6 sneaky physical signs of anxiety (because it's not always in your head)

Although anxiety is a mental health issue, there’s more to it than constant worry. Anxiety can also cause physical symptoms. Many of these reactions are not only unpleasant but can also make your anxiety worse.

From head to toe, the symptoms of anxiety can be traced back to the body’s natural response to danger, explains Jo Eckler, a licensed clinical psychologist. When we encounter a potential threat, our sympathetic nervous system (known as the fight-or-flight response) automatically kicks in. A flood of stress hormones is released, forcing our muscles to tense, hearts to pound, breath to quicken — and more.

Trouble is, the nervous system can’t tell the difference between an actual threat, like a near miss behind the wheel, and an imagined threat, like preparing for a tense conversation. So, it often responds to the two scenarios in similar ways, says Eckler. That is why just thinking about stressful situations can cause physical symptoms.

Here are some of the most common physical signs of anxiety to be on the lookout for — and what to do if you experience them.

Sneaky anxiety sign #1: Shakiness

You have a stress hormone known as cortisol. When you sense a threat — whether it’s real or imaginary — cortisol levels go up. This rise tells your body to release more glucose (also known as sugar) to give you the energy to handle it.

“These changes in blood sugar can make us feel shaky and queasy,” Eckler says.

However, shakiness can have other causes aside from anxiety, such as essential tremor, Parkinson’s disease or simply too much caffeine. If you notice that you’re shaking often, even when you’re not anxious or stressed, check with your doctor to see if there may be other issues at play, Eckler says.

Sneaky anxiety sign #2: Rapid heartbeat

Ever notice how your heart starts to race when you’re in the middle of a stressful situation? That happens because your sympathetic nervous system controls your heart rate, according to information from Harvard Medical School.

Remember, in the face of a fight-or-flight situation, your body churns out cortisol and epinephrine (a stress hormone you might know better as adrenaline). The result is a chain reaction, states a paper in World Journal of Cardiology.

First, your heart pumps faster. Next, the rapid heart rate prompts more blood to go out to your muscles so you’re able to fight or flee the potential threat.

“That’s really handy if a grizzly bear walks into your living room, but not as useful if you’re just sitting and thinking about making a difficult phone call,” Eckler says. In this latter case, she says, a speeding heart often leads to more anxious feelings.

Sneaky anxiety sign #3: Digestive issues

Forget butterflies in your stomach. Worry, doubt and fear can sometimes make it seem like a steamroller has taken over your GI tract. In times of stress, your sympathetic nervous system focuses energy and resources to where they’ll be most helpful in the short-term, and pauses anything that isn’t essential.

“Digestion is more of a long-term investment for the body, so it tends to slow down or even come to a stop,” Eckler says.

As a result, your digestive tract may empty out quickly, or not much at all, leading to issues like constipation, diarrhea or stomach pain. “And since digestive problems can be painful and stressful, this can create a cycle that feeds anxiety and keeps digestive problems going,” she says.

Sneaky anxiety sign #4: Unsatisfying sleep

Do racing thoughts keep you up at night? Anxiety can leave you feeling restless, making it hard to fall asleep or stay asleep, notes the National Institute of Mental Health (NIMH).

On the flip side, sleep struggles can cause more anxiety, creating a continuous cycle. In fact, people with chronic insomnia (one of the most common sleep problems) face a high risk of developing an anxiety disorder, notes the Anxiety and Depression Association of America (ADAA).

Sneaky anxiety sign #5: Tense, achy muscles

The same stress response that revs you up also tells your muscles to tighten and brace for an attack. “Again, that’s fine if there’s a bear coming after us, but if we aren’t actually under attack, we just end up with sore and achy muscles,” Eckler says.

Tension headaches (mild to moderate pain that feels like having a tight band around your head) are common among people with anxiety, according to the ADAA. It’s also common to feel tension and soreness in the shoulders, neck and jaw.

Sneaky anxiety sign #6: Sweating

Stress and anxiety can make you sweat more than usual, especially your palms, face, armpits and the soles of your feet. This is partly thanks to hormones like epinephrine and norepinephrine, which get a boost any time your body senses danger, according to a review in Skin Pharmacology and Physiology.

Here’s what happens: You start to worry. That worry causes your heart rate to speed up and the blood vessels in your skin to tighten. Next, your body temperature goes up, which leads to sweating as your body tries to cool itself down. Eckler says there’s even a name for this reaction: nervous sweating.

How to handle anxiety

Feeling anxious from time to time is completely normal. However, if your anxiety gets to a level where it’s causing a lot of problems or making it hard to get through your day, it’s time to get help, says Eckler.

Visit your doctor to rule out other health issues that may be to blame for the physical symptoms you’re experiencing. If all signs point to anxiety, talk to your doctor or a mental health professional about treatment options.

There’s no one-size-fits-all solution for anxiety, notes the NIMH. Your doctor will take a look at your symptoms and lifestyle and help you find a mix of treatments that are right for you. These might include talk therapy, prescription medications or support groups.

“Activities that relieve stress might also be helpful to add into your day,” Eckler says. Restorative or gentle yoga, tai chi, spending time with loved ones, being out in nature and enjoying hobbies are all great options.

“Anxiety isn’t going to completely go away, but with some help and effort, you can find ways to help reduce its impact on your life,” Eckler says.