8 Symptoms Doctors Often Dismiss As Anxiety

When Vanessa Walilko was in her late 20s, she got strep throat—and then she got it again and again. Because she’s allergic to strep bacteria, she says her illness turned into scarlet fever several times within a few months. Soon, she started having heart issues. After spending a day in the sun selling jewelry at an art fair, she nearly passed out. A friend rushed her to the emergency room, where a doctor asked if she had a family history of people dropping dead in their 20s. When Walilko said no, the doctor told her to learn to better manage her stress and sent her home.

“I don’t know if I can convey how smug and flippant he was,” recalls Walilko, 41, who lives in Evanston, Ill. “It was unreal—I was so glad my friend was there with me, because I was pretty delirious. I had to check with her: ‘Did I catch all that?’”

Walilko knew something was wrong—yet says clinicians continued to brush off her symptoms. After doing internet research, she figured out that her boyfriend was likely a strep carrier, which meant he was harboring strep bacteria in his throat while remaining asymptomatic. Seven different doctors dismissed her theory, she says, before one finally agreed to test Walilko’s boyfriend—who was positive for strep.

That unlocked the key to her physical recovery, though the emotional scars lingered. “We should be able to put our faith in doctors,” she says. “If something is cut-and-dried, like a broken bone, a heart attack, or cancer, doctors are like, ‘Great. We have a plan.’ But if it’s something that requires nuance and thinking outside their training, they kind of freak out and dismiss it.”

Walilko’s experience isn’t unique: Researchers, clinicians, and patients alike have found that doctors routinely dismiss real medical symptoms that have nothing to do with mental health as anxiety. Across the internet, people have shared viral stories about medical gaslighting, describing the ways that doctors chalked up their symptoms of appendicitis, heart conditions, or even cancer to anxiety.

Why do doctors assume it’s anxiety?

There are a variety of reasons why this is a common occurrence, says Dr. Robert Gee, assistant dean of student affairs and a behavioral sciences professor at Ross University School of Medicine. Anxiety symptoms overlap with those of other medical issues, which makes it easy for both patients and clinicians to mistake a physical condition for one related to mental health, he points out. And if a patient has a history of anxiety, their provider will typically be even quicker to assume that physical symptoms are a recurrence, rather than a sign of something new.

Other research has found that clinicians’ lack of knowledge is partly to blame. Limited time with patients also plays a role. “This is a huge factor for physicians,” Gee says. Some might lean toward an anxiety diagnosis because it seems like the simplest explanation, especially when symptoms are vague—like “I’m so tired all the time”—and when diagnostic tests don’t provide a clear explanation. “It’s complicated,” he says. “Some illnesses begin with mild symptoms that look a lot like anxiety before clearer signs appear.”

Read More: When Should I Go to the Doctor With Cold Symptoms?

The consequences of a misdiagnosis can be significant. “Patients may suffer longer, without proper treatment, which can make their health worse,” Gee says. “Ironically, being told it’s ‘just anxiety’ can make them even more anxious, since they have to worry that their concerns aren’t being taken seriously.” This loss of trust can dissuade people from seeking further care, he adds.

We asked experts which symptoms are most likely to be misdiagnosed as anxiety.

Digestive problems

Anxiety can cause your stomach to lurch up and down, making you nauseous and leading to cramping, bloating, or diarrhea. But so can food-borne illnesses, gastroesophageal reflux disease (GERD), gallbladder problems, irritable bowel syndrome, peptic ulcers, and any number of other gastrointestinal issues. An endoscopy, stool test, or ultrasound can help pinpoint an accurate diagnosis. So can asking the right questions, says Dr. Monika Roots, a psychiatrist who’s co-founder and president of Bend Health, which provides pediatric mental-health care.

Roots often sees kids who have been referred by their pediatrician for anxiety—but who are actually experiencing something else, like a stomach issue. She makes it a point to ask: “Do you feel like this all the time, or only when you’re stressed, like if you have a test at school? Are there specific foods you’ve noticed that change how your stomach feels? Are you super tired all the time? Are you vomiting?” The answers can help reveal whether something else is being overlooked. If she suspects mental health is not the culprit, she collaborates with the patient’s primary care doctor to ensure the child receives more in-depth testing.

A racing heart

If your heart is pounding rapidly—more than 100 beats per minute—or feels like it’s fluttering, you very well might be experiencing anxiety. When you’re in a state of high arousal and stress, your fight-or-flight response kicks in, leading to an uptick in heart rate. Yet it’s also possible you’re experiencing a cardiac issue, says Dr. Saima Shikari, a women’s health cardiologist at the VCU Health Pauley Heart Center. “It could indicate an arrhythmia or an issue with your thyroid,” she says. (People with hyperthyroidism often experience a rapid heartbeat.) 

