Anxiety and Physical Symptoms: Does the Body Actually Keep the Score?
This blog is adapted from one of our recent podcast episodes. You can take a listen at the button above.
We're continuing the anxiety series today with a topic that comes up constantly in my practice, and one that I think genuinely surprises people when we get into it: the physical symptoms of anxiety.
Most people think of anxiety as a mental experience. Worried thoughts, racing mind, catastrophizing. But anxiety is body first, thoughts second. And for some people, the body is where it starts and where it stays with very little cognitive experience at all.
Today let’s walk through six questions on anxiety and physical symptoms. Let's get into it.
Key Takeaways
In this blog post, you'll learn:
What physical symptoms are actually caused by anxiety (the list is longer than most people expect)
Why anxiety shows up in the body at all and why it's actually body first, not brain first
What happens when doctors say nothing is wrong and what to do next
What somatic anxiety is and how to recognize it
Why EMDR is particularly effective for anxiety that lives in the body
What I'd say to someone who is convinced their symptoms are purely physical
Question 1: What Physical Symptoms Are We Actually Talking About?
A lot of people don't connect their physical symptoms to anxiety, and I understand why. When you think of anxiety, you think of worried thoughts. But here's what I see in practice:
Headaches
Stomach issues and digestive problems
Chronic muscle tension
Difficulty falling or staying asleep
Fatigue that doesn't resolve even with good sleep — people will tell me their Oura Ring score is excellent but they still feel exhausted
Elevated heart rate for no apparent reason
Shortness of breath without a physical cause
Skin responses like rashes that seem to come from nowhere
The body can have some pretty significant reactions as a result of anxiety. And when these symptoms are chronic, something important happens: the body itself starts to reinforce the anxiety response.
Here's what I mean by that. When someone has had an anxiety disorder for a long time, their body has been in a state of chronic tension for so long that the tension itself begins to signal to the nervous system that there's a threat. The muscle tension is telling the brain: something is wrong. Which produces more anxiety. Which produces more tension. It becomes its own feedback loop.
This is why I talk a lot about the value of bodywork alongside therapy (chiropractic care, massage therapy) as part of anxiety treatment. Relieving that physical tension directly is a research-backed way to reduce anxiety symptoms, and you'll often see faster symptom reduction when you combine physical and therapeutic approaches.
If you're in Springfield, Missouri, I refer regularly to Dr. Abigail Emory. She's my chiropractor and she's wonderful.
Learn more about anxiety treatment at Seen Therapy Services →
Question 2: Why Does Anxiety Show Up in the Body at All?
This is a deceptively simple question, and my honest answer is: anxiety is the body.
When we talk about anxiety, we default to thinking about anxious thoughts. But the physical response comes first. Anxiety is the fight-or-flight response - it is, at its core, a body experience. The thoughts come second.
This is why some people come to me describing significant anxiety symptoms (elevated heart rate, stomach issues, constant tension) but they're not having ruminating, catastrophic thoughts. They have the body response without much cognitive experience. And that confuses them, because everything they've read about anxiety is about the thought spirals.
For those people: the absence of anxious thoughts doesn't mean the absence of anxiety. The body got there first and just... stayed there.
Question 3: A Lot of People Have Been Told by Doctors That Nothing Is Wrong. What Happens to Them?
This one comes up a lot. Someone is having intense stomach pain, chest tightness, chronic headaches. They've had the tests run. Everything looks fine. The doctor has cleared them. And they're still suffering.
What happens next, ideally: they come to therapy.
I actually have a brochure I share with doctors' offices specifically about when to refer patients to EMDR, and one of the key indicators listed is unexplained physical symptoms. When the physical workup comes back clear and the symptoms persist, the nervous system is often where we need to look next.
Unfortunately, the reality is that dismissal often makes things worse before they get better. When someone's unexplained physical symptoms are waved away without a referral to mental health, those symptoms tend to escalate. The nervous system is carrying something, and it keeps signaling until someone pays attention.
If you have done your due diligence with your primary care like run the tests, seen the specialists, and gotten clearance, and things are still not right, please consider therapy. The body and the mind are not separate systems. If one is struggling, the other is too.
