Can Anxiety Cause Real Physical Symptoms?
But I don’t feel anxious.
I hear this one a lot. If someone tells you your physical symptoms might be connected to anxiety, but you’re sitting there thinking, I’m literally not anxious right now, the explanation can feel pretty unconvincing. Maybe your stomach hurts, you’re dizzy, your chest feels tight, your heart is racing, your hands are tingling, or your muscles ache. Those things feel very physical because they are very physical.
Anxiety can cause real physical symptoms. But I think the way we talk about this sometimes makes it sound much simpler than it actually is. It isn’t always you feel anxious → your stomach hurts. Sometimes your body reacts before you even consciously register that you’re anxious. Sometimes the stressful thing happened hours ago. And sometimes a physical response that began during a period of anxiety or stress can become something your brain and nervous system have learned to produce automatically. That last piece is especially important when we’re talking about neuroplastic symptoms, because it helps explain something that otherwise seems pretty confusing: Why am I still having symptoms when I don’t even feel anxious?
Anxiety isn’t just happening in your thoughts
When we hear the word anxiety, we tend to think about worrying, racing thoughts, overthinking, or lying awake at 2 a.m. mentally rehearsing a conversation that probably isn’t going to happen. But anxiety isn’t only happening in your thoughts. It’s a whole-body response. Imagine you’re walking through the woods and suddenly see a bear. Your brain doesn’t calmly say, Interesting. A bear. I should perhaps make some physiological adjustments. Your heart beats faster, your breathing changes, your muscles tense, and digestion suddenly becomes a whole lot less important. You didn’t consciously decide to do any of that. Your brain and nervous system made those adjustments automatically because they believed you were in danger. And thankfully so. If there really is a bear standing in front of you, this is not the time for your body to prioritize digesting lunch.
The problem is that your brain doesn’t only respond to bears. It responds to perceived danger. You’ve probably experienced this yourself. Maybe you were nervous before a presentation and your stomach suddenly hurt, you were waiting for an important phone call and couldn’t eat, or you were about to have a difficult conversation and noticed your heart pounding. Nothing was physically attacking you, but your body still responded. Nobody would tell you those sensations weren’t real simply because a physical injury didn’t cause them. We already accept that what is happening in the brain can create very real changes throughout the body. We just seem to have a harder time making sense of it when those physical symptoms don’t disappear as soon as the stressful situation does.
Anxiety and nervous-system activation can affect all kinds of physical processes, which is why they can show up in so many different ways. Some people notice a racing heart or changes in their breathing. Others experience nausea, diarrhea, stomach pain, dizziness, headaches, muscle tension, shaking, sweating, tingling, fatigue, or that weird lump-in-your-throat feeling that seems to come out of nowhere. Of course, having one of those symptoms doesn’t automatically mean anxiety is causing it, and new, unexplained, changing, or concerning symptoms deserve appropriate medical evaluation. But once medical concerns have been appropriately evaluated, it can be worth asking whether the nervous system may be contributing to what you’re experiencing.
But what if I really don’t feel anxious?
This is where I think the conversation gets much more interesting.
Our brains are learning machines. They are constantly noticing patterns and making associations, most of which happen without our conscious involvement. That’s incredibly useful. You don’t want to relearn how to drive every time you get into your car. You want your brain to remember what it learned yesterday and use that information today.
But sometimes the brain learns patterns we would rather it didn’t.
Imagine that you go through a particularly stressful period and start experiencing stomach symptoms after eating. At first, there may be a pretty clear connection between the stress and what your body is doing. But after this happens enough times, eating itself can start to feel threatening. You wonder whether a particular food will bother you. You pay close attention to your stomach after meals. You remember how awful you felt the last time. Maybe you start avoiding certain foods or only eating when you know you’ll be close to a bathroom. The brain is very good at noticing all of this, and over time it may learn an association between eating and danger.
Eventually, you can eat lunch on a perfectly lovely Saturday afternoon with absolutely nothing stressful happening and still get symptoms.
That doesn’t necessarily mean you’re secretly anxious and just don’t know it. It may mean the pattern has become learned.
This is one reason I don’t love explanations that boil everything down to, Well, you’re anxious. Anxiety may have been part of what started a symptom cycle without being the only thing keeping it going. Stress, an illness, an injury, a frightening physical sensation, or another period of feeling unsafe can all give the nervous system a reason to become more protective. Then the brain can begin associating certain foods, movements, situations, places, times of day, or physical sensations themselves with danger.
