My Doctor Says It's Just Anxiety: When Chronic Illness and Anxiety Coexist

Oct 12

16 min read

Woman undergoing a medical examination with her doctor during a healthcare appointment.

When physical symptoms remain unexplained, anxiety can become part of the conversation. But what happens when it becomes the entire explanation?

You have been dealing with symptoms for months, perhaps even years. You've kept track of what you're experiencing, attended appointments, completed testing, and followed recommendations. You've tried to be patient, reasonable, and open-minded.

And yet, you still don't have answers.

Then, during another appointment, you hear something that has become painfully familiar: “It's probably just anxiety.”

If you've ever left an appointment thinking, “My doctor says it's just anxiety, but something still doesn't feel right,” you're not alone in struggling to make sense of that experience.

Perhaps your physician suggests depression. Maybe your test results have come back normal, and you're told that stress could be contributing to your symptoms.

You may even agree that you're anxious. How could you not be? Your body is behaving in ways you don't understand, your daily life has changed, and you're becoming increasingly concerned about what might be happening.

But there's something unsettling about the conversation.

You came looking for help understanding your physical symptoms. Somehow, the focus has shifted to your emotional response to having them.

And now you're left wondering whether your physician believes you.

For people living with chronic illness, especially those with complex, rare, or difficult-to-diagnose conditions, this experience can create a painful divide between patients and the healthcare professionals they depend upon.

The difficulty is that anxiety and physical illness are not mutually exclusive. They frequently coexist, influence one another, and sometimes produce remarkably similar symptoms.

Understanding that relationship requires us to move beyond the assumption that symptoms must be either physical or psychological.

Sometimes, both are part of the picture. And sometimes, important pieces of that picture remain undiscovered.

Why Anxiety and Chronic Illness So Often Travel Together

Living with chronic illness can create a degree of uncertainty that is difficult to appreciate unless you've experienced it.

You may wake up not knowing how your body will function that day. Symptoms that were manageable yesterday may become overwhelming today. Plans are made with qualifications. Work, relationships, finances, and even ordinary household responsibilities can become complicated by limitations you never anticipated.

There may also be the constant mental work of managing an illness: researching symptoms, tracking medications, arranging appointments, navigating insurance, and trying to determine which changes deserve medical attention.

Over time, this can take a significant psychological toll.

Anxiety may develop around the unpredictability of symptoms, the possibility of further deterioration, or the fear that an important medical problem has been overlooked.

Depression may emerge as someone struggles with persistent pain, reduced functioning, isolation, or the loss of activities and roles that once provided meaning.

These emotional responses are not evidence of personal weakness. Nor are they necessarily indications that the physical illness is being caused by a mental health condition.

They may be understandable responses to living with something that has fundamentally changed the experience of everyday life.

And yet, anxiety and depression are also legitimate clinical conditions that deserve attention in their own right.

A person experiencing chronic illness can benefit tremendously from counseling, appropriate psychiatric care, and psychological coping strategies.

The problem arises when identifying anxiety or depression becomes a reason to stop considering other explanations.

Anxiety may be a consequence of illness, a contributor to symptom severity, an independent condition, or some combination of these.

Determining how these factors interact requires curiosity rather than premature conclusions.

When Anxiety Begins in the Body

We often think of anxiety as beginning with a thought.

Someone worries about something, their brain perceives danger, and their body responds. Their heart races, their breathing changes, their muscles tighten, and they may begin to feel shaky or lightheaded.

But the relationship between the body and the brain also works in the other direction.

Sometimes, physical changes occur first.

A person experiences a racing heart, dizziness, trembling, or an unusual sensation of internal agitation. The brain then attempts to interpret those sensations.

Why is my heart pounding?

Something doesn't feel right.

Am I about to faint?

These thoughts may increase distress, which can further intensify the physical sensations.

This feedback loop can occur in anxiety disorders, but similar physical sensations can also arise from medical conditions that are not primarily psychiatric.

Understanding the difference matters.

Dysautonomia, POTS, and Symptoms That Resemble Anxiety

The autonomic nervous system regulates many functions that occur without conscious effort, including heart rate, blood pressure, digestion, temperature regulation, and aspects of the body's stress response.

When this system isn't functioning as expected, people may experience symptoms that overlap with those commonly associated with anxiety.

One example is postural orthostatic tachycardia syndrome (POTS), a form of orthostatic intolerance associated with an excessive increase in heart rate upon standing, along with symptoms that may include dizziness, palpitations, fatigue, exercise intolerance, and cognitive difficulties.