I'll also note: I don't think physicians are resistant to mental health referrals. I think private practice clinicians like me who specialize in a specific approach aren't always well-connected to primary care offices. That's something I'm actively working to change - going to doctor's offices, leaving materials, building those relationships. But in the meantime, if your doctor isn't making that referral, you can make it yourself.
Question 4: Is There a Name for Anxiety That Shows Up Primarily as Physical Symptoms?
Not a clinical diagnosis, just like high-functioning anxiety, this won't appear as a code in the DSM-5. But we do have language for it: somatic anxiety or body-based anxiety.
Everyone has a physical experience with anxiety - the body is always involved. But for some people, the physical experience is the dominant one, with very little cognitive experience alongside it. That's what we mean when we talk about somatic anxiety.
It's also on a spectrum. For some people, the physical symptoms are fleeting, such as elevated heart rate during a stressful moment that passes quickly. For others, the symptoms are chronic and persistent, present even when there isn't an immediate stressor in front of them. Extreme muscle tension that never fully releases. A gut that's always slightly off. A baseline of fatigue that never lifts.
The longer someone has been running in an anxious state, the more likely those symptoms are to become chronic rather than situational.
Question 5: What Does Treatment Look Like When Anxiety Is Mostly Physical?
This is one of the reasons I find EMDR particularly powerful for anxiety work.
Talk therapy, particularly approaches that focus on changing thought patterns, trims the weed. It addresses the cognitive experience of anxiety at the surface level. But if anxiety lives in the body, we need to address it where it lives. We need to pull the weed up by the roots.
EMDR and other somatic approaches work at the level of the nervous system. They address the body's stored experience, not just the thoughts that come after. For someone whose anxiety is primarily physical, who doesn't have a lot of the ruminating thought pattern that we typically associate with anxiety, this matters enormously. Cognitive approaches alone are often not going to get there.
The body and the mind cannot be separated. Anxiety doesn't start as a thought. It starts as a nervous system response. Treatment that works at that level is treatment that can actually reach the source.
Learn more about EMDR therapy for anxiety at Seen Therapy Services →
Question 6: What Would I Say to Someone Who Is Convinced It's Physical, Not Psychological?
Follow that intuition. Talk to your primary care. Get the referral to the specialist. Do your due diligence. I mean that genuinely, I'm not going to tell someone to skip the physical workup.
And when that workup comes back clear, I'd ask: can we consider, for a moment, what the nervous system might be carrying?
The body and the mind are one system. They are not two things that happen to coexist. If you have been chronically anxious, even if you haven't had that label for it, even if it's just been a constant hum of stress and tension for years - your nervous system has had a heavy load to carry. That load shows up somewhere.
It often shows up in the body first.
Frequently Asked Questions About Anxiety and Physical Symptoms
Can anxiety cause physical symptoms?
Yes, and the list is longer than most people expect. Anxiety can cause headaches, digestive issues, chronic muscle tension, fatigue, sleep disruption, elevated heart rate, shortness of breath, and skin responses. When anxiety is chronic, the physical symptoms can become persistent rather than situational.
Why does anxiety feel physical?
Because anxiety is, at its core, a physical response. The fight-or-flight response is a body experience (heart rate, muscle tension, breathing) that happens before and independent of conscious thought. Anxious thoughts are secondary to the body's threat response, not the other way around.
What is somatic anxiety?
Somatic anxiety refers to anxiety that is experienced primarily or predominantly through physical symptoms rather than cognitive ones. Some people have significant anxiety responses in the body like tension, digestive issues, fatigue, elevated heart rate, without much of the ruminating thought pattern typically associated with anxiety. It's not a formal clinical diagnosis but a useful way of describing this presentation.
What if my doctor says nothing is physically wrong?
If you've done a thorough medical workup and everything is coming back clear but symptoms persist, the nervous system is worth exploring. Unexplained physical symptoms that have been medically cleared are often a sign that the body is carrying anxiety, and therapy, particularly somatic approaches like EMDR, can help address that directly.
