“Not everything that shakes is panic.” Anxiety disorders might be the most prevalent mental health diagnosis in America, but here’s the surprise some individuals with racing hearts, dizziness, or chronic fatigue aren’t even experiencing anxiety at all. They could be dealing with a whole different medical condition that simply happens to appear and feel like it.
With over 20 million Americans diagnosed with anxiety disorders annually, it’s no wonder that similar symptoms create confusion. Heart palpitations, sweating, foggy brain, or abdominal pain can indicate anxiety or a different condition altogether. And when the mislabeled stick, years of effective treatment are put on hold.
From endocrine disorders to ongoing infections, many medical conditions can even convincingly masquerade as anxiety that even seasoned practitioners can be deceived. Here’s an examination up close of seven conditions to familiarize yourself with because the correct diagnosis makes all the difference.
1. Postural Orthostatic Tachycardia Syndrome (POTS)
POTS impacts the autonomic nervous system, resulting in an abnormally increased heart rate when transitioning from lying down to standing. Such a sudden increase can induce dizziness, lightheadedness, and palpitations symptoms that usually get confused with panic attacks.
As Johns Hopkins Medicine reports, POTS affects an estimated one to three million Americans, and it can take six to eight years to get diagnosed. The only difference? Symptoms are brought on by changes in posture, not stress. A tilt-table test can diagnose the condition.
Robert Wilson, DO, of Cleveland Clinic Neuromuscular Center, advises against misdiagnosis of POTS as anxiety, which can cause treatment delay and frustration. “It’s likely that a lot of these patients have a high sympathetic response that might be called anxiety when actually it’s POTS,” he says. Treatment tends to combine lifestyle modifications such as increasing fluid and salt consumption with specific medications.
2. Inflammatory Bowel Disease (IBD)
Crohn’s disease and ulcerative colitis, the two most common forms of IBD, result in long-term inflammation in the gastrointestinal tract. Flares may usher in abdominal pain, cramping, diarrhea, and fatigue symptoms that can produce or mimic anxiety.
The overlap occurs because stomach discomfort may activate the body’s stress response, and anxiety may activate gut distress. But IBD has distinguishing features anxiety doesn’t, including blood in the stool or unexpected weight loss.
Diagnosis normally uses colonoscopy and imaging. With 3.3 million affected Americans, identification of the distinction is important for proper treatment and to prevent unnecessary psychiatric care.
3. Endometriosis
Endometriosis happens when tissue like the uterine lining appears outside the uterus, leading to pain, heavy bleeding, and sometimes infertility. The World Health Organization estimates over 190 million women worldwide have it, but many are reassured their pain is “just in their head.”
A U.S. study in 2020 discovered almost half of patients were first informed their symptoms were mental health–related when they were finally correctly diagnosed frequently after years of anguish. Yale University’s Hugh Taylor, MD, describes the condition as sending inflammatory signals to the brain, which can change mood and behavior.
In addition to the biological connection, chronic pain and stigmatization may lead to depression and anxiety. Diagnoses require pelvic exams, imaging, and in some cases, laparoscopy, and now specialists advocate for multidisciplinary treatment addressing physical as well as mental health.
4. Polycystic Ovary Syndrome (PCOS)
PCOS is a hormonal disorder that affects about 1 in 10 menstruating individuals, but the majority are undiagnosed. Symptoms such as periods, acne, and excessive hair growth are familiar yet the mental health effect is frequently overlooked.
Research indicates individuals with PCOS are three to eight times more likely to develop anxiety or depression. All of these hormonal imbalances, insulin resistance, and body image issues can be contributing factors. High androgens can also affect brain chemistry involved in regulating mood.
Treatment may involve lifestyle modifications, medications such as metformin, and counseling. Treating both the physical and emotional is what often improves the quality of life.
5. Hyperthyroidism
If the thyroid gland is overproducing hormone, it accelerates virtually every aspect of the body. The consequence? Palpitations, sweating, shakiness, and nervousness symptoms that can be confused with anxiety.
Hyperthyroidism strikes approximately 1.3% of Americans. In contrast to anxiety, it tends to go hand in hand with heat intolerance, unexpected weight loss, and an enlarged thyroid gland (goiter). Blood tests to determine thyroid hormone levels are crucial for diagnosis.
Because untreated hyperthyroidism can lead to heart problems and bone loss, early detection is important. The solution may be medication, radioactive iodine, or surgery, depending on the underlying cause.
6. Lyme Disease
This tick-transmitted disease causes fever, rash, joint pain, and nervous system problems but it may also trigger persistent fatigue, foggy brain, and mood swings that resemble anxiety or depression.
Experts at the Johns Hopkins Lyme Disease Research Center emphasize that the symptoms are biologically triggered, not psychosomatic. MRI studies even reveal structural brain alterations in certain patients. Joseph Trunzo, PhD, adds that anxiety driven by Lyme is like having the gas on the floor and it doesn’t stop.
With 476,000 Americans diagnosed and treated annually, early diagnosis and treatment with antibiotics help to avoid long-term complications.
7. Adrenal Insufficiency
If the adrenal glands aren’t making enough cortisol, the body’s response to stress is weakened. Fatigue, dizziness, low blood pressure, and emotional changes may all result sometimes confusingly described as anxiety.
A telling hint is salt appetite, and in some individuals, darkening of the skin (hyperpigmentation). Blood studies of cortisol and ACTH levels diagnose the condition. Since adrenal insufficiency is fatal if left untreated, prompt identification and replacement therapy with hormones are essential. In contrast to anxiety, however, this disorder must be managed medically for life.
Anxiety is real, but it’s not necessarily the whole picture. If the symptoms won’t go away with treatment or don’t exactly fit the picture of anxiety it makes sense to look deeper. Recognizing lookalike conditions gives patients the power to ask more questions, seek a second opinion, and demand thorough testing. The correct diagnosis is not merely about labeling the issue it’s the beginning of actual relief.