Many of Shikari’s patients are women with symptoms of heart disease who were initially misdiagnosed with anxiety. “Unfortunately, a lot of women get told that when they’re having palpitations, they’re having anxiety,” she says. “If you happen to go to the doctor when you’re not having your symptoms at that moment, I can understand how people would say, ‘Well, maybe it isn’t coming from your heart.’” That’s why it’s helpful to track your symptoms, especially by using a wearable. You’ll be able to tell your doctor, “‘This is what my Apple Watch showed,’” she adds.

Chest pain

Anxiety can make your chest feel tight, like your insides are burning or being squeezed. But chest pain could also indicate a heart attack, or it might be caused by acid reflux, a lung condition, or even asthma, Gee says. Clinicians can use EKGs, chest scans, or tests for acid levels to rule out these conditions—while also checking in on stress levels.

Read More: How Stress Affects Your Heart Health

“This is something I think clinicians in general struggle with: asking the patient’s perspective,” Gee says. “What we want is for patients to tell us, in their own words, what they think might be happening with their chest pain: any alleviating factors, any aggravating factors, any antecedents, any consequences from their various activities, and how it’s impacting them at home and at work and their activities.”

Fatigue or weakness

Feeling tired all the time is one of the most common—and vague—symptoms that patients describe. There’s no single test to determine the root cause of fatigue, which is why doctors often blame it on anxiety or depression. “Fatigue is unfortunately a sign of multiple different things,” Shikari says. “You can have fatigue because you have congestive heart failure, and you’re not pumping blood as efficiently as you need to. You can have fatigue because you have an arrhythmia, and your heart is in overdrive. You can have fatigue because your thyroid isn’t working the way that it needs to, so you’re really tired. You can have fatigue because you have a GI disorder and you’re malabsorbing things and are nutritionally deficient.” 

Read More: What to Do if You Have Sleep Apnea

Relentless fatigue could also indicate diabetes, insomnia, or chronic fatigue syndrome, among other conditions. Ideally, an exam will include a thyroid test, blood sugar check, and sleep study to zero in on what’s really driving it.

Shortness of breath

If you’ve ever had intense anxiety or a panic attack, you understand what it’s like to feel like you’re gasping for air. While shortness of breath is a common mental-health symptom, it can also indicate a respiratory condition like asthma, chest infection, or an array of heart problems, among other potential concerns. “Shortness of breath is what we call an anginal equivalent,” Shikari says. “Some people don’t have chest pain—they have shortness of breath, and that’s a sign of having a heart attack. Shortness of breath can also come along with heart failure or an arrhythmia.” That’s why it’s so crucial for doctors to run thorough tests, she says.

Migraines or severe headaches

Headaches can certainly be stress-related; how many times have you had to pop a Tylenol after a rough day at work? But they “can also signal vascular issues,” says Dr. Sam Setereh, a staff cardiologist at Cedars-Sinai Medical Center and senior clinical researcher at the National Heart Institute. For example, a headache could point to a transient ischemic attack or a condition like epilepsy, multiple sclerosis, or fibromyalgia. 

Head pain is also associated with sinus problems, vision issues, and high blood pressure—which is why it’s important for doctors to take a detailed history and order tests like an MRI or CT scan, Setereh says. If you suffer from frequent headaches, tracking details like when they start, how long they last, and how severe they get can help your doctor pinpoint the cause.

Dizziness or lightheadedness

In the throes of anxiety, you might feel like the world is spinning. But vertigo can also point to inner-ear issues, low blood sugar, anemia, or a sudden drop in blood pressure. “There could be a neurological basis or some kind of nerve issue or a syndrome like epilepsy,” Gee says.

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Plus, dizziness is associated with conditions that are traditionally difficult to diagnose, like multiple sclerosis. Ideally, doctors should test your ear function, check your blood pressure, and look into your blood sugar and iron levels, Gee adds.

Sweating, flushing, or feeling hot 

Anxiety can trigger sweating and flushing, especially during panic attacks. But conditions like an overactive thyroid, menopause, or early onset of a serious infection can, too, Gee says. Blood work, including a thyroid test and hormone test, can help doctors figure out the best course of action. So can active listening. “Communication skills are absolutely critical in this,” he says. 

Gee recommends doctors ask open-ended questions and make it clear that they’re hearing what patients say while remaining nonjudgmental. That can encourage people to share not only the details of their current illness, but also their social history, family history, and past medical history, he says—all of which can be illuminating. “I’m a seasoned clinician, and I myself have to catch myself in making a quick judgment about, ‘Oh, I’ve seen this before,’” he says. “You have to keep an open mind.”