Does EMDR help with physical symptoms of anxiety?
Yes. EMDR works at the level of the nervous system rather than just at the cognitive level, which makes it particularly effective for anxiety that is primarily physical. It addresses where anxiety actually lives rather than just trimming the surface experience.
Should I see a therapist or a doctor for physical anxiety symptoms?
Both, ideally, and in the right order. Start with your primary care physician to rule out any underlying physical causes. If the workup comes back clear and symptoms persist, that's when therapy becomes particularly important. The two are not mutually exclusive — bodywork like chiropractic care and massage can also be a meaningful part of anxiety treatment alongside therapy.
Related Resources
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Hello. Hello. Hello, friends, welcome to the podcast where we simplify everything about mental health. Just kidding. But here's what we are gonna do. We're gonna sit down together a licensed mental health professional, that's me and a regular old Joe as my husband Garth would describe himself. We're gonna talk about the nitty gritty of EMDR, some nervous system mapping, how couples can help each other heal. What's healthy parenting actually look like? Maybe a little bit of good old banter mixed in. All with the goal of making mental health a little bit simpler for you. Quick note, because my lawyer says that I have to, I'm a therapist, but not your therapist. Unless I am. Even if I am. This is still just a podcast. Okay, now have a good listen. Hello, friends. We are moving along in our anxiety series today. We are talking anxiety and physical symptoms. Does the body actually keep the score? Bum, bum, bum. Garth there's a big controvershy- controversy right now regarding the body keeps the score book. We're not gonna really talk about that today, but I just wanna throw that out there. Mm. Ooh. What is it? I, I, I don't even know. Okay. I mean, I do, but it's... I don't know how to explain it really quickly. Gotcha. But we are gonna be talking about physical symptoms of anxiety today, and before we really roll into it, bant us away, sir. Man, okay. So- Favorite musician or music group of all time I genuinely have no idea Yeah, I figured. I figured you wouldn't You know the lyrics to everything you've ever heard, but could not tell a soul who sung it or what band or what the name of the song is. Mm-hmm. It's impressive. Yep. You can sing along to things. I'm like, "There's no way you've ever heard this song before," and you're just singing along, and I'm like, "Okay." I legitimately don't have to hear it more than once for it to just be, like, locked in. Mm-hmm. Whatever is happening in my brain that makes that happen, like I had a client just today actually that I had not seen for over a year. They were a returning client. Mm-hmm. And they were like, "Well, let me remind you of..." And I was like, "Yeah, I, I don't need reminded." Remind me. Yeah. It is, like, i- locked in there somehow. Mm-hmm. But yeah, couldn't, couldn't tell you who's singing the song who the band is. Don't know. Don't know. So anyway, yeah, I'm sorry. I think this might be the first band that I don't have an answer to. I mean, I could throw somebody out there- Inadequate answer ... but it just wouldn't be true. Yeah. Well, throw, throw one out there- I will tell you- ... so we get a sense of the style you're into. My favorite concert was probably Ed Sheeran just because- Mm-hmm ... I thought his looping was really, Yeah ... impressive. It was awesome. It was very performative and impressive, and- If I'm honest- ... he's not just a pretty face ... if I'm honest though- He knows his stuff ... Ed Sheeran was probably my second favorite concert, but I know that my first favorite concert, I know- Anyway, Garth really loves the Foo Fighters, loved the Foo Fighters, but was very let down by Dave Grohl's, Recent events ... recent events. Let's just leave it at that. Yeah. Not a great dad move, or a great partner move. I say not a great dad move, I mean- Yeah. To who? Right, right. The worst dad, worst dad move would've just been to completely ignore it, I guess. But anyway- Mm-hmm ... here we are. So how about you? Yeah, it's, it's gotta be my boys over at Coheed and Cambria. Knew it. Okay. Gotta be. I s- I don't necessarily guess your ban- Mm-hmm ... answers correctly as often- Often ... as I would like to. Yeah. But I had that one in my head. Yeah. Had it locked away. Yep. Okay. I've got their tour, tour dates pulled up. Next time they're in Kansas City or St. Louis, we're gonna have to, we're gonna have to go. Sorry, we're just gonna have to. Pop on over there. Yeah. Okay. Sounds