.
**Practice Healthy Relaxation Techniques**
Practice techniques that help you relax in a healthy way. This does not include things like alcohol or benzodiazepines - those have a biphasic impact. They might give you a feeling of relaxation, but when their half-life is through and they're processing through your body, they leave you more anxious than you were before. They have two phases and aren't going to help you get over anxiety in the long run.
Instead, focus on techniques like:
- Yoga
- Diaphragmatic breathing
- Progressive muscle relaxation
- Grounding techniques
- Mindfulness practices
All of these can help you be here now and pull your mind back away from all the projected problems. Even if your anxiety is hitting you physically, it's going into a cycle where you begin to worry about the physical symptoms.
Understanding Your Anxiety Cycle
Whether your anxiety starts with thoughts or physical feelings, it creates a cycle. If you start with physical feelings, you might say, "Well, I didn't have a story. There wasn't something I was worried about. I just got hit with these physiological feelings." But then because you were hit by them, you started to worry.
That's where your cycle starts. Whether it starts with thoughts or physical feelings doesn't matter in terms of how you approach healing - if it starts with physical feelings, you need to help it not lead into worry about those physical symptoms.
I think that's one reason to understand that these symptoms could actually be anxiety. If they are, you don't have to worry about them - you have to calm yourself.
The anxiety cycle can start in two fairly typical ways:
1. **External Problem Starting Point**: There's some kind of external problem and our minds jump into trying to figure that problem out. We jump into the future and might catastrophize.
2. **Sensory Event Starting Point**: There's some kind of sensory event (sometimes below your awareness - it could be a smell or something you weren't even aware of) that causes a physiological reaction. That anxiety makes you think, "I'm feeling anxious, there must be something I should worry about." Then you jump into the cycle of wondering what you have to worry about, or your mind goes through all your problems.
Wherever it starts, it goes into this entire cycle: anxious feelings lead to anxious thoughts or increase the ones you're having already. They also lead to anxious behaviors (which can be either compulsive or avoidant). Both anxious thoughts and anxious behaviors then increase those physiological and emotional feelings of anxiety.
It's really key to understand your cycle - your anxiety cycle - where it starts, where it goes, how it works, and how you can learn to interrupt it.
Looking Ahead
This video is part of a three-part series. Next week, I'll be releasing a video about anxiety when there is no story - for people who feel anxious but can't identify what they're worried about. We'll talk about how our past experiences get linked deep in the brain, creating connections between certain sensory information and emotional responses. This link can be either positive or negative and can often be the trigger for anxious physical symptoms, sometimes out of your conscious awareness.
**Remember: anxiety is very treatable.** You can definitely make improvement and lower your anxiety. If you're getting value from this information, please share it with others who might benefit.
Let me know what you thought of this article and whether it was helpful. Understanding that your physical symptoms might be anxiety-related is the first step toward managing them effectively and breaking the cycle that keeps you stuck.
Blog Author: Barbara Heffernan, LCSW, MBA. Barbara is a licensed psychotherapist and specialist in anxiety, trauma, and healthy boundaries. She had a private practice in Connecticut for twenty years before starting her popular YouTube channel designed to help people around the world live a more joyful life. Barbara has a BA from Yale University, an MBA from Columbia University and an MSW from SCSU. More info on Barbara can be found on her bio page.
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The main thing that drives rumination is actually the BELIEFS we have about the FEELINGS that come up from a difficult situation. Rumination is driven by the habitual patterns of thinking combined with our judgments about whether we can handle the emotions, both of which can be changed to experience relief.
