The tremors started shortly after Patty Blue Hays discovered her husband of seven years was having an affair.
Soon, she began to have balance problems and unsteadiness while walking. She often felt nauseated and sometimes vomited up meals. She couldn’t sleep at night because her brain wouldn’t quiet down enough for her to relax.
“There was a constant cycle of the same thoughts and feelings,” Hays, now 53, told TODAY. “It was like my mind was on a hamster wheel and couldn’t get off.”
Hays didn’t know what was wrong with her. But one day she mentioned all those physical symptoms to her therapist. Without missing a beat he said, “Oh that’s anxiety,” and suggested she go to her primary care physician to get medication to help.
It’s not unusual for anxiety to be expressed physically rather than emotionally—or for us to get so used to feeling anxious that we begin to ignore it and fail to link the physical symptoms with the anxiety.
Which can make it difficult for doctors to make the right diagnosis since anxiety can produce a wide variety of symptoms.
“That’s the challenge,” says Dr. Michael Ziffra, an anxiety specialist and psychiatrist at Northwestern Memorial Hospital. “You might be more prone to headaches and it’s not unusual for it to cause impairments in cognition, problems with attention, focus and concentration. You might even find your memory is impaired.”
No part of the body, it seems, is immune. “Often there are gastrointestinal manifestations, such as constipation or diarrhea,” Ziffra says. “It can lead to neck and back tension — stress and anxiety are believed to be a big component of chronic back pain.”
When the anxiety is intense, it can lead to panic attacks. “Your heart might start racing or you might feel short of breath,” Ziffra says. “You could feel faint or dizzy or very hot or very cold. You might develop tremors. Or there could be a sensation that you’re off balance.”
These symptoms are all related to the fight or flight response, says Dr. Emanuel Maidenberg, a clinical professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine and director of the Cognitive Behavioral Therapy Clinic at the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles.
The tricky part for doctors is that many of the symptoms of anxiety can mimic physical medical issues, such as an asthma attack, a heart attack or vertigo, Ziffra said.
And the only way to know what’s really going on is to rule out those medical conditions first, he added.
In Hay’s case, the physical symptoms resolved as her anxiety was brought under control.
For some people, though, the physical symptoms of anxiety can lead to a chronic problem—which explains many phobias. When intense physical symptoms of anxiety are triggered by a specific experience, such as being in a small space, it can lead to chronic avoidance of that experience, Maidenberg says.
“The very thought and anticipation of the symptoms can produce anxiety,” Maidenberg said.
So ultimately, even if people realize there’s nothing inherently frightening about a small, enclosed space, they develop a terror of experiencing the sensations anxiety provokes, Maidenberg said.
“The feeling itself becomes the threat."
These days physicians often couple medication with other kinds of interventions, such as meditation, yoga, mindfulness and massage, Ziffra says. “I talk to people about making sure they’re getting enough exercise, having a good diet, avoiding drugs and alcohol and caffeine,” he said. “I make sure they’ve got good sleep habits.”
That’s the kind of advice Hays wishes she’d heard when she originally talked to her primary care doctor.
“He gave me a prescription for Xanax and I don’t recall him telling me about anything other than medications,” she said. “I don’t recall any discussion about deep breathing exercises, or walking or meditation. Today I realize that there are many tools available and I’ve learned to recognize the symptoms and to manage them—and to reach out for help.”