Somatic Anxiety: When Symptoms Are Physical

Anxiety doesn’t always appear as feelings of worry or fear. It can also cause real physical symptoms, including pain, chest tightness, stomach problems, dizziness, fatigue, and tense muscles. 

For older adults, physical body symptoms of anxiety — known as somatic anxiety — aren’t just a part of getting older, and these symptoms deserve both appropriate medical attention and compassionate support. 

What physical symptoms of anxiety can feel like

Anxiety can affect your body through the fight-or-flight stress response, even when you wouldn’t describe yourself as worried. 

Physical anxiety symptoms can affect several body systems, including:

• Heart and breathing: Shortness of breath, fast breathing, racing or pounding heart, sweating, and chest tightness
• Digestion: Stomach pain, nausea, diarrhea, loss of appetite, and indigestion
• Muscles and pain: Tension headaches, tight muscles, and pain that you can’t explain
• Balance and dizziness: Weakness, shakiness, lightheadedness, feeling hot, and tingling in your lips or fingers
• Sleep and fatigue: Feeling tired, waking up frequently, difficulty falling asleep, and brain fog

It’s important to note that chest pain, shortness of breath, fainting, new severe pain, or sudden changes to your health should be evaluated by a healthcare provider. While anxiety can cause physical symptoms, don’t assume that anxiety is the cause without having a doctor rule out other explanations. 

If you’ve gone through the tests and blood work, and everything comes back normal, it doesn’t mean your symptoms are fake. What it means is the cause of your symptoms is stress or anxiety-related and tied to the nervous system, rather than a structural problem in the body. 

Older adults often feel anxiety in the body first

Older adults are more likely to have physical instead of emotional symptoms of anxiety compared to younger adults, according to a 2019 study in the Asian Journal of Psychiatry. Instead of saying, “I feel anxious,” older adults may describe distress through physical discomfort, sleep changes, fatigue, restlessness, or pain.

Trying to differentiate somatic anxiety symptoms from a physical medical concern can be difficult in older adults. There are a lot of different factors at play that can all make the anxiety-body connection harder to interpret, including chronic health conditions, medication side effects, bereavement, loneliness, falls, caregiving stress, and loss of independence.

This doesn’t mean physical anxiety symptoms should be brushed off in older adults. Often, older adults need a “both/and” approach — to rule out medical causes and also consider anxiety. 

If you or a loved one has made multiple visits to the emergency department or doctor’s office for physical symptoms, only to be told that nothing is wrong, it doesn’t mean you’re overreacting. But it can lead to a medical workup loop, where repeated appointments and normal test results provide only temporary reassurance while the nervous system continues to signal that something is wrong. These visits don’t resolve the underlying fear.

Somatic anxiety vs worry and health fears

Somatic anxiety refers to anxiety that shows up mainly through the body rather than through thoughts. This is different than cognitive anxiety, which looks more like racing thoughts, dread, worry, or trouble concentrating.

Older adults can have physical anxiety symptoms without feeling anxious. Your body can stay on alert even when you’re unable to consciously identify feelings of fear or worry. 

Somatic anxiety can also overlap with other similar disorders such as somatic symptom disorder and health anxiety:

• Somatic symptom disorder is when there’s an excessive amount of worry or attention to physical sensations that disrupt daily life. 
• Health anxiety is focused on the fear of illness itself, and isn’t just about physical sensations.  

How the anxiety-body cycle keeps symptoms going

Here’s how you can picture the anxiety-body cycle: 

1. A sensation comes, such as a racing heartbeat
2. That sensation causes you to pay close attention to it, which can lead to closely monitoring the sensation or becoming fearful that something is wrong
3. The fear kicks up the nervous system, which can cause the original sensation to feel more intense
4. This can lead to more fear

In daily life, this cycle might look like checking your pulse repeatedly after noticing palpitations (when your heart feels like it’s racing or skipping a beat). It might be that you start avoiding walks after one of your walks ended with a dizzy spell. You may notice you start sleeping poorly because nighttime sensations feel louder in the quiet darkness. 

Your feelings are valid, but unfortunately, avoiding activities and situations can shrink life over time. You may start running fewer errands, which leads to less time out of the house, which can cause you to move less, and this can lead to isolation and more symptoms. 

Ways to calm the body’s anxiety response

First and foremost, it’s always a good idea to get new or changing physical symptoms medically checked. Then, if anxiety is part of the picture, therapy can help reduce that fear response. 

Therapy can also help you learn to recognize patterns and triggers, reduce the fear of bodily sensations, help you feel more confident in your body, and respond differently when symptoms flare. 

