So many people have sat in my therapy room and said some version of: "I did not think I had anxiety. I thought there was something physically wrong with me."
This is incredibly common. Anxiety does not always announce itself as worry or nervousness. Often, the first and most prominent symptoms are physical - and they can be frightening, confusing, and exhausting.
When your brain's threat detection system activates (and if you read the previous blog on the smoke alarm metaphor, you will know how this works), it triggers a cascade of physical changes designed to prepare your body for danger. These changes are adaptive if you actually need to run from a predator. They are considerably less helpful when you are sitting at your desk or trying to fall asleep.
Here is what anxiety can feel like in the body:
Chest tightness and pain: the muscles around your ribcage tense, and your breathing pattern changes. Many people experiencing this for the first time are convinced they are having a heart attack.
Shortness of breath: anxiety changes your breathing pattern, often to rapid, shallow chest breathing rather than slow diaphragmatic breathing. This can create a sensation of not getting enough air, which increases panic.
Nausea and stomach problems: your digestive system slows or shuts down during the stress response. This can cause nausea, loss of appetite, stomach pain, or irritable bowel symptoms. Many people with long-term anxiety have been investigated for gastrointestinal conditions without anyone considering anxiety as a contributing factor.
Dizziness and lightheadedness: hyperventilation (over-breathing) reduces carbon dioxide levels in your blood, causing dizziness, visual disturbances, and a feeling of unreality.
Tingling and numbness: the same hyperventilation that causes dizziness also causes tingling, particularly in the hands, feet, and face.
Muscle tension and pain: chronic anxiety keeps your muscles in a state of readiness. This commonly presents as tension headaches, jaw pain (from clenching), neck and shoulder pain, and lower back pain.
Heart palpitations: your heart rate increases and you become more aware of your heartbeat. Skipped beats or a fluttering sensation are common and, while alarming, are usually harmless.
Derealisation and depersonalisation: these are perhaps the most frightening anxiety symptoms. Derealisation is the sense that the world around you is not quite real - as if you are looking at it through glass or watching a film. Depersonalisation is the sense of being detached from yourself, as if you are observing yourself from outside. Both are nervous system responses to overwhelm, and while they feel deeply strange, they are not dangerous.
Fatigue: this seems counterintuitive for a condition associated with being "wound up," but chronic anxiety is profoundly tiring. Your body is burning through energy maintaining a state of high alert, and the result is often deep exhaustion that sleep does not resolve.
The cruel irony of physical anxiety symptoms is that they fuel more anxiety. You notice a physical sensation, you become anxious about it, the anxiety produces more physical symptoms, and the cycle escalates. This is particularly pronounced in health anxiety, but it occurs in all anxiety presentations.
So what can you do when anxiety is in your body? The goal is to work with your nervous system rather than against it - to send signals of safety that help your body shift out of the threat response.
Start with your breath. Slow, diaphragmatic breathing is one of the most effective ways to activate the parasympathetic nervous system (the brake pedal for your stress response). Breathe in through your nose for a count of four, letting your belly expand rather than your chest. Hold for a count of two. Exhale slowly through your mouth for a count of six. The exhale being longer than the inhale is the key - it signals safety to your vagus nerve.
Grounding brings you back into the present moment and out of the anxiety spiral. The 5-4-3-2-1 technique works well: name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This engages your sensory system and redirects attention from internal threat monitoring to external reality.
Movement helps discharge the physical tension that anxiety creates. This does not need to be a gym session - a brisk walk, shaking your hands, stamping your feet, or even pushing your palms hard against a wall can help complete the stress cycle and release the energy your body has mobilised.
Temperature can be a useful circuit-breaker. Splashing cold water on your face activates the dive reflex, which slows your heart rate. Holding something cold (a cold drink, a chilled flannel) provides a sensory anchor that can interrupt the anxiety spiral.
Finally, if physical symptoms of anxiety are significantly impacting your life, please see your GP. It is important to rule out physical causes, and it is also important to name what is happening so that you can get appropriate support. There is no shame in anxiety producing physical symptoms - it is your body doing exactly what bodies do under stress.
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Some of my written resources and posts are drafted with the support of AI tools. The clinical thinking and final words are always my own. You can read more on my AI and Transparency page.
Best wishes,
Vicky