8 sneaky signs of anxiety

Racing thoughts, constant worry, feelings of panic, fear or loss of control. These are all things that may come to mind when you think about symptoms of anxiety. And while they’re good explanations of how anxiety can make you feel, there’s more to it.

Although anxiety is a mental health issue, it almost always causes physical symptoms too, says Renee A. Exelbert, Ph.D. She’s a licensed psychologist and adjunct professor of psychology at New York University in New York City.

That’s because when we face danger, our sympathetic nervous system automatically kicks in. Stress hormones are released, your heart rate quickens and your muscles tense. Each of these changes prepares us to flee or fight off that potential threat.

This is useful when you encounter an actual risk and you need to react quickly, such as when a car swerves into your lane. But when you have anxiety, or the threat is imagined, you’re simply left with the uncomfortable physical symptoms of a revved-up body.

The most classic physical symptom of anxiety is feeling “keyed up” or especially restless, says Brenna Renn, Ph.D. She’s a licensed clinical psychologist and assistant professor of psychology at the University of Nevada, Las Vegas. But there are other, more concrete symptoms to look out for.

Here are some of the most common signs of anxiety that may be mistaken for something else, and what to do if you experience them.

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Sneaky anxiety symptom #1: Nausea and upset stomach

Anxiety can show up as stomach pain or nausea when a person internalizes their feelings, Exelbert says. These can be confused with other gastrointestinal issues, a food allergy or intolerance.

It may even make it hard to keep food down. Stress can also cause a buildup of the hormone cortisol, which can result in bowel irregularities such as diarrhea. Medical conditions, such as irritable bowel syndrome (IBS), can be further exacerbated by stress, Exelbert says.

Sneaky anxiety symptom #2: Rapid heart rate

A racing heart is a common physical symptom of anxiety, Renn says. That’s because your sympathetic nervous system releases hormones to accelerate your heart rate. And remember, when anxiety tells your body there’s something to be worried about, that system automatically kicks into high gear.

When that happens, your body churns out stress hormones such as cortisol and epinephrine (adrenaline). That triggers a domino effect of physical changes, including rapid heart rate and elevated blood pressure.

Sneaky anxiety symptom #3: Fatigue

Wait, doesn’t anxiety make you feel amped up and restless — the opposite of feeling tired? Yes, that’s true. But all that stimulation can eventually wear you out, Renn says.

Constantly worrying and anticipating the worst, plus the physical symptoms those feelings may cause, can be exhausting.

Also, anyone who ever lies awake in bed with racing thoughts knows that anxiety can interfere with sleep. That’s another reason it may leave you feeling extra groggy.

It can be a vicious cycle: Anxiety can make it hard to fall or stay asleep, and then not getting the sleep you need can cause more anxiety. That’s why sleep disorders, particularly insomnia, are common in people with chronic anxiety.

Recommended reading: Our beginner’s guide to anxiety disorders covers everything you need to know about the different types, their symptoms, treatments and more.

Sneaky anxiety symptom #4: Sweating

Whether it’s your palms, forehead, armpits or the soles of your feet, you may notice more sweat than usual when anxiety ramps up. It’s just another common physical reaction to feelings of anxiety. Again, it’s due in part to those stress hormones.

Sneaky anxiety symptom #5: Trouble swallowing

Have you ever been so worried that it feels like you have a lump in your throat? You’re not alone. Anxiety can cause a feeling of tightness in your throat or that something is stuck in it. There’s even a name for it: globus sensation.

It’s unclear exactly why this happens. But experts suggest it could be a physical manifestation of the fears or worries a person holds in. Or it may simply be a result of being physically tense.

Anxiety can cause people to stiffen or clench muscles without even realizing it, Renn says. The result: tightness and discomfort in different areas of the body.

Sneaky anxiety symptom #6: Inability to focus

When your mind is preoccupied with something that happened in the past, or if it’s locked in a worry cycle about a future event, it’s hard to think about anything else.

“When the fight-or-flight response kicks in, there’s a cascade of stress hormones. Our survival is prioritized over our need to think rationally,” Exelbert explains. “The thinking part of our brain is temporarily hijacked by the emotional part of the brain, the amygdala.”

Sneaky anxiety symptom #7: Dizziness

Dizziness that comes with anxiety is often described as lightheadedness or feeling woozy. There may also be a sense of swaying or imbalance even though you’re standing still.

The exact reason that anxiety can make you feel dizzy isn’t totally clear. Exelbert says that sometimes it’s due to sudden changes in blood pressure. Or it could be connected to the impact that stress hormones can have on the vestibular system. That’s the link between your inner ear and brain responsible for maintaining balance and equilibrium.

Sneaky anxiety symptom #8: Headache

Migraines and tension headaches are commonly associated with anxiety. In fact, about half of people who deal with migraines also have anxiety, according to the American Migraine Foundation.

One explanation: Stress, lack of sleep and muscle tension are all known headache triggers, and they’re also all symptoms of anxiety. Changing levels of serotonin in the brain may also play a role, Exelbert says.

Serotonin is a hormone that regulates mood and impacts many important processes in the body. Low levels of serotonin are associated with depression and anxiety.

When serotonin levels drop, it can cause blood vessels to constrict and muscles to tighten, Exelbert explains. This can trigger both migraines and tension headaches.

What to do if you experience physical symptoms of anxiety

First, take a deep breath. Second, think about what else is going on in your life. Many of the sneakier symptoms of anxiety are also associated with a variety of other health conditions. Anxiety isn’t usually the first thing considered.

But if these symptoms show up alongside persistent feelings of nervousness, worry or fear that’s hard to control at times, anxiety may be the real culprit.

“When the worry train feels like it’s getting away from you is when people get really distressed,” Renn says.

Feeling anxious from time to time is normal, but if you feel like you can’t stop it or it’s making everyday life difficult, it’s time to seek help.

Visit your doctor to rule out any other health conditions that may be causing your symptoms. If all signs point to anxiety, talk to your primary care physician or a mental health professional about treatment options. 

Treatment for anxiety often includes medication and therapy

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Additional sources
Sympathetic nervous system triggers: Merck Manual (2020). “Overview of the Autonomic Nervous System”
Sweat and anxiety: World Journal of Cardiology (2015). “Autonomic and Endocrine Control of Cardiovascular Function”
Dizziness and stress: Frontiers in Neurology (2012). “Interactions Between Stress and Vestibular Compensation – A Review”