good. All right, sir. We're doing the same format that we've done for the last two. All right. You've got the questions. I'm ready. Hopefully I have some answers. So if you wanna take us away with questions, I will start trying to answer them. Okay. A reminder, today's topic is anxiety and physical symptoms. Mm. Pretty much. Boom, boom, boom. I'm summarizing. So, question number one: I think a lot of people don't connect their physical symptoms to anxiety. What are we talking about? Okay. You have physical symptoms of anxiety. You have headaches. You have stomach issues, digestive issues. You have chronic muscle tension. I wanna loop back to that one. You have difficulty falling asleep, staying asleep, fatigue that does not relieve even when you do sleep well. So people will tell me, like, "My sleep score for my Oura Ring is really high, but I'm still feeling exhausted." You experience an elevated heart rate for no reason. Shortness of breath for no reason. Start to have skin responses like rashes for seemingly no reason. The body can really start to have some, I'm moving away from the microphone some pretty significant reactions as a result of anxiety. I wanted to loop back to mon- muscle tension because for folks with a- an anxiety disorder we'll say their body over time has become so tense that the body itself is starting to indicate to the body that it should be having an anxiety response because of the level of tension that it's in. Mm. Yeah. So this is where, you know, chiropractic care massage therapy. If you're in Springfield, Missouri, shout out Dr. Abigail Emory. She is wonderful. She is my chiropractor, and she is hiring a massage therapist the week of this recording, which is the beginning of August. So, going and relieving that muscle tension really is an, an efficacious re- which essentially just means, like, research-backed way to help you to manage anxiety. You will see faster symptom reduction if you do some physical things for that muscle tension alongside therapy. Yeah. So fun fact. Okay. That makes sense to me. That brings us to question number two you talked about. Sorry, you're just like, "I am rolling us along. I am not taking the bait on your long-winded answers today." Nope. Not today. Not today. Question number two. Okay. Why does anxiety show up in the body at all? What's the mechanism? You talked about it just now. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Why does anxiety show up in the body at all? Mm-hmm That's hard to answer because it's like anxiety is the body. Sure, yeah. It's, it's the body first. I think when we think of anxiety, we think of anxious thoughts, but the body is... Or I'm sorry, anxiety is body first, thoughts second. Mm-hmm. Does that make sense? Yeah. Like, why does it even show up in the body? It, it is the body. Like, it is- 'Cause it's where it is. It's there, yeah. Right, right. Like, it is the fight or flight response. Like, there's, Yeah. W- we do. We- I think maybe on a more, like, literal level, it shows up in the body because it's designed to protect you in situations where you may need to fight or flight, right? Fight or flee. Yeah, we talked about this in a previous episode, like, anxiety's not a bad thing. Mm-hmm. And I think, too, because we, for, for whatever reason, and I don't- I'm not sure if this is something that's come about as a result of, like, cognitive behavioral therapy. I don't know. But when we think of anxiety, we do think of anxious thoughts. Mm-hmm. And some people are confused because they come to me and they're describing anxiety symptoms, but they're not really having anxious thoughts. Some people don't- Mm-hmm ... get all the way there. Yeah. They have the body response without the, like, really cognitive response. Does that make sense? Mm-hmm. Yeah, for sure. They're, they're like- Yeah ... they're not having that ruminating thinking that we th- that we think of when we think of anxiety, but they are having that initial body response. Yep. Yeah. Okay, question number three. I, I should... I feel like I need some sort of, like, sound bite whenever I'm done, like, ding. When you're done you, you need a little ding. Yeah. Yeah. Okay, question three. You could just do that. All right. Now I'm just a little obsessed with it. Three, a lot of people have been told by doctors that nothing is wrong. What happens to them? Can you tell me more, more what you mean wh- about what happens to them? So a lot of people are having this anxiety, it's showing up in their body, and doctors are like, "You're fine. Nothing's broken. Everything's working like it should." What do they do then? Gotcha. So- The doc- the doctor said you're fine So like I'm having this intense stomach pain, but