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Persistently worried or think you may have generalised anxiety disorder (GAD)? Here’s how it could be affecting you physically, along with expert tips, techniques & self-care strategies that may help 


Anxious thoughts – they’re all in your head, right? Not necessarily. While worrying about bills that need paying and looming deadlines is normal, anxiety – the kind that persists and causes real emotional distress (and can develop into GAD) – can impact on our physical and mental health. While you may experience both psychological and physiological symptoms of GAD, here, we focus on the potentially lesser-known physical symptoms of the disorder, and speak to Dr Jon Van Niekerk, a member of the General Adult Faculty at the Royal College of Psychiatrists, who answers our most niggling questions on anxiety in a bid to (quite literally) help put our minds at ease. 


If you do find yourself experiencing any of the below symptoms, it's always worth visiting your GP who may carry out a physical examination and advise blood tests in order to rule out other conditions first. If there are no underlying health issues, psychological therapies may be suggested or you could be referred to a specialist.


What is anxiety?


‘Anxiety is a word we use to describe the unpleasant feeling we get when we're in a stressful, threatening or difficult situation, or are facing a problem,’ explains Dr Niekerk, adding that although worry, fear and anxiety are unpleasant, they can be helpful because:


• They psychologically keep us alert and give us the “get up and go” to deal with problems


• They make our body physically ready for action, helping us to run away from danger or  to attack it – known as the “fight or flight” response. 


When it comes to anxiety, what’s normal & what’s not?


It’s totally normal to have feelings of anxiety at some point in your life. During stressful situations, such as sitting an exam or having a job interview, feeling anxious can be particularly common. However, if you’re dealing with more constant feelings of anxiety, then it’s helpful to be mindful of it and to seek advice from your GP.


‘Signs that it could become a problem include your anxiety feeling very strong, feeling anxious all the time and feeling anxious for no obvious reason,’ says Dr Niekerk. ‘When this happens, anxiety can make you feel constantly uncomfortable, stop you from doing the things you want to, and make it difficult for you to enjoy life.’


When should you contact your doctor?


‘Anxiety is very common and many of us overcome it or cope with it without professional help. However, if it’s severe or goes on for a long time, anxiety can affect your physical health,’ says Dr Niekerk. 


Generalised anxiety disorder is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed.


According to the NHS, the severity of symptoms varies from one person to the next. Some people experience only one or two, while others may experience more. As always, see your GP if anxiety is affecting your daily life or is causing you distress.


Dr Niekerk agrees: ‘Speak to your GP if you’re having difficulties with your anxiety. They may be able to refer you for further treatment, such as cognitive behaviour therapy, or prescribe medicine.’


What physical symptoms are linked to GAD?

Dizziness

‘Patients generally complain of a sense of motion or vertigo – this is the sense that things around you are spinning. You can feel faint or lightheaded, and some patients complain that they feel unsteady or that their balance is affected,’ explains Jon. ‘It’s thought that breathing changes related to anxiety, such as rapid deep breathing, reduces the level of carbon dioxide in your blood. It can also be caused by the release of adrenaline when you’re feeling symptoms.’ 


One way of dealing with this symptom? ‘Slow down your breathing to allow you to focus your thoughts on something else,’ says Jon. ‘It’s also important to ensure that there’s not a physical cause of dizziness. It’s recommended that you meet with your GP to determine the cause.’


Sleep difficulties 

‘Anxiety can make it hard to fall asleep and stay asleep through the night,’ says Dr Niekerk. ‘It’s important to also note that sleep difficulties in themselves can also cause anxiety – and even more specifically, sleep anxiety (worrying about falling asleep), which can exacerbate the insomnia cycle


‘To help, you should first practice good sleep hygiene. If this doesn’t help, make sure to see your GP for further consideration of treatment options,’ says Dr Niekerk. ‘It’s important to ensure that there’s not a physical cause of insomnia and anxiety.’


Are your worries keeping you up at night? You might find our guide to night-time anxiety helpful.


