When Anxiety Gets Physical
I’m Alice. I’m a freelance writer and editor with anxiety and depression, fibromyalgia and functional neurological symptoms in the form of tics and muscle spasms, likely related to my fibro nonsense. I’d like to talk about my experience with anxiety and the role it’s played in shaping my physical health.
All in your head?
I was about 12 or 13 when I had my first panic attack on a school bus. But I didn’t recognise it as one. In fact, I wouldn’t notice the deep-set anxiety worming its way into my brain until I was at university. I have memories of being very young and feeling perpetually nauseous or being unable to sleep because my heart was pounding. These things worried me, but I felt unable to speak up about them, convinced I wouldn’t be believed. I thought it was normal to secretly hate everything about yourself, to believe everyone else hated you too, to second guess every single decision you made. All the signs were there, but I either didn’t have the language, the self-awareness, or the knowledge to recognise them. Anyone who lives with it will tell you that anxiety can have a lot of physical tells, some of which can be quite distressing and disruptive to your everyday life. Dizziness, fatigue, dry mouth, pins and needles in your hands and feet, digestive problems, chest pain, heart palpitations, forgetfulness, mental fogginess – all these can be a direct result of anxiety. It’s not just being a little too worried, and it’s never ‘all in your head’. A strong reaction to stress is the leftover of a survival instinct from our caveman days. Adrenaline makes our hearts beat faster to get the blood flowing to where it’s needed, to get us out of danger quicker. This fight-or-flight response from our autonomic nervous system (this internal system of reflexes in our brain that unconsciously regulate many bodily functions including heart rate, respiratory rate, and digestion) was developed to keep us safe, but it was only designed to be a short-term solution. When the rush of hormones from stress keeps flooding our body, over and over, the response can become damaging. We have trouble eating, sleeping, concentrating, and even breathing. We’re taking in too much information through our heightened senses and it’s overwhelming.
You’re ‘Just’ Anxious
When it comes to openness about mental illnesses like depression and anxiety, we’ve come a long way. We’re talking about it more on social media and with our friends and family members. Going to therapy is seen less as a thing to be ashamed of and more as an act of self-care that anyone should have access to. But we’re not all the way there. The stigma still exists — we see it in comments from others that surely we’re just not trying hard enough, or that we did something to cause it, or it’s all in our heads, or that we’d feel better if we went outside and did some exercise. This kind of thinking — which has been discussed throughout various InSPIre the Mind pieces over the years — dismisses mental health and illness, only making it harder for those struggling to share how they really feel, leaving them to believe that perhaps nobody is really hearing them. It isolates us inside our heads and makes the healing process longer. Just as frustratingly, if the physical symptoms we experience are judged as belonging to a mental illness, they are often dismissed too. While it’s true with treatment such as talk therapy, medication, and CBT, our symptoms can improve over time, the hurt they cause is all too real and all too distressing. I’ve had physical symptoms attributed to anxiety dismissed as inconsequential by some doctors and later validated by different doctors. I felt vastly different leaving these appointments. Being told what I was experiencing was real did help how I thought about and dealt with the distressing symptoms I was experiencing. How we talk about and think about all aspects of mental health matters – it never stays just in our heads.
Anxiety or Chronic Illness?
Often, the trouble with the physical symptoms of anxiety is that they don’t just point to anxiety. They can be unhelpfully vague and apply to a whole range of conditions and chronic illnesses. A couple of years ago, I began experiencing hip pain that suddenly spread to the whole of my body, along with fatigue and cognitive difficulties, best described as ‘brain fog’. It stopped me from doing anything except lying on the sofa or hobbling to an endless parade of hospital appointments. What was eventually thought to be a spectacularly bad case of vitamin D deficiency eventually morphed into a diagnosis of fibromyalgia – or fibro for short, as I’ll be referring to it. The main three symptoms of fibro are widespread chronic pain, fatigue, and issues with mental processes like concentration and memory, known to some as fibro fog. Another common component for many fibro patients is anxiety. Anxiety and fibro have a messy, messy involvement with each other. Fibro as a condition is not well understood. The NHS website lists it as a long-term condition, and I’ve also seen it described as a musculoskeletal condition, not a muscle condition, neurological, a mental illness, not a mental illness, an autoimmune condition, not an autoimmune condition, a chronic pain condition, and by some doctors, not even real. Anxiety is listed as a symptom of fibro, with some also suggesting anxiety itself could be a potential cause, leaving me in a particularly impossible quandary. Are my symptoms of anxiety all actually because of fibro, and it’s just that the anxiety happened to be discovered first? Did my anxiety come first and develop itself into this chronic illness? Or do these two conditions co-exist inside me, both doing their worst to torture my body and mind? I will probably never get the answer to this.