everything looks- They've run the tests like it's checking- Yeah ... out. Yep. Why, why is this happening? Mm-hmm. Yeah. So and, and then what, what happens to them? Like what, what's the next step? Yeah. Well, hopefully they come to therapy. Like Right ... I, I have a brochure that I hand out to doctor's offices, and it, the whole brochure is like when to know to refer your patient, and it's to EMDR specifically when to know, how to know when to refer your patient to EMDR. But one of the things that it talks about is having physical symptoms that are going unexplained. Mm-hmm. Right? And so unfortunately, oftentimes if somebody is dismissed, their symptoms do exacerbate quite a bit before they're addressed in therapy. Mm-hmm. But if you are having physical symptoms that you have done a thorough you've done your due diligence to have that addressed with like your primary care and everything's coming up seemingly fine consider therapy. Because I'm referencing back to what I said earlier, it is confusing for folks when they aren't having anxious thoughts, but they are having body responses to or they're having anxiety responses. That does happen. Mm-hmm. So if you're one of those people who's having those significant unexplained symptoms, but you're not having like the ruminating thoughts go to therapy. Come see us. Come go see somebody- Yeah ... that can start to kind of, walk through that with you. Yeah. Does that make sense? Does that answer the question? I think it does. Ding. And unfortunately, I, and maybe this is my perception, maybe you can help me here, doctors aren't always eager to refer out to mental health. Sometimes it's, "Oh, you have a stomach issue. I didn't find anything. You need to go see the specialist doctor," and it's not a referral to maybe mental health. Maybe that's just a cons- misconception that I have. Not a doctor, not a therapist, but- Yeah ... I don't know I do think because of how we generally pursue litigation in this country that like a primary care, for instance, would be more likely to refer to you know, a cardiologist when you're having chest tightness. Mm-hmm. Not in the present moment, but like when you describe having had it y- you know, Mm-hmm every two weeks fairly consistently. And also like, yeah, go to the car- but I, I want you to go to the cardiologist. Sure. Right? And when the cardiologist clears you, I want them to refer you to me. I guess I've never totally thought through that before. But yeah, I go see a lot of primary cares. I don't see a lot of specialists, but really if I'm a primary care, I'm sending somebody to the cardiologist. So anyway. Mm-hmm. Yeah, it makes sense to me. I, I don't think that primary cares, or that physicians in general are resistant to mental healthcare referrals And I do think they should do their due diligence- Mm-hmm ... bef- beforehand. Yeah. I don't think that primary cares are often very connected to private practice clinicians like myself- Mm-hmm that niche, that specialize in something. Mm-hmm. But that's not necessarily on them. Like, I think we as clinicians need to be working to make that connection. Yeah. Anyway, really got off there, so ding. That's what I'm here for. Yeah. Drive you off topic ... yeah, subbing myself out. All right. Okay. What's our next one? Question number four, is there a name for this, the anxiety that shows up as physical symptoms? Mm-hmm. Again, this would... So our last episode was on high functioning anxiety. That is not a clinical term. This is not a clinical term, so it's not, like, a diagnosis in the DSM5, but we would call it somatic anxiety or body-based anxiety. Again, folks that everybody has a physical experience with anxiety, but some people really only have a physical experience and don't have much of a cognitive experience. And no matter how much you notice the physical experience, the physical experience does come before the cognitive experience. Mm-hmm. Yeah. Mm-hmm. Okay. And it's also on a spectrum. Like, is that physical experience fleeting, or is it really worn on your body, and even when you're not in an immediate anxiety, stress response, you're still experiencing some significant symptoms like extreme muscle tension? Mm-hmm. Right? So everybody has that anxiety response, and then some people also notice a significant cognitive response. And then if that happens long enough, you're also going to experience more chronic symptoms like intense muscle tension. Did you follow there? Did I get- Mm-hmm ... off track? Okay. No, I think that answers it. It was a pretty straightforward question, so I think you answered it fully. Ding. Ding. Question number five. Okay. What does treatment look like when anxiety is mostly physical? Are