Some individuals with POTS also experience tremulousness, sweating, and other adrenergic symptoms. A subset has hyperadrenergic features, although the mechanisms and presentations of POTS vary considerably.

Imagine sitting in a physician's office describing episodes of a racing heart, shakiness, and feeling suddenly overwhelmed.

Those symptoms could reasonably prompt a clinician to consider anxiety.

But they may also warrant evaluation for autonomic dysfunction or other physical conditions, depending on the patient's history, examination, and clinical findings.

The challenge is that the symptoms can look similar from the outside, even when their underlying mechanisms differ.

And, importantly, someone with POTS can also experience anxiety.

The presence of one does not rule out the other.

Chronic Pain and the Body's Stress Response

Chronic pain creates another complicated relationship between physical and psychological experiences.

Pain is not simply a sensation that occurs in isolation. It involves the nervous system, attention, emotional processing, previous experiences, and the body's protective responses.

When pain persists, people may become increasingly alert to bodily sensations or situations associated with worsening symptoms.

They may find themselves bracing for pain, sleeping poorly, experiencing muscle tension, or having difficulty tolerating additional stress.

In some cases, heightened nervous system sensitivity contributes to an ongoing cycle in which pain and distress reinforce one another.

This does not mean the pain is imaginary.

It means that the nervous system participates in both the experience of pain and the body's response to perceived threats.

Psychological treatments can help reduce distress, improve coping, and sometimes lessen pain-related disability. But responding to treatment does not establish that the original pain was psychological in origin.

The brain and body are connected. They are not competing explanations.

When Your Doctor Says It's Just Anxiety: The Risk of Diagnostic Overshadowing

There is a meaningful difference between considering anxiety as part of a differential diagnosis and allowing it to overshadow other medical possibilities.

Clinicians must consider common explanations for symptoms. Anxiety can cause significant physical symptoms, including chest discomfort, gastrointestinal changes, dizziness, fatigue, and palpitations. It would be inappropriate to dismiss those possibilities simply because a patient believes something physical is wrong.

But the reverse is also true.

When someone already has a diagnosis of anxiety or depression, there can be a tendency to interpret subsequent physical complaints through that existing diagnosis.

This phenomenon is called diagnostic overshadowing.

Diagnostic overshadowing occurs when symptoms are incorrectly attributed to an existing condition, particularly a mental health condition, rather than being evaluated on their own merits.

Research has identified diagnostic overshadowing as a patient-safety concern because it can contribute to missed or delayed recognition of physical illness. (https://pubmed.ncbi.nlm.nih.gov/25369130/)

Consider someone with a longstanding anxiety diagnosis who begins experiencing new episodes of dizziness and rapid heart rate.

Their anxiety history is relevant. It belongs in the clinical picture.

But it should not automatically determine how the new symptoms are interpreted.

Similarly, someone with chronic pain may also be depressed. Their depression deserves treatment, but treating it does not eliminate the need to appropriately evaluate and manage their pain.

There is another distinction worth making here.

Having symptoms that remain medically unexplained is not the same as intentionally fabricating symptoms.

A test result that falls within normal limits tells us something about what was measured, under the circumstances in which it was measured. It does not necessarily establish that the person is healthy or that their symptoms have no physical basis.

At the same time, normal findings can provide meaningful reassurance and may appropriately reduce concern about certain conditions.

Both realities deserve room in the conversation.

For patients who have spent years searching for answers, the fear of being perceived as exaggerating, noncompliant, or deliberately producing symptoms can become almost as distressing as the symptoms themselves.

Some begin carefully managing how they present during appointments.

They rehearse what to say. They worry about appearing too emotional, because they fear their distress will reinforce a psychiatric explanation. Yet they also worry that appearing calm will make their symptoms seem less serious.

They may hesitate to ask questions because they don't want to appear difficult.

They may even minimize their own suffering in an effort to remain credible.

This is an exhausting way to approach healthcare.

And it can gradually erode the very trust that an effective patient-provider relationship requires.

Why Doctors and Patients Can Experience the Same Appointment So Differently

It would be easy to frame this problem as one of uncaring physicians and vulnerable patients.

But that explanation is neither complete nor particularly helpful.

Most healthcare professionals enter their fields because they want to help people. Many are deeply committed to their patients and genuinely troubled when they cannot identify the cause of someone's suffering.

Yet they practice within systems that can make thoughtful, comprehensive care difficult.

