You’ve been to the GP maybe more than once, had tests, been checked over, been told everything looks fine, and yet something in your body doesn’t feel fine.
The chest tightness, the nausea, the headaches, the fatigue, the dizziness, the feeling that your heart is doing something it shouldn’t, all of it is real.
Anxiety is not just in your head, it lives in your body just as much as it lives in your thoughts, and for a lot of people, the body is actually where they notice it first.
When your brain perceives a threat (real or imagined, present or anticipated) it activates the sympathetic nervous system and triggers the release of stress hormones, primarily adrenaline and cortisol (Cannon, 1932). This is the fight-or-flight response. It evolved to help you survive immediate physical danger, and is *extraordinarily* good at its job.
The problem is that your nervous system cannot distinguish between a physical threat and a psychological one. A difficult conversation, a deadline, an uncertain relationship, a persistent sense that something is wrong, all of these can activate the same response as an actual emergency.
And when that response fires, your entire body responds. Every physical symptom associated with anxiety is a direct result of this system doing exactly what it was designed to do (Barlow, 2002).
Heart palpitations and racing heart. Adrenaline increases heart rate to pump more blood to your muscles in preparation for action. When there is no action (because the threat is psychological, not physical) the elevated heart rate has nowhere to go. It sits in your chest and frightens you.
Chest tightness. The muscles around the chest and ribcage tense during threat response. Combined with changes in breathing, this produces a sensation of tightness or pressure that can feel alarmingly similar to cardiac symptoms. This is one of the most common reasons people with anxiety end up in A&E.
Shortness of breath. Anxiety changes breathing patterns, typically making them faster and shallower, which can lead to hyperventilation. This reduces carbon dioxide in the blood, producing dizziness, tingling in the hands and feet, and a paradoxical sensation of not being able to get enough air (Ley, 1985).
Nausea and digestive issues. The gut and the brain are directly connected via the vagus nerve, what researchers now call the gut-brain axis. During threat activation, blood is diverted away from the digestive system towards the muscles. This produces nausea, stomach cramping, and in chronic anxiety, contributes to conditions like irritable bowel syndrome (Mayer, 2011).
Dizziness and light-headedness. A combination of hyperventilation, changes in blood pressure, and muscle tension in the neck and shoulders can all contribute to dizziness. It feels alarming, but it is not dangerous.
Fatigue. Chronic anxiety keeps the nervous system in a sustained state of activation which is physiologically expensive. Carrying that level of alertness day after day is exhausting in a way that sleep alone doesn’t fix, because the nervous system isn’t fully switching off even at rest.
Headaches and muscle tension. The body braces under threat, shoulders rise, jaw clenches, neck tightens. Held over time, this tension produces headaches, jaw pain, and a general feeling of physical heaviness.
Skin responses. Flushing, sweating, and in some cases skin sensitivity or flare-ups of conditions like eczema or psoriasis, all have documented links to stress and anxiety activation (Hunter, Momen & Kleyn, 2015).
There is a significant proportion of people presenting to GPs with physical symptoms that have no identifiable medical cause. Research suggests that somewhere between 25 and 50 percent of all GP consultations involve medically unexplained symptoms, and anxiety and psychological distress are among the most common underlying factors (Kroenke, 2007).
This is not to say that physical symptoms should be dismissed or not investigated, they should. Ruling out medical causes is important and appropriate. But when investigations come back clear and the symptoms persist, the body is often pointing towards something that medicine is not designed to treat.
Physical symptoms of anxiety have a particularly unhelpful relationship with anxiety itself.
You notice a symptom, the symptom frightens you, the fear activates more anxiety, more anxiety intensifies the symptom, the symptom confirms that something is wrong, the anxiety increases further.
This is the loop that Clark (1986) described in his cognitive model of panic, and it applies just as much to chronic physical symptoms as it does to acute panic attacks. The body produces a sensation, the anxious brain attaches threat meaning to it, and the sensation intensifies in response.
For people with health anxiety specifically, physical symptoms become evidence of feared illness. But even without health anxiety, the presence of unexplained physical symptoms tends to generate its own layer of worry, which then maintains the very activation causing them.
Understanding that the symptoms are real but not dangerous is a meaningful starting point, but it is rarely sufficient on its own. Knowing something intellectually does not switch off a mind that has learned to stay on edge.
Approaches with a strong evidence base include CBT, which targets the interpretations and behaviours that maintain the anxiety-symptom loop, psychodynamic work that explores what the body has been carrying and why (van der Kolk, 2014; Hayes, Strosahl & Wilson, 1999), and Transactional Analysis (TA) which explores relational patterns and ego states underlying the anxiety.
Body-based work, including Hypnotherapy and approaches informed by somatic therapy and nervous system regulation, that work directly with the body’s held tension and activation rather than purely with thought patterns, are increasingly recognised as important precisely because anxiety is not just a cognitive experience. If it lives in the body, the body needs to be part of the work.(van der Kolk, 2014)
If any of this resonates and you’re wondering whether therapy might help, you’re welcome to book a free 15-minute call to explore working together.
Not sure if therapy is right for you yet? Read: How to find the right therapist.
Integrative Therapist (Psychotherapy & Hypnotherapy), working with anxiety, relationships, habits & compulsions, and the not-enough feeling.
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