When Medicine Has No Answers
There can be a couple of troubling dualities when considering the links between mental and physical health – these symptoms can all be rooted in a mental illness, with no physical cause to be found and no physical treatment that would help solve them. However, this can be a painful revelation and a difficult conclusion to be left with. The mental health aspect might not be considered until all physical tests have been exhausted – or at least not given as much weight – leaving it feeling like a last resort and a way to brush off a patient there seems to be no other way of helping. In contrast, considering the tremendous stigma around mental health and its relationship with physical health, some patients may instead feel dismissed because they’re told their anxiety is causing physical symptoms that they’ve been experiencing – it’s ‘just’ because of anxiety. Do we chase a physical diagnosis because of the lingering stigma of our symptoms all being due to a mental illness? Simply put, no. The experience of the symptoms is not any less real just because the root is in our mind rather than our bodies. Other possible diagnoses for people with medically unexplained symptoms are conditions such as somatic disorders or descriptions such as functional symptoms. While this may explain their pain, fatigue, or other health concerns, there is again a level of stigma associated with these conditions which we – both patient and doctor – need to be aware of. Anyone experiencing troubling symptoms deserves reassurance, empathy and care, no matter the origin of their symptoms. Over the past couple of years, I have developed muscle spasms and tics. A referral to a neurologist led to a tentative diagnosis of functional neurological symptoms, described as a “software glitch rather than a hardware issue”. My nerves are physically normal, but the signals being sent to them, perhaps due to being in constant pain, are buggy. Other functional symptoms can include limb weakness, paralysis, seizures, tremors, blurred vision, and more. A third of new neurology patients have medically unexplained symptoms, and a study into their experience concluded their distress and disability were very real and should be taken seriously.
It’s Not Our Fault
For many like me, physical aspects of mental illness can leave you with a strong sense of self-blame – we must have done something ‘wrong’ to cause ourselves this pain. I believe this reveals the work we still have to do in how we think about mental illness and how we balance its importance alongside physical wellbeing. The ways it can manifest so strongly physically indicate a need for us to understand it better and take it as seriously as any other health condition. It’s common for people with chronic illnesses to have worsening mental health conditions. When you spend every day in pain and drag yourself to appointment after appointment, and see others go out and do things you’re no longer able to do, it’s natural that your mental state would suffer. And to add to the fun, higher levels of anxiety and depression are likely to also impact and worsen your physical symptoms, such as pain and fatigue. Yay. So why isn’t counselling or CBT or some kind of mental wellbeing check-in standard with chronic illness diagnosis? Why is the mental wellbeing of chronically ill patients so often overlooked? Why does it have to get to a crisis point before it enters the discussion? Given the high chance that you’re going to end up needing mental health support, surely it would make more sense for us to be given the tools at the very start of our journeys? I live in the UK, and while the NHS is incredible in so many respects, our mental health services are chronically underfunded, which is really damaging people’s wellbeing by preventing the fast access to services that they need. This isn’t the NHS’s fault, but it’s yet another indication of how little mental wellbeing is prioritised compared to physical health in our society. There is an undeniable and strong link connecting our mind and body, with evidence that stress can lower our immune systems, impact how well we fight illnesses or even respond to vaccines, and even increase our risk for cardiac conditions. When one is sick, the other is likely to follow. It’s more than past time they were both given the same level of importance.