there different things that you do? Yeah, this is why EMDR can be so helpful in addressing anxiety, right? Is because, again, not everybody gets to the cognitive part in a really significant way. So EMDR and other, like, somatic work focuses on the body, the nervous system. There is some thought work in EMDR as well. But we have to utilize something that can work at the place where the anxiety originated, where it lives. I use the imagery often, like, I want to pull up the weed. I don't want to just cut it off at the top, right? Mm-hmm. And so I think- Right ... addressing just cognitions trims the weed. Addressing where the anxiety lives, which is in the body, pulls the weed up. Mm-hmm. Yeah, you cannot separate anxiety from the body. We have known it as more of a cognitive-based experience, but it is, it does not start there. And for some people, it never gets there. Yeah. Ding. Ding. I need an actual physical bell. You do. I'll work on that. Mm-hmm. Okay. Last question. Okay. If you answer it quickly, we may be under 20 minutes for the first time in our lives podcasting. Whoa. What would you say- No pressure ... to someone who is convinced it's physical and not psychological? That there's something physically wrong with them and it's not anxiety causing these, these physiological symptoms Well, someone is really intent that something physical is going on, I am always going to encourage them to pursue talking to their primary care, talking to, you know, getting a referral for a specialist. Like, follow that intuition. And at the same time, we cannot separate body and mind. Like, it is a full system. Mm-hmm. If we have pursued things with our primary care and even specialists can we consider for a moment what the nervous system might be carrying? Hmm. Like, is, is that possible, right? Yeah. To, to just sit with that. So again, I'm, I'm always encouraging people, let's do our due diligence with primary care, as well specialists. But we cannot separate the body and the mind, and if you have been chronically anxious, your nervous system has had a ca- a heavy load to carry. Mm-hmm. I beat 20 minutes, but now you've gotta summarize for us. Go. Number one, I think a lot of people don't connect their physical symptoms to anxiety. What are we talking about? Number two, why does anxiety show up in the body at all? What's the mechanism? Number three, a lot of people have been told by doctors that nothing is wrong. What happens to them? Number four, is there a name for this anxiety that primarily shows up as physical symptoms? And number five, what does treatment look like when anxiety is mostly physical? And number six, what would you say to someone who's convinced it is physical, not psychological? Ooh. Still didn't make it. We're at 20:30. Wow. But it was close. Close. It was dang close. Folks, thanks so much for stopping in and having a listen with us. I really appreciate it. I know Garth does as well. We are genuinely just... I, I mean, we enjoy putting this podcast out and love that people sit down and, and listen to us every week. So, tell your friends, come back for another listen, and we'll talk to you soon. Bye. Well, that's all folks. Please see our show notes for ways to connect with us or go give us a follow on Instagram. You can find us at Simply Mental. If this episode resonated with you, send it over to a friend. Give us a five star rating. Subscribe. Download all the things the cool kids are doing these days. Thanks for having to listen.
About Cassandra Minnick
EMDR Intensive Therapy for Busy Professionals | Trauma & Anxiety Treatment | Licensed Professional Counselor, EMDRIA Certified
I'm an EMDRIA-certified EMDR therapist with over a decade of experience helping adults understand and heal from chronic trauma. My practice focuses on the often-confusing patterns that emerge in adulthood—the behaviors, reactions, and relationship dynamics that don't make sense until we trace them back to their origins.
Chronic trauma doesn't always look like what we expect. It shows up in how we respond to conflict, how we relate to ourselves, and in the persistent feeling that something is "off" even when life looks fine on the surface. I work with clients to make sense of these patterns and create lasting change through EMDR therapy.
I specialize in EMDR intensive therapy—a condensed format that works particularly well for busy professionals who need effective treatment without the commitment of weekly sessions stretched over months or years.
I've been practicing EMDR since 2016, and I'm passionate about helping people move from survival mode to actually living their lives. When you've spent years adapting to trauma, reclaiming yourself is both powerful and possible.