Appointments are often brief. Medical records may be scattered across multiple healthcare systems. Insurance companies influence which tests, referrals, and treatments are accessible. Specialists may focus on particular organ systems, while complex illnesses do not always respect those boundaries.

And medicine, despite its remarkable advances, does not have an explanation for every symptom or an effective treatment for every condition.

A physician may review a patient's history, perform an examination, order appropriate testing, and arrive at a point where the available evidence does not support a specific physical diagnosis.

That uncertainty can be frustrating for the physician, too.

At that point, suggesting anxiety or depression may be a reasonable part of the clinical discussion.

But how that possibility is communicated matters enormously.

A physician might intend to say:

“I haven't identified a physical explanation for these symptoms through the evaluation we've completed. I also recognize that anxiety may be contributing, and I'd like us to address that while we determine what additional follow-up, if any, is appropriate.”

What the patient hears, however, may be:

“There's nothing wrong with you. This is all in your head.”

Those are very different messages.

Sometimes the misunderstanding arises from hurried communication. Sometimes it reflects a patient's previous experiences of dismissal. And sometimes a clinician really has reached a conclusion prematurely.

We cannot assume which explanation applies in every situation.

But we can recognize that the resulting rupture in trust may have consequences for both the patient's emotional well-being and their future medical care.

The patient may become less willing to share concerns openly. The physician may experience increasing difficulty distinguishing new symptoms from longstanding complaints.

Over time, both may become frustrated.

The relationship begins to revolve around whether the patient's symptoms are believable, rather than around the shared goal of understanding and managing them.

And that is a loss for everyone involved.

The Emotional Toll of Feeling Disbelieved

One of the more difficult consequences of repeated medical uncertainty is the gradual loss of confidence in your own perceptions.

You know what you are experiencing.

But after enough appointments without answers, you may begin to question yourself.

Am I making too much of this?

Maybe everyone feels this way and I'm just not handling it well.

What if I really am causing this somehow?

For some people, these doubts become especially powerful when their symptoms fluctuate.

Perhaps you were unable to get out of bed yesterday but feel relatively well during today's appointment. Or you have weeks of significant symptoms followed by periods when your functioning improves.

The inconsistency can make it harder to explain your experience, particularly when your illness is largely invisible.

You may begin to feel responsible for producing enough evidence of your suffering to justify receiving help.

This is one reason repeated medical encounters can become psychologically distressing even when someone continues attending appointments.

The anxiety isn't necessarily about the doctor as a person.

It's about what the appointment represents.

Another opportunity for answers. Another possibility of disappointment. Another conversation in which you may feel compelled to defend the reality of your experience.

You might notice yourself becoming tense days before an appointment, sleeping poorly the night before, or replaying the conversation afterward.

You may feel angry with a physician you otherwise respect. Or ashamed of how emotional you became when trying to explain your symptoms.

These reactions can be particularly confusing because you still need medical care.

You may simultaneously appreciate your healthcare providers, depend on their expertise, and feel frightened by the possibility of being dismissed again.

That tension can be part of the emotional aftermath of difficult healthcare experiences.

In my article, When Healthcare Becomes Traumatic: Understanding Medical Trauma, Medical Gaslighting, and the Long Road Back to Trust, I explore how medical experiences can affect our sense of safety, trust, and emotional well-being.

Not every difficult appointment constitutes trauma, and not every disagreement between a patient and physician is medical gaslighting. But repeated experiences of feeling powerless, disbelieved, or unable to obtain needed care can leave lasting emotional effects.

Those effects deserve attention even when the underlying medical questions remain unresolved.

How Can Patients and Physicians Begin Bridging the Divide?

There is no simple formula for navigating complex medical symptoms, particularly when diagnostic uncertainty persists.

But there are ways to create more productive conversations without requiring either the patient or the physician to abandon their perspective.

For Patients: Advocate Without Feeling You Must Prove Yourself

When you've experienced repeated dismissal, it can be tempting to enter appointments prepared for a confrontation.

You may arrive with pages of research, extensive symptom logs, and a determination not to leave without an answer.

Those preparations may reflect years of careful observation and genuine effort to understand your health.

But the pressure to prove yourself can also become emotionally exhausting.

It may help to shift the goal from convincing someone that you are sick to collaborating on what is known, what remains uncertain, and what reasonable next steps might be available.