Whether you try them on your own or in conjunction with therapy, there are some do-it-yourself body-level strategies you can try, including:

• Paced breathing: Slowing down your exhale while breathing can help signal your nervous system that you’re safe. 
• Grounding techniques: Use your senses to anchor your attention in the present moment so your body can focus on what’s in front of you versus the racing thoughts.
• Progressive muscle relaxation: Tensing and relaxing muscle groups helps teach the body to recognize muscle tension and learn to release it. 
• Gentle movement: Exercises like short walks, swimming, and tai chi have been shown to improve your mood and lower anxiety, according to a 2026 study in the journal Sports Medicine and Health Science. 
• Having a cozy sleep routine: Sleep and anxiety can also affect each other, like the anxiety-body cycle. Signal to your body it can start to relax and get tired for bed by having a regular bedtime, and build in activities that help you relax. This might include a warm bath, reading by a fireplace, or listening to calming music. 
• Reducing symptom-checking: Place limits for yourself, such as reducing how often you check your blood pressure or pulse out of worry.  

When to get help for physical anxiety symptoms

It’s worth seeking therapy for physical anxiety symptoms — it doesn’t mean anything is medically wrong, and it certainly doesn’t mean the symptoms aren’t real. 

Some signs it might be time for additional support include: 

• Symptoms keep returning, and medical tests haven’t found a clear cause
• You’re avoiding activities you enjoy because of symptoms
• Reassurance doesn’t last long before the symptoms return
• Sleep is becoming affected
• Family members notice a growing fear or withdrawal

Adult children may notice signs such as repeated doctor visits, frequent phone calls about symptoms, or increased fear after a health scare. 

How Sailor Health can help

When anxiety shows up as physical pain, dizziness, or chest tightness, breaking the pattern takes more than just being told your medical tests came back normal. Therapy can help calm an overactive nervous system, ease the fear around physical sensations, and help you feel confident in your body again.

Fortunately for those worn out by doctor appointments and medical tests, getting mental health support doesn’t require driving across town or sitting in another waiting room. Sailor Health makes therapy easier to access directly from home, with therapy sessions available by video or phone call, including traditional landlines.

Our therapists are experienced older adults themselves who understand the unique ways mental health changes in later life, especially when anxiety speaks through physical symptoms rather than conscious worry. We’ll match you with a therapist who fits your needs and preferences, and you may be able to begin therapy as soon as 24 hours after signing up.

All of our providers take Medicare, and most of our Medicare patients have a $0 copay. If physical anxiety symptoms are making daily life feel stressful or overwhelming, support may be easier to reach than you think. Reach out when you’re ready, and we’ll help you take the first step.

Somatic anxiety FAQ

Can anxiety cause physical pain in older adults?

Anxiety can cause physical pain in older adults, which is known as somatic anxiety. An older adult may not feel worried or fearful, but might have physical symptoms of anxiety such as chest tightness, fast heartbeat, and shaking. 

What’s the difference between somatic anxiety and health anxiety?

Somatic anxiety is when you or your loved one has physical symptoms of anxiety, whereas health anxiety is worry and focus on the illness itself. Somatic anxiety and health anxiety can overlap. 

Should older adults see a doctor before assuming symptoms are anxiety?

It’s always a good idea to get physical symptoms medically checked, such as chest pain, shortness of breath, or numbness and tingling. Then, if any medical causes are ruled out, somatic anxiety can be considered. 

How can therapy help with physical symptoms of anxiety?

Therapy can help you manage physical symptoms of anxiety by reducing the fear of body sensations, rebuilding trust in your body, and recognizing patterns and triggers for anxiety. 

Does Medicare cover therapy for anxiety symptoms in older adults?

Medicare covers therapy for anxiety symptoms in older adults — even if you aren’t actually feeling worried. Somatic anxiety can happen to anyone, especially with older adults, and help is available. 

References

1. Grover, S., Sahoo, S., Chakrabarti, S., & Avasthi, A. (2019). Anxiety and somatic symptoms among elderly patients with depression. Asian Journal of Psychiatry, 41, 66-72. doi:10.1016/j.ajp.2018.07.009. https://www.sciencedirect.com/science/article/abs/pii/S187620181830515X
2. Wetherell, J. L., Ayers, C. R., Nuevo, R., Stein, M. B., Ramsdell, J., & Patterson, T. L. (2010). Medical conditions and depressive, anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder. Aging & Mental Health, 14(6), 764. doi:10.1080/13607861003713240. https://pmc.ncbi.nlm.nih.gov/articles/PMC4066633/
3. D'Souza RS, Hooten WM. Somatic Symptom Disorder. (2023). StatPearls [Internet].  https://www.ncbi.nlm.nih.gov/books/NBK532253/
4. Merck Manual. (2026). Illness Anxiety Disorder. https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/illness-anxiety-disorder
5. Fang, Z., Qian, Y., Sun, S., Qin, H., Zhu, Y., Tang, J., Chen, S., & Luo, Z. (2026). Mechanisms of exercise against anxiety disorder: A review of the research progress. Sports Medicine and Health Science, 8(2), 145-152. doi:10.1016/j.smhs.2025.09.005. https://www.sciencedirect.com/science/article/pii/S2666337625001052
6. Chellappa, S. L., & Aeschbach, D. (2022). Sleep and anxiety: From mechanisms to interventions. Sleep Medicine Reviews, 61, 101583. doi:10.1016/j.smrv.2021.101583. https://www.sciencedirect.com/science/article/abs/pii/S1087079221001684