Anxiety & Mood
Physical symptoms of anxiety: what they mean and when to worry
Racing heart, chest tightness, numbness, weak legs, itching: why anxiety causes real physical symptoms, which ones need urgent checking, and what helps.
Anxiety does not stay only in the mind. It can cause a racing heart, a tight chest, dizziness, trembling, numbness, weak legs and even itching. The symptoms are real, not “imagined”. But a new or intense symptom needs a medical check first, and some need one immediately.
How often anxiety shows up in the body
In a Norwegian survey of 50,377 adults without a known physical illness, people with anxiety reported more physical symptoms than people with neither anxiety nor depression: on average 5.9 compared with 3.6 in women and 4.5 compared with 2.6 in men. The higher the anxiety and depression score, the more symptoms people had [1].
In primary care practices in the United States, almost 1 in 5 patients (19.5%) had at least one anxiety disorder. 41% of them were receiving no treatment at all [2].
Put simply: anxiety is common in everyday doctors’ offices too, and it often goes untreated.
Why anxiety causes physical symptoms
When the brain senses danger, it prepares the body for “fight or flight”: the heart beats faster, breathing speeds up, muscles tense. In the face of real danger this is useful. In anxiety the alarm goes off without real danger, or it does not switch off.
Many symptoms are explained by fast or deep breathing (hyperventilation). A Cochrane review describes how dysfunctional breathing can cause breathlessness, chest tightness, dizziness, trembling and tingling. It is estimated to affect about 9.5% of adults [3].
The most common symptoms and when they need urgent checking
Each symptom below is listed with how it links to anxiety and when you should call 166 or 112 instead of waiting [3][4][8][9]:
Racing or pounding heart. The “alarm” speeds up the heart. Urgent when it comes with chest pain, sweating, nausea, dizziness or breathlessness.
Chest tightness or pain. Muscle tension and fast breathing. Urgent when there is sudden pain or pressure that does not pass, or pain that spreads to the arm, neck, jaw, stomach or back.
Numbness or tingling, including in the left arm. Hyperventilation. Urgent together with chest pain or pressure, or numbness on one side of the body.
Weak legs, trembling. Hyperventilation and muscle tension. Urgent with weakness on one side, a drooping face or difficulty speaking.
Dizziness, unsteadiness. Hyperventilation. Urgent with a fall, blurred vision, confusion or a very severe headache.
Itching. Anxiety makes itching worse, and itching makes anxiety worse. Have it checked by a doctor for skin or other physical causes.
Another example: an overactive thyroid can cause nervousness, anxiety, a fast heartbeat, trembling and difficulty sleeping [10]. That is why a medical check-up may include the thyroid.
When a physical condition, such as the thyroid, causes symptoms that look like anxiety, we treat it first. It mimics anxiety and makes it worse, so the physical check comes first.
“Psychosomatic” does not mean “imaginary”
Psychosomatic means that mind and body affect each other. The symptom is real; it simply is not caused by damage to an organ.
Itching is a good example. A 2018 review describes a vicious circle: chronic itch comes with stress and anxiety, and stress and anxiety make the itch worse. This circle is seen in various conditions with itching, and to some degree in healthy people too. Treatments that reduce anxiety have shown encouraging results for itching as well [4].
When, after a proper medical check, no adequate explanation is found for a symptom, doctors speak of “medically unexplained physical symptoms”. There is treatment for these too, as you will see below.
“I feel it, so it must be true” is one of anxiety’s most convincing traps. A symptom can be intense and real without meaning that something dangerous is happening. In the practice I hear phrases such as “I’m choking” or “a thousand thoughts and then panic”. We accept the feeling; we examine the catastrophic conclusion.
What helps
A proper medical check. A physical cause is ruled out first, especially for new symptoms.
Cognitive behavioural therapy. The guidelines of the World Federation of Societies of Biological Psychiatry (WFSBP) consider it the first-choice psychotherapy for anxiety disorders [6]. For medically unexplained physical symptoms, a Cochrane review of 21 studies with 2,658 participants found that psychological therapies, mainly cognitive behavioural therapy, reduced symptoms compared with usual care. The benefit was small, but it lasted after a year [5].
Medication, where needed. The same guidelines name antidepressants from the SSRI and SNRI classes as the first-choice medication for anxiety disorders [6]. Whether they are needed is decided after the assessment.
Breathing exercises, with realism. They are widely used, but the Cochrane review on hyperventilation found only one small study and no reliable evidence that they help on their own [3]. In an analysis of 72 studies on panic disorder, breathing retraining made treatment more acceptable, with little effect on the outcome [7].
When checking becomes a habit, such as taking your pulse, searching online or having new tests for the same symptom, it keeps the anxiety going. So does avoidance, for example giving up exercise because it raises your heart rate. The goal is not to wait for the anxiety to go away first. It is to reduce checking and avoidance step by step.
When to ask for help
Symptoms keep coming back even though your tests are clear.
You keep checking your body or your pulse, or searching your symptoms online.
You avoid places, travel or exercise for fear of the symptoms.
Worry about your health takes up many hours of your day.
Safety: Sudden chest pain or pressure that does not pass, pain that spreads to the arm, neck, jaw, stomach or back, or chest pain with sweating, nausea, dizziness or breathlessness: call 166 (ambulance, EKAV) or 112 immediately [8]. The same applies to numbness or weakness on one side of the body, a drooping face or difficulty speaking [9]. Do not wait for it to “pass”. If you have thoughts of harming yourself, call 166, 112 or the Suicide Prevention Line 1018.
How I can help
Book a psychiatric assessment, at the practice in Trikala or online. See also the page on anxiety and panic attacks. Once the physical check has been done, psychiatric follow-up can also take place by video call: see how working with an online psychiatrist works. To see how anxiety differs from ADHD and depression, read ADHD or anxiety and depression?, or book an appointment.
This article is educational and does not replace individual clinical assessment. Do not change or stop any treatment you are already taking without talking to your doctor.
Sources
Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med. 2004. https://doi.org/10.1097/01.psy.0000145823.85658.0c
Kroenke K, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007. https://doi.org/10.7326/0003-4819-146-5-200703060-00004
Jones M, et al. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD009041.pub2
Sanders KM, Akiyama T. The vicious cycle of itch and anxiety. Neurosci Biobehav Rev. 2018. https://doi.org/10.1016/j.neubiorev.2018.01.009
van Dessel N, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014. https://doi.org/10.1002/14651858.CD011142.pub2
Bandelow B, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry. 2023. https://doi.org/10.1080/15622975.2022.2086295
Pompoli A, et al. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med. 2018. https://doi.org/10.1017/S0033291717003919
NHS. Chest pain. Last reviewed 8 August 2023. https://www.nhs.uk/conditions/chest-pain/
NHS. Stroke: symptoms. Last reviewed 12 September 2024. https://www.nhs.uk/conditions/stroke/symptoms
NHS. Overactive thyroid (hyperthyroidism). Last reviewed 11 April 2023. https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
