What are the physical symptoms of stress or anxiety?

Physical Symptoms of Stress and Anxiety

Anxiety and stress manifest through a wide range of physical symptoms including cardiovascular (palpitations, tachycardia, chest pain), respiratory (shortness of breath, tachypnea), neurological (trembling, dizziness, sweating), gastrointestinal (nausea, indigestion), and musculoskeletal (muscle tension, fasciculations) symptoms. 1

Cardiovascular and Respiratory Manifestations

The most commonly recognized physical symptoms involve the cardiopulmonary system:

• Palpitations and tachycardia are hallmark features of anxiety, particularly in panic attacks 1
• Chest pain frequently drives patients to seek emergency care, often mimicking cardiac conditions 2, 3
• Shortness of breath (dyspnea) and rapid breathing (tachypnea) occur as part of the hyperventilation response 1, 4
• Dizziness results from hyperventilation and autonomic dysregulation 1, 3

These symptoms are particularly prominent in panic disorder and can be so severe that patients initially present to emergency departments or primary care settings believing they have a cardiac emergency rather than a psychiatric condition. 2, 3

Neurological and Autonomic Symptoms

The autonomic nervous system activation produces multiple physical manifestations:

• Trembling or shaking reflects increased muscle tension and autonomic arousal 1
• Sweating and sweaty palms occur through sympathetic nervous system activation 1
• Fasciculations (muscle twitches) can result from anxiety-induced muscle tension and the body's fight-or-flight response 5
• Numbness or tingling sensations may occur, particularly during panic episodes 4

Gastrointestinal Symptoms

Digestive symptoms are frequently reported, especially in certain cultural contexts:

• Nausea is a common presenting complaint in anxiety disorders 3
• Indigestion and bowel symptoms are particularly prominent in non-Western populations with generalized anxiety disorder 1
• Gastrointestinal distress can be severe enough to warrant evaluation for primary GI disorders 4

Musculoskeletal Manifestations

Chronic muscle tension produces several physical symptoms:

• Muscle tension is one of the six core associated symptoms in DSM criteria for generalized anxiety disorder 1
• Headaches are commonly reported in anxious patients 1
• Muscle twitches and fasciculations can be managed through anxiety reduction techniques including breathing exercises and progressive muscle relaxation 5

Systemic and General Symptoms

Several non-specific physical symptoms accompany anxiety:

• Fatigue or loss of energy despite adequate rest 1
• Restlessness or feeling keyed up or on edge with observable motor tension 1
• Sleep disturbance including difficulty falling asleep, staying asleep, or experiencing restless unsatisfying sleep 1
• Irritability which bridges both physical arousal and emotional symptoms 1

Cultural Considerations in Symptom Presentation

Physical symptoms may be more prominently reported than psychological symptoms in certain cultural contexts, particularly among non-Western populations and Spanish-speaking individuals. 1

• Studies in Nepal, Mexico, United Arab Emirates, and Hong Kong demonstrate higher endorsement of somatic symptoms compared to psychological worry in GAD patients 1
• Bilingual Latino patients report more somatic symptoms when assessed in Spanish versus English, even for the same anxiety disorder 1
• Common culturally-prominent somatic symptoms include palpitations, difficulty breathing, sweating, dizziness, and indigestion—symptoms that were removed from DSM-IV criteria but remain in ICD-10 1

Clinical Pitfalls and Important Caveats

Medical conditions must be ruled out before attributing physical symptoms solely to anxiety, as numerous medical disorders can mimic or coexist with anxiety symptoms. 1, 4

Critical medical mimics include:

• Endocrine disorders: hyperthyroidism, hypoglycemia, pheochromocytoma 1
• Cardiac conditions: arrhythmias, valvular disease 1, 4
• Respiratory diseases: asthma, chronic obstructive pulmonary disease 1, 4
• Neurological conditions: migraine, epilepsy, cerebral palsy 1, 4
• Metabolic disturbances: hypocalcemia, lead intoxication 1

Laboratory testing (thyroid function, glucose levels) should be considered when signs and symptoms suggest an underlying medical condition, though routine testing is not necessary for straightforward anxiety presentations. 1

Assessment Approach

Physical symptoms should be systematically assessed using validated screening tools and mental status examination, recognizing that these symptoms cause significant functional impairment in social, occupational, and other important life domains. 1

Observable signs during examination may include:

• Tremor, fidgetiness, or restlessness 1
• Poor eye contact and hypervigilance 1
• Pressured speech or poverty of speech 1
• Disheveled or fastidious appearance 1

The presence of severe physical symptoms—particularly those suggesting risk of harm, severe agitation, psychosis, or delirium—requires immediate referral to a psychiatrist or equivalently trained professional. 1