You can probably recall a time when you were with someone who was intensely anxious—and within minutes, you began to feel anxious yourself. Perhaps your heart rate increased. Your breathing became shallow. The knot in your stomach tightened. Or maybe you remember the opposite: a time when you were with someone who was truly grounded and calm, and their presence actually calmed you down. Your shoulders dropped. Your breathing deepened. The tension you had been carrying began to dissipate. This is not your imagination. This is emotional contagion, and it is scientifically proven. Understanding how your own emotional regulation—or lack thereof—impacts other people, and how other people's emotional states impact you, is essential for healthy relationships. Learning emotional regulation tools can improve your relationships significantly. Learning how to lower your susceptibility to emotional contagion can help as well. In this article, I will explain what emotional contagion is, how it impacts relationships, and provide five specific strategies for improving regulation in your own relationships. What Is Emotional Contagion? Emotions are contagious. Extensive research—both behavioral research and neuroscience—shows that we pick up the emotions of the people around us. The closer our relationship with them and the more invested we are in that relationship, the more this phenomenon occurs. This may not always feel accurate because we also tend to balance each other out. If someone is very upset, we might suppress our own emotions in response. But as I will explain, that suppression is actually part of the same dynamic. Three Pathways to Emotional Contagion There are three pathways that lead to emotional contagion: Pathway 1: Automatic Mimicry Unconsciously, when we see facial expressions in another person, we mimic them. If someone smiles, we tend to smile immediately. If someone frowns, we might make the same expression. This happens not just with facial expressions but also with voice, tone and body posture. Pathway 2: Autonomic Mimicry This involves our autonomic physiological system which works in synchrony with other people. Our heart rate, our breathing rhythm, and even our pupil dilation tend to mimic each other. Our nervous systems influence each other constantly. Pathway 3: Affective Convergence This is the convergence of feelings. When our facial expressions and body posture mimic another person's, and our physiological system aligns with theirs, we develop the same affective feelings. We end up experiencing a version of that emotion ourselves. The Suppression Trap: Why "Staying Calm" Can Make Things Worse If someone is extremely upset, you might calm way down. If this happens almost automatically, you are probably suppressing your emotions rather than regulating them. Extensive research shows that when one person suppresses their emotions, it actually makes the other person more anxious. And the person who is suppressing—while they might appear calm externally - is experiencing all the physiological signs and symptoms of anxiety or a heightened emotional state. Even when we are trying to be the balance in the room, we might actually be escalating the emotions present. This is particularly true for those who grew up parentified. Adults who were parentified as children often feel their emotional regulation is better than anyone else's in their families. While that might be true to some extent, without substantial self-awareness and genuine emotional regulation tools, you are likely using emotional suppression, not regulation. Where Emotional Regulation Patterns Come From The means by which you emotionally regulate—and whether you are highly regulated or highly dysregulated—is largely due to how you were raised. I am not saying this to assign blame, nor do I want you to spiral into worry about what you may have done to your own children. These are intergenerational patterns, and all we can do is work with the present. However, it can help to recognize that if you feel your own emotional regulation is lacking, you probably learned from dysregulated caregivers. If you have a partner who is very dysregulated, the same is likely true for them. This understanding allows us to remove blame and accusation from the discussion. We can approach this with compassion, recognizing that these are skills that should perhaps be taught in school or more seriously in our society—but they are not. The good news is that you can learn them now. Five Practical Tools to Improve Emotional Regulation in Your Relationships It truly is possible to improve your own emotional regulation and have a postiive impact on your relationships. These tools are helpful even for the partner that feels they are the one who is more emotionally regulated. And as a heads up, Tools 1 and 5 require substantial work - but gradual improvement is helpful! Tools 2, 3, and 4 are easier to implement immediately. Tool 1: Develop Your Emotional Boundaries Because emotional contagion is so strong—particularly if you grew up in a caretaker role in your family—it is important to begin recognizing when the emotions you are feeling are the ones you are absorbing from someone else. Begin to visualize a see-through bubble around you which represents you and your emotional boundary. Begin to think of your emotions as existing within that bubble. And picture another bubble around the other person - give it a light, see-through color. Picture that all their emotions are within their bubble. Differentiate between what you are feeling and what they are feeling. Bring in your observer brain to look at what you are feeling. For example... "Wait a second. I am feeling anxious because my partner is anxious about their interview tomorrow. What is my anxiety about?" You can begin to see whether your anxiety is about getting them to calm down so they can perform well in their interview. Perhaps you don't want them to be disappointed, or you have a vested interest in them getting a job. Once you understand why you are feeling anxious, you can apply tools to reduce your own anxiety, rather than focus on theirs. Because if we get anxious about making sure someone else is not anxious, it simply escalates the anxiety in the room. Part of developing emotional boundaries is understanding that other people's emotions are not ours to solve. We can be empathetic without feeling responsible for calming the other person down or changing their emotional state. Your observer brain can help you think through, "I do not have to convince them. I can recognize the impact their emotional state has on me, but I do not have to spiral into desperately trying to fix something I cannot fix." Tool 2: Use Your Breathing Deliberately If you learn diaphragmatic breathing and use it during difficult moments in relationships, you can keep your physiology within a tolerable range. In EMDR therapy, there is a concept of keeping your emotions within a "window of tolerance." They can