Some questions you might consider asking include:

“I understand that anxiety may be contributing. Are there other physical explanations we should consider?”
“What findings make you think anxiety is the primary cause of these symptoms?”
“What conditions have we reasonably ruled out, and which possibilities remain?”
“If my symptoms continue or change, what would you recommend as the next step?”
“Can we address my anxiety while continuing to monitor the physical symptoms?”

These questions are not demands for unnecessary testing or guarantees that every symptom has an identifiable cause.

They are invitations to shared clinical reasoning.

You can also be open about your emotional experience.

For example, you might explain that previous diagnostic uncertainty has made appointments stressful and that understanding the reasoning behind a recommendation would help you feel more comfortable with the plan.

When possible, maintaining a consistent relationship with a clinician who knows your history can also be valuable.

And if communication repeatedly breaks down, seeking an appropriate second opinion may be reasonable.

The goal is not to find someone who will automatically agree with you. It is to establish a relationship in which your concerns are evaluated thoughtfully and you understand the clinical decisions being made.

For Healthcare Professionals: Make Room for Both Possibilities

For clinicians, one of the most powerful things may be communicating uncertainty without communicating disbelief.

There is a meaningful difference between saying, “Your tests are normal, so this must be anxiety,” and saying, “The tests we've completed haven't identified the cause of your symptoms. Anxiety may be contributing, but I recognize that you're still experiencing something significant.”

That distinction does not require a physician to order every available test or pursue increasingly unlikely diagnoses indefinitely.

It simply preserves the difference between what has been established and what remains uncertain.

It can also help patients understand why particular diagnoses are being considered, what evidence supports them, and what changes would warrant reevaluation.

Validation does not require agreement with every explanation a patient proposes.

And acknowledging psychological factors does not require dismissing physical symptoms.

Both can be part of responsible, compassionate care.

Treating Anxiety Without Abandoning the Search for Physical Answers

There is another important consequence of the divide between physical and psychological explanations.

Patients who have repeatedly felt dismissed may become reluctant to accept mental health treatment, even when they are experiencing significant anxiety or depression.

And that reluctance is understandable.

If you've spent years being told that your symptoms are psychological, agreeing to counseling may feel like conceding that the physical illness was never real.

But receiving psychological support does not require that concession.

Therapy can be beneficial whether someone has a confirmed medical diagnosis, remains in the middle of a diagnostic process, or is learning to live with symptoms that medicine cannot yet fully explain.

Counseling may help with the anxiety of unpredictable symptoms, grief over changes in functioning, chronic pain coping, strained relationships, and the emotional exhaustion of navigating healthcare.

It can also provide a place to process anger, disappointment, fear, and the loss of trust that sometimes develops after difficult medical experiences.

And when depression or an anxiety disorder is present, treating it is important for its own sake.

You do not have to choose between taking your physical health seriously and taking your mental health seriously.

Both deserve care.

In my article The Diagnostic Odyssey: What 20 Years of Undiagnosed Illness Taught Me About Rare Disease, Self-Advocacy, and Finding Your Way Back to Wellness, I share my own experience of spending two decades searching for answers to symptoms that were eventually connected to Ehlers-Danlos syndrome and dysautonomia.

That experience shaped my understanding of how complicated it can be to live in the space between knowing something is wrong and knowing what to call it.

It also reinforced something I believe is essential: we should not have to postpone caring for our emotional well-being until every medical question has been answered.

And for people whose illness has changed how they see themselves, there is often another layer of work involved. My article Who Am I When I Look Fine But Don't Feel Fine? Identity and Invisible Illness explores the quieter losses and identity changes that can accompany chronic illness.

These experiences are interconnected, but they are not interchangeable.

Medical treatment addresses medical needs. Mental health treatment addresses psychological needs. Ideally, the two work together.

Moving Beyond “Physical or Psychological”

Perhaps the most important shift we can make is to stop treating physical and psychological explanations as though they are competing for legitimacy.

A person can experience anxiety because their body is producing frightening sensations.

Those sensations may then increase anxious thoughts, which can intensify the body's stress response.

Someone can experience depression because chronic illness has dramatically altered their quality of life.

And that depression may affect sleep, motivation, energy, and the ability to manage ongoing medical demands.

A person can benefit from therapy while continuing to need medical evaluation and treatment.

None of these realities cancels out the others.

There will be times when anxiety is the primary explanation for physical symptoms. There will be times when an underlying medical condition is responsible. And there will be many situations in which physical and psychological factors interact in complicated ways.

The goal should not be to insist on one explanation before the evidence supports it.

