Unnerving Physical Symptoms? Anxiety's Not All In Your Head

You’re sweating, even though it’s the middle of winter. You’re struggling to get a full breath, but you don’t smoke or have asthma. Your heart is pounding, but you’re not in love or exercising. Anxiety doesn’t have to be a full-blown panic attack to show up physically. In fact, every 14 out of 1,000 visits to the emergency room are due to anxiety, stress, and other nonpsychotic mental disorders, according to the Centers for Disease Control and Prevention.

“There’s a huge mind-body connection,” says Thea Gallagher, Psy.D., clinical psychologist in the department of psychiatry at NYU Langone Health in New York City. “When you have anxiety, your nervous system is activated.” Your blood vessels constrict, increasing your heart rate and blood pressure; stress hormones, such as cortisol and adrenaline, pour forth, which can trigger an inflammatory cascade; and muscles stiffen, often provoking a variety of bodily sensations. 

How this shows up in your body isn’t always obvious. We’ve rounded up the most common ways anxiety manifests physically—along with the steps to calm your nervous system and yourself. 

Sneaky Sign #1: Frequent Urination

The usual question a person asks when hitting the loo again and again: Could I have a urinary tract infection? Of course, you want to rule that out with your doctor, but if there’s no burning or blood, your repeated pee breaks may be anxiety-induced.

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“When you get anxious, your muscles get tense,” says psychiatrist Anisha Patel-Dunn, D.O., chief medical officer at LifeStance Health, a mental health provider network. “The muscle tension can put pressure on your bladder, causing urinary urgency and frequency.” 

Sneaky Sign #2: Your Stomach Is Gurgling

Trusting your gut takes on literal meaning here: There’s a big ol’ link between gut health and anxiety. It’s why people often dub the gut your “second brain.” Your actual brain controls your central nervous system. The gut has its own unique nervous system. Called the enteric nervous system (ENS), it’s made up of 100 million neurons that line the gut wall. It doesn’t actually think for itself, but it does communicate back and forth with your brain. 

“The relationship between anxiety and stomach issues seems to be bi-directional,” says Dr. Gallagher. When you’re in an anxious state, stress hormones and neurotransmitters flood your body, including the GI tract. These can upset your gut flora, the bacteria and organisms that keep the gut happy and healthy, and may interfere with digestion and even cause cramping. 

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On the flip side, when your gut is upset—say in the case of irritable bowel syndrome (IBS)—the ENS sends messages to the brain, sparking mood and emotional shifts. This may explain why so many people with IBS also develop anxiety issues and disorders.

Now, if you’re thinking, I get the poops now and then…so…I have an anxiety problem, too? Negative. Anxiety-related gastrointestinal symptoms go far beyond flutters. They can include more severe issues such as acid reflux, diarrhea, constipation, IBS, nausea, and vomiting, and they are likely ongoing.

“Generally speaking, an occasional stomach issue is probably not cause for alarm,” says Dr. Patel-Dunn. “If you notice more long-term symptoms that tend to arise ahead of certain events—i.e., every day before you leave for work—it could be an indication that there’s something deeper to look into.”

Sneaky Sign #3: Persistent Headaches

There’s a reason they’re called tension headaches. “When you get anxious, your muscles tense, including those in your head and neck, leading to tension headaches,” says Dr. Patel-Dunn. In addition to the tension variety, anxiety can cause cluster headaches, which cause a sharp, piercing pain behind the eye, as well as migraines—severe throbbers that can last for days.

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As with GI troubles, the link between anxiety and migraines seems to go both ways. Your migraine can prompt a bout of migraines, and your anxiety can bring on a migraine. A review in Frontiers in Neurology found that the chances of having anxiety with migraines is about four times higher than in those who don’t have the headaches.

Sneaky Sign #4: Pins and Needles

That pins-and-needles feeling? Could be your nerves. When blood vessels contract during moments of panic, it reduces blood flow to certain body parts, including hands and feet. “This can cause tingling, numbness, or a cold feeling,” says Dr. Patel-Dunn.

The phenomenon is known as paresthesia, and while unsettling, it’s not much different than when your foot falls asleep—weird but short-lived. “This can happen if you experience an anxiety disorder, or during an isolated stressful event,” says Dr. Patel-Dunn. Anxiety can also show up as weird pain sensations, she says, including tense muscles, shaking or trembles, and muscle soreness. Ouch.

Sneaky Sign #5: You Feel Itchy

Itchy skin can stem from minor issues like dry skin and chronic (sometimes severe) conditions such as eczema. But if you don’t have those issues, you may be left scratching your head at what’s driving your itch. It could be what’s known as psychogenic itching, a dermatologic response to your stress and anxiety, says Dr. Patel-Dunn. Research points to an active central nervous system here, too.

When you’re wigging, your central nervous system activates, in turn stimulating nerve endings. Whether you’re in an anxious moment or have chronic anxiety, this can result in sensory responses such as itching, tingling, or burning of the skin (anywhere on your body), says Dr. Patel-Dunn.

There’s also an itch-anxiety cycle: People with itchy skin conditions (think: eczema and psoriasis) are more prone to anxiety. And anxiety itself, as we’ve just explained, can exacerbate itch. (Yes, it’s unfair. You’ve got one condition so now you’ve got two?)

Okay… What’s a human to do about all this stuff? Once you’re sure your symptoms stem from anxiety—it’s important to get checked out by your doctor—we’re sorry to report that reducing them won’t likely be a quick fix. Of course, you can soothe dry skin and headaches with remedies for those particular symptoms, but getting your root anxiety or disorder under control is a matter for therapy.

“Most cognitive behavioral therapy protocols take about 10 to 20 sessions,” says Dr. Gallagher. The goal is to retrain your brain so that when you’re having symptoms, you can pause and think, That’s just my nervous system activating; I’m okay. While your physical symptoms may not go away completely, “it’s about learning how to manage them, and not panic more when you experience them,” she explains.

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