Trembling, sweating & shortness of breath

‘While these are separate symptoms, they’re all related to the activation of the Autonomic Nervous System (ANS),’ explains Dr Niekerk. In a nutshell, the ANS is part of the peripheral nervous system that regulates involuntary physiologic processes that include heart rate, blood pressure, respiration, digestion and sexual arousal. ‘This releases stress hormones that prepare us for a fight or flight situation. When these hormones are activated, the heart rate increases and pumps more blood to the organs. This also causes us to breathe faster, which can result in shortness of breath,’ says Dr Niekerk, who advises that relaxation techniques and doing regular exercise can help. 


‘It’s also important to ensure that there’s not a physical cause of shortness of breath, sweating and chest pain. Seek immediate medical advice and care if you develop chest pain or severe shortness of breath,’ he adds.


Change in bowel habits

‘Activation of the ANS can also affect the digestive system, which can cause problems with nausea, vomiting, stomach ache, feeling bloated, heartburn, constipation, diarrhoea and bowel spasms,’ says Dr Niekerk. 


If anxiety tends to make you feel sick, some things that may help include getting some fresh air, distracting yourself (for example, listening to some music), taking sips of a cold drink or ginger or peppermint tea, or eating foods with ginger. 


Headaches

‘Most types of headaches (tension headaches, migraines and cluster headaches) can all be triggered and associated with anxiety,’ says Dr Niekerk. ‘However, headaches in themselves can also cause anxiety,’ he adds. ‘If you experience severe headaches or migraines, it’s important to see your GP to clarify what type of headache you’re suffering from.’


The next time you get a headache – and migraines and something more serious have been ruled out – try to relax, get some rest, drink plenty of water and consider taking some paracetamol or ibuprofen.


Heart palpitations

‘Patients sometimes report they feel like their heart is pounding, racing or skipping a beat,’ says Dr Niekerk. ‘Heart rates tend to increase when people are anxious during a stressful response.’ 


The good news? ‘While heart palpitations can cause alarm, they aren’t usually dangerous,’ says Dr Niekerk. However, seek urgent medical attention if you experience shortness of breath, chest pain, dizziness or confusion accompanying palpitations to ensure there’s not a physical reason for them.


Muscle aches & tension

‘Muscle aches and tension can be caused by anxiety,’ says Dr Niekerk. ‘This is because anxiety can lead to muscles tensing up.’ What can help? ‘Relaxation techniques and regular exercise may again help here,’ he says.


Discover how you can manage your own mental health by the mental health experts themselves. 


Dealing with anxiety


Dr Niekerk suggests the below measures:


Talk about it: This can help when the anxiety comes from recent knocks, like a partner leaving, a child becoming ill or losing a job. Who should you talk to? Try a friend or relative who you trust and respect, and who’s a good listener. They may have had the same problem themselves, or know someone else who has.


• Self-help groups: These are a good way of getting in touch with people who have similar problems. They can understand what you’re going through. As well as having the chance to talk, you may be able to find out how other people have coped. Some of these groups are specifically about anxieties and phobias. Others may be for people who have been through similar experiences, such as women’s groups, bereaved parents’ groups or survivors of abuse.


• Learning to relax: If anxiety doesn’t go away, it can be really helpful to learn some coping techniques and ways of relaxing to help be more in control of your anxiety and tension, such as meditation and breathing techniques. It’s a good idea to practise relaxation regularly, not just at times of crisis.


How can Boots help?


There are a range of mental health services* available online, offering tools and treatment options to suit your specific needs. These services can be accessed conveniently from the comfort of your own home, from How Are Things? Mood & Symptom Checker, Livi Talking Therapies and SupportRoom to Boots Online Doctor Depression & Anxiety Treatment


If you’re experiencing a mental health crisis or are at risk of harming yourself or others, please call 111, speak to your GP or the Samaritans on 116 123, or text Shout on 85258.

*Eligibility criteria and charges apply. Treatments provided by Boots Online Doctor are subject to an online consultation with a clinician to check suitability.