It should be to remain thoughtful, curious, and appropriately responsive to the whole person.

For patients, that means being willing to consider psychological support without feeling that doing so invalidates their physical experience.

For clinicians, it means recognizing that identifying anxiety or depression does not automatically resolve every medical question.

And for therapists, it means helping people address psychological distress without assuming that all unexplained physical symptoms originate in the mind.

Anxiety may be part of the clinical picture without being the whole picture.

When we make room for that possibility, we create more opportunities for trust, collaboration, and meaningful care.

We also give people living with chronic illness something they may have been missing for a long time: the freedom to receive help for their emotional suffering without having to defend the reality of their physical suffering.

Medical Trauma Recovery: You Can Care for Both Your Mind and Your Body

If repeated medical experiences have left you feeling anxious, discouraged, or uncertain about your own judgment, counseling can provide a place to begin working through those experiences.

At Life By Design Counseling, I help women process the emotional effects of medical trauma, chronic illness, diagnostic uncertainty, and healthcare experiences that have damaged their sense of trust.

My work is not a substitute for medical evaluation or treatment. Rather, it offers support for the psychological and relational consequences of living with difficult medical experiences.

You can learn more about my Medical Trauma Recovery services through Life By Design Counseling.

I offer in-person counseling in the Middle Georgia area and secure telehealth sessions for women throughout Georgia.

If you're wondering whether counseling might be helpful, I invite you to schedule a free 15-minute consultation. We can talk about what you've been experiencing and whether working together would be a good fit.

You don't need a definitive medical diagnosis to begin addressing the emotional impact of what you've been through.

Frequently Asked Questions

Can anxiety cause physical symptoms even when I don't feel mentally anxious?

Yes. Anxiety can involve physiological arousal that produces symptoms such as palpitations, muscle tension, dizziness, sweating, and gastrointestinal discomfort. Sometimes people notice these physical sensations before recognizing anxious thoughts or emotions. However, similar symptoms can also occur with medical conditions, so new, persistent, or concerning symptoms deserve appropriate medical assessment.

Why does my doctor keep saying my symptoms are anxiety?

Anxiety is a legitimate consideration because it can produce significant physical symptoms and can coexist with many medical conditions. A physician may also consider anxiety when testing has not identified another explanation. However, an inconclusive evaluation does not automatically establish anxiety as the cause. It is reasonable to ask what evidence supports the assessment and what follow-up is appropriate if symptoms persist.

Can I have a chronic illness and an anxiety disorder at the same time?

Absolutely. Physical illness and anxiety disorders can coexist, and each may affect the experience of the other. Treating anxiety may improve emotional well-being, coping, sleep, or certain physical symptoms without necessarily resolving an underlying medical condition. Both deserve appropriate attention.

Can POTS or dysautonomia feel like anxiety?

Yes. POTS and other forms of autonomic dysfunction can cause physical symptoms that overlap with anxiety, including palpitations, shakiness, dizziness, and sweating. POTS is a physiological condition, not an anxiety disorder, although someone with POTS may also experience anxiety. A medical professional can evaluate whether symptoms suggest autonomic dysfunction or another condition. (Johns Hopkins Medicine)

Can chronic pain cause anxiety or depression?

Chronic pain can contribute to anxiety and depression through persistent discomfort, disrupted sleep, uncertainty, limitations in daily functioning, and changes in quality of life. Psychological distress can also influence how pain is experienced. The National Institute of Neurological Disorders and Stroke recognizes this reciprocal relationship.

What should I do if my doctor says my symptoms are psychological but I still feel physically unwell?

Try to keep the conversation collaborative while asking for a clear explanation of the clinical reasoning. You might ask which physical conditions have been considered, what findings support the current assessment, and when reevaluation would be appropriate. A second opinion may be helpful when symptoms remain unexplained or communication has broken down. Seek prompt medical attention for new or potentially urgent symptoms rather than assuming they are anxiety-related.

Can therapy help with medical trauma if I still don't have a diagnosis?

Yes. Counseling can help you process distressing healthcare experiences, manage uncertainty, address anxiety or depression, and strengthen your ability to communicate your needs. Therapy does not require you to conclude that your physical symptoms are psychologically caused. Medical evaluation and psychological support can proceed alongside one another.

Medical disclaimer: This article is for educational purposes and does not provide medical advice or establish a diagnosis. Physical symptoms that resemble anxiety can have multiple causes. Consult a qualified healthcare professional for individualized assessment, and seek urgent care for potentially serious symptoms.