Think about driving. When you first learned, you probably had to consciously think about almost everything you were doing. Eventually, your brain automated most of it. You don’t pull out of your driveway every morning and consciously instruct your foot to move from the brake to the gas. Your brain learned the pattern.
Learned symptom responses can become automatic too.
That can explain why someone might say, But I’m not anxious anymore, and be completely right. The anxiety may have settled while the physical pattern it helped create stuck around. If you’ve ever wondered why symptoms can continue long after the stressful period when they began—or why they can appear in situations where you feel perfectly calm—this is one possibility worth considering.
Sometimes the symptom itself becomes the scary thing
There is another layer to this that I see all the time. Even if anxiety wasn’t there at the beginning, it’s pretty easy for it to show up once you’ve had an unexplained physical symptom for a while.
You get dizzy. Why am I dizzy?
It happens again. Is something wrong with me?
Then you’re standing in line at the grocery store and notice the tiniest hint of that familiar feeling. Oh no. Not here.
Now you’re checking. Is it getting worse? Am I going to have to leave? What if I pass out?
Of course you’re anxious. Your brain thinks something may be wrong with your body. It would actually be pretty strange if you felt completely indifferent about that.
The problem is that this can create a feedback loop. The symptom feels dangerous, so you become afraid of it. Fear increases your brain’s sense that something important and threatening is happening, which can make the nervous system more activated and the symptom more noticeable. The increased symptom then seems like pretty convincing evidence that you were right to be afraid of it in the first place.
Around and around we go.
This doesn’t mean you caused your symptoms by worrying about them, and I think that distinction matters. Telling someone, You’re making yourself sick because you’re anxious, isn’t only unhelpful; it misses how automatic these processes can be. You didn’t sit down one day and decide to teach your brain to fear dizziness, stomach pain, headaches, or a racing heart. Your brain was trying to protect you based on the information it had.
The good news about a learned response is that learning can change. That’s the idea behind neuroplasticity, and it’s a big part of the work we do in Pain Reprocessing Therapy (PRT). Rather than spending all of our energy trying to eliminate anxiety or control every possible trigger, we can begin helping the brain have different experiences with the sensations and situations it has learned to fear.
Maybe you notice a familiar sensation and practice responding with curiosity rather than immediately checking whether it’s getting worse. Maybe you gradually return to an activity you’ve been avoiding. Maybe you start gathering evidence that your body is capable of things your brain has decided are dangerous. For some people, emotional work is important too. What that looks like depends on the person and what seems to be keeping their nervous system on alert.
The goal isn’t to become a person who is never anxious.
Thank goodness, because I don’t know any of those.
It’s to help the brain learn that anxiety itself, physical sensations, and the ordinary experiences of being a human being don’t always mean you’re in danger.
So, are my physical symptoms caused by anxiety?
Maybe. But I think there is a better question.
Could my brain and nervous system be playing a role in what I’m experiencing?
That leaves room for a much more nuanced answer. Sometimes anxiety really is driving physical symptoms. Sometimes it contributed to how the symptoms began, but a learned neuroplastic pattern is now helping keep them going. Sometimes there is a medical or structural issue and the nervous system is amplifying the symptoms associated with it. And sometimes anxiety has very little to do with the symptom at all.
We don’t need to force every physical symptom into one category.
What we can do is look at the whole story. When did the symptoms start? What was happening in your life at the time? Do they change with stress, attention, expectation, or environment? Have they developed predictable triggers? Are there times your body surprises you by doing something you thought it couldn’t? What has appropriate medical evaluation shown?
Those patterns can give us much more useful information than simply asking whether you consider yourself an anxious person.
If you’re wondering whether your own symptoms may have a neuroplastic component, my Neuroplastic Symptoms Self-Assessment can help you start looking at some of that evidence. You can also read How Do I Know If My Symptoms Are Neuroplastic? for a deeper look at the patterns I pay attention to, or What Is Neuroplastic Pain? if this whole idea is new to you.
And if you’d rather talk through your particular symptoms with someone, I offer free 15-minute connect calls where we can talk about what you’ve been experiencing, what you’ve already tried, and whether PRT might make sense for you.