still fluctuate, but you remain relatively regulated throughout. Diaphragmatic breathing is a powerful way to help yourself do that. When you breathe in a calm, regular manner, it is actually helpful to the other person as well. Your regulated physiology can support theirs. Tool 3: Establish a Guideline for Taking Breaks Put in place for yourself a boundary about taking a break from a conversation if you become too emotionally dysregulated. What typically happens in couple relationships (and I saw this extensively during 20 years of couples counseling) is that one person is visibly out of control upset, and the other says, "We need to take a break until you calm down" (and there's usually a finger point that goes along with the "you"). Generally, this escalates the emotions in the room. In actuality, even if you are the one who appears less upset externally, you are probably very physiologically activated internally. There is a marriage and family therapist and researcher who has a rule: if your pulse rate is 10% above its normal resting rate ), you need to take a break. ( John Gottman, PhD, Seven Principles for Making Marriage Work ) The problem with telling the other person they need a break to calm down is that it will make things worse. It feels like criticism and attack. It makes someone defensive. It increases their fight-flight-freeze response. Instead, say: "I am having a hard time regulating myself in this moment. Can we take a 10-minute break? I will be right back. I just need 10 minutes to do some slow breathing. We can set our alarm." You must put a time frame on it. Take a five-minute break, a 10-minute break, or if you are extremely dysregulated, revisit the conversation in the morning. Without a time frame, the other person will feel abandoned, which escalates their emotional dysregulation. You may also be feeding into your flight mode—your reactive pattern of running away from conflict. Set the boundary for yourself, not for the other person: "If I get too upset, I will take a mini timeout to calm myself down." I recognize this does not work in every situation. You cannot simply walk away from a young child. But you can incorporate this thinking to develop creative strategies of your own. Tool 4: Validate Before You Fix or Problem-Solve One of the most regulating things you can do for someone else is help them feel truly heard. Acknowledging their emotional experience before moving to "let's fix this and problem-solve" will de-escalate their emotional response and prevent the conversation from escalating out of control. I know I said you are not in charge of their emotional regulation—and you are not. However, knowing strategies that benefit the relationship benefits you. These are basic relational tools. If you have a partner who has difficulty validating your emotions, and you are emotionally regulated, you can say: "I am very upset about this, but I do not want to jump into problem-solving. I simply want to feel heard." There is an element where we sometimes have to help train people how to be in relationship with us. If you are in couples counseling with a therapist facilitating this, excellent. But if you are not, sometimes it helps to explain these concepts to your partner. Let them know what will help you calm down when you are upset. You might have to remind them, and I know that takes substantial emotional regulation on your part. But honestly, that is the big picture here: the best thing you can do for your relationships with others—as well as your relationship with yourself—is learn emotional regulation tools. Tool 5: Practice Honest, Regulated Communication This can be understood as assertive communication that is also compassionate. If you are feeling overwhelmed, I understand. These concepts can seem complex and somewhat unattainable. I have an online boundary program that addresses emotional regulation as the foundation for healthy boundaries. It includes an exercise on visualizing emotional boundaries to strengthen that skill, and an entire section on assertive communication so you can set and maintain boundaries. Healthy boundaries are not about keeping people away or controlling other people's behavior. Healthy relationships actually require good boundaries. Good boundaries are about knowing yourself—where you end and the other person begins—and knowing it is acceptable for you to have needs. Compassionate, assertive expression of whatever needs to be communicated will help the relationship. It can be done in a way that supports your own emotional regulation and possibly helps the other person—or at minimum, does not contribute to escalation. Suppressing your own emotions and needs will escalate the negative cycle of conversation. This is not about suppression. It is definitely not about lashing out, exploding, or releasing everything you have been suppressing because you are angry and frustrated. If you have taken that timeout when needed, if you have been aware ("my heart rate is way up; I am in fight-flight-freeze mode"), you will not reach that explosion point because you will have taken your break and calmed down. All these steps are interrelated. Expressing what you feel in a regulated manner keeps you in connection with the other person. Remember: it is not just what you say but how you say it, and even how you are feeling when you say it. A statement like "I am feeling overwhelmed right now with too much to do" will enable you to stay in connection far more effectively than exploding because your partner has not done what they were supposed to do. Anytime we explode with attack or criticism, we contribute to emotional dysregulation in the room. Bringing It All Together Consciously keep track of your own emotional regulation Visualize your emotional boundary Use breathing techniques to stay within your window of tolerance, aware that you might need to take a mini timeout for yourself if you cannot stay within that window Validate the other person's feelings, emotions, and experience. Pay attention to: "This is me and my emotions, and that is them and theirs." Practice assertive communication which includes compassion for yourself and the other person This is not easy work. I know that. But what I want you to understand is that emotional contagion is real, and there are tools you can use to work with it. You can understand the other person without fully absorbing their emotional state. We are not individual emotional islands. Each one of us impacts those around us. Let me be very clear: Impacting others is not the same as causing their emotions or being responsible for their emotions. They are not responsible for ours. We are responsible for our own emotions and what we do with them. Yet there is this framework of interconnectedness among us, and knowing how to work with it can improve your life and your relationships significantly. Please share in the comments if you found this valuable. What resonated with you? What questions do you have?