During my senior year of college, my social life looked like this: I'd get a text from someone inviting me out for the night—it didn't matter where: a party, a movie, a drink at a local bar—and I'd accept eagerly, being an obnoxious extrovert who welcomed any excuse not to study. But every time, an hour or two before we'd meet up, I'd suddenly start to feel sick. My skin would get clammy. I'd get the chills. I'd get nauseous and need to rush to the bathroom every ten minutes. Ultimately, I'd have to call and cancel. And within minutes of cancelling, I'd start to feel better again, every single time.
In hindsight, it's obvious that I had some underlying issue—I wasn't just coincidentally getting a stomach bug every time I had to leave my apartment and then miraculously recovering. But at the time it took me nearly a year to figure out what was going on. It wasn't until I was in a therapist's office to seek treatment for my post-traumatic stress disorder (PTSD) that I realized these bouts of illness were actually just different facets of the same problem—severe anxiety.
On television and in movies, panic attacks look like one thing only: The character who's having a panic attack clutches at his chest, gasps for air, and then breathes into a paper bag to calm himself. But that's never been my experience, and it's probably why I spent the better part of a year thinking something was seriously wrong with me. Anxiety—I thought—wasn't a physical experience, apart from looking sort of like an asthma attack. It didn't look like chills and aches and nausea. It didn't look like immediately shitting your pants during a date because a car honked too loudly outside the restaurant window (true story).
But for myself and the 40 million adults who live with anxiety, it absolutely is a physical experience. When our brain senses danger (real or perceived, incoming attacker or loudly honking car), the amygdala sends a distress signal to the hypothalamus, which then releases a cascade of hormones like cortisol and adrenaline to prepare the rest of our body for action. Physiologists have termed this the “fight or flight response,” since it primed our earliest ancestors to either fight against the incoming danger, or run the hell away from it.
The rush of hormones causes our heart to beat wildly, our blood pressure to rise, and our senses to sharpen, along with a host of other physical symptoms, all so we can respond to danger. What's more, the book Mindfulness and Psychotherapy explains that the hippocampus, which is close to the amygdala, is responsible for storing our emotional memory—which means that even a traumatic memory or something that reminds us of danger can trigger that same panic response.
When we look at anxiety from an evolutionary perspective, the physical symptoms start to make more sense. But why, then, might someone crap her pants during a date because a car honked too loud and then have to end the date early and waddle ten blocks back to her apartment to change her pants? This is due to the body's gut-brain connection, which explains the nausea, vomiting, and pants-crapping we might experience in a state of extreme hyper-arousal, says New York-based psychotherapist Laura Federico.
“Any time someone is experiencing an emotional distress, it's expressed somehow,” Federico explains. “And when things are happening emotionally, it changes what happens in our gut.” Stress, depression, or anxiety can actually change the physiology of our gut, or cause our GI tract to contract or move. Anxiety can even make inflammation worse in the gut or make us more susceptible to infection. It's why we develop loose stools, stomach pain, nausea, or vomit under crisis, she tells me.
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In addition to bubble gut, anxiety can manifest as pain elsewhere too. “Some of my clients have pain in a specific area of their body that they thought was another really scary medical thing, and they've come to understand it's a sign they're stressed out,” Federico says. “It could be pain in their throat, pain in their armpit, pain in their back—but these seemingly random physical experiences can be directly linked to anxiety.”
For some patients, localized pain could be due to how they were raised to understand anxiety and expressing emotion, Federico says. “For someone who was brought up to understand emotions as a weakness, it might not be okay for that person to say 'I'm feeling stressed out.' They may have been raised in an environment where they saw someone experience a heart attack and witnessed the medical intervention that followed, and they learned that experiencing physical pain was more socially acceptable,” she says. It could be that our mind is so powerful that it's trying to express some psychic pain in whatever way seems socially appropriate.
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There are, it seems, as many different physical symptoms of anxiety as there are people who suffer from it—whether it's pain, numbness, hot flashes, or uncontrollable diarrhea. But one thing that I learned—and what Federico wants her clients to understand—is that physical symptoms of anxiety are natural and normal to experience, no matter how weird they may seem. And what's more, recognizing your symptoms and knowing that they're part of your anxiety experience can actually make the whole experience a lot less scary.
In college, plagued with diarrhea and chills and hot flashes, I trekked over to the on-campus health clinic after a week of missing class and told the nurses, sobbing, that I was definitely dying of Swine Flu. When I found out I was actually most likely having a prolonged panic attack, I felt humiliated at first, then ashamed—then, slowly, relieved. Federico is right: Knowing how anxiety feels physically, for your own body, can take away a lot of fear that keeps you in that heightened state. I still experience those symptoms when I have a panic attack, unfortunately—but knowing it's a standard part of my own anxiety experience helps me come down from that panic. Within minutes, without canceling my plans, I start to feel better again, every single time.
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This article originally appeared on VICE US.