Anxiety symptoms: physical signs, causes and when to get help

Almost everyone feels anxious before an exam, a hospital appointment or a difficult conversation. That kind of anxiety is a normal alarm system, and it fades once the situation passes. It becomes a health problem when it is out of proportion to the circumstances, difficult to switch off, or begins to dictate what you do and avoid.

The NHS explains that when you feel anxious or scared the body releases stress hormones such as adrenaline and cortisol, which can quicken the heart and increase sweating. That is why anxiety so often feels like a physical illness. People frequently arrive in a GP surgery convinced they have a heart problem, a stomach complaint or a neurological condition, and later discover that anxiety was driving the symptoms; others discover that a physical cause was being blamed on anxiety too quickly, which is why a considered assessment matters.

The NHS describes three overlapping groups. You do not need all of them, and the mix differs from person to person.

• Physical: a faster, irregular or more noticeable heartbeat, light-headedness and dizziness, headaches, chest pains, loss of appetite, indigestion, stomach cramps, bloating and nausea, constipation or diarrhoea, sweating, breathlessness, feeling hot and shaking.

• Mental: feeling tense or nervous, being unable to relax, worrying about the past or future, feeling tearful, being unable to sleep, difficulty concentrating, fear of the worst happening, and for some people intrusive memories or obsessive thoughts.

• Behavioural: no longer enjoying leisure time, difficulty looking after yourself, struggling to form or keep relationships, avoiding places and situations that provoke anxiety, and compulsive behaviour such as constantly checking things.

Doctors use the pattern, rather than any single symptom, to work out which anxiety condition fits. The NHS pairs the typical presentations with their names, and they can overlap; it also notes that it is common to have more than one anxiety disorder at the same time.

Several physical conditions imitate anxiety. The NHS panic disorder page makes the point directly: most panic-attack symptoms can also be symptoms of other problems, giving a racing heartbeat with very low blood pressure as an example. An overactive thyroid can cause a fast pulse, tremor, sweating and weight loss. Heart rhythm disorders cause palpitations. Asthma and lung conditions cause breathlessness. Caffeine, energy drinks, alcohol withdrawal and some medicines can all provoke jitteriness, and the NHS notes that caffeine can disrupt sleep and make anxiety harder to control.

This is why a first assessment for anxiety usually includes a physical check. A GP may feel your pulse, listen to your heart, check blood pressure, and arrange blood tests such as a thyroid function test or a full blood count if the story suggests it. A normal result is reassuring and often relieves a good portion of the anxiety itself.

Anxiety on its own is not a medical emergency, but some situations need quick action. The NHS pages direct anyone in a mental health crisis to urgent help: support is available if you or someone you know is having a mental health crisis or emergency, whatever you are going through, and its mental health pages link to where to get that help. Samaritans can be reached at any time on 116 123.

• Thoughts of harming yourself or ending your life, or a feeling that you cannot keep yourself safe: use the NHS page on where to get urgent help for mental health, contact Samaritans on 116 123, or call 999 or go to A&E if there is immediate danger.

• Chest pain that is sudden, does not go away, spreads to the arm, jaw or back, or comes with sweating or breathlessness: treat as a possible heart attack and call 999, as the NHS chest pain page advises, even if you think anxiety is the explanation.

• Fainting, new confusion, weakness on one side or slurred speech during a surge of symptoms: call 999.

• Anxiety that comes with severe low mood, a sense of hopelessness, or voices and unusual beliefs: arrange an urgent GP or crisis assessment.

• Not coping despite self-help: the NHS advises seeing a GP if you are struggling and the things you are trying are not helping.

The GP will ask about your worries, how often you feel anxious, how long it has lasted, what sets it off and how it affects work, sleep and relationships. They may ask about alcohol, caffeine, drugs and medicines, because all of them can drive symptoms. Honesty matters: the NHS GAD page says it is important to be honest even when talking about emotions is hard, because that is what lets the GP diagnose or rule out an anxiety disorder.

There is no blood test or scan for anxiety. Questionnaires that score symptoms are sometimes used, and physical tests are done only to rule out other conditions. The GP will explain the treatment options, which for GAD the NHS lists as talking therapies (usually cognitive behavioural therapy), medicines (usually a type of antidepressant called an SSRI) and, if needed, referral to a community mental health team.

The NHS suggests talking about your feelings with someone you trust, learning calming breathing exercises, trying activities such as yoga, getting enough sleep, exercising regularly and eating regular meals. It advises cutting back on tea, coffee, cola and energy drinks, and not using alcohol, cigarettes, gambling or drugs to relieve anxiety, because they tend to add to the problem.

It also cautions against avoiding the situations that make you anxious. Slowly building up the time you spend in them can gradually reduce anxiety, which is the same principle used in CBT. During a panic attack, the NHS suggests staying where you are if possible, breathing slowly and deeply, and reminding yourself that the attack will pass.

On the NHS, the quickest entry for many adults is self-referral to a local talking therapies service, with no GP referral needed. A GP can also refer you, and may review you regularly while therapy is under way. Medicines, if offered, can take weeks to work: the NHS panic disorder page says antidepressants can take 2 to 4 weeks to start working and up to 8 weeks to work fully.

Some people also choose private therapy or psychiatry for shorter waits or different styles of therapy. Whichever route you use, check that the therapist is registered with a recognised professional body and that treatment is based on evidence such as CBT.