How to understand your troubling symptoms — and their cause.
A one-size-fits-all approach to panic and anxiety just doesn’t make sense. But in our medical system, most people with anxiety and panic are thrown into the same small diagnostic bucket (aka Generalized Anxiety Disorder), and thus receive similar treatments.
That’s how I was trained — how we all were trained. Throughout both my master’s degree in clinical psychology and medical school, my colleagues and I were instructed that mental health and brain health symptoms were problems to be organized into diagnostic categories and treated based on their categorization (usually involving a mix of counseling and some sort of prescription medication). It felt like a conveyor belt: Patient comes in and gets a diagnosis and referral for treatment. Next! Rinse and repeat.
But by looking carefully at the symptoms of panic, we gain the ability to understand the nuance and meaning of each symptom — and recognize that anxiety can manifest in so many different ways.
Allow me to introduce you to the nine different types of panic and anxiety. Want to diagnose yourself first? Take this quiz to better understand what you’re experiencing.
Chest Anxiety
Symptoms of stress related to tightness in your chest, racing heart, difficulty breathing, skipping beats, and even chest pains are associated with a type of anxiety called Chest Anxiety. It shows up in . . . yep, you guessed it: your chest.
While Chest Anxiety is one of the most common places panic presents, symptoms manifesting in the heart and lungs can be particularly alarming. This is why so many Chest Anxiety sufferers wind up going to the emergency department, afraid that they’re having a heart attack.
Nervous System Anxiety
This manifests in symptoms associated with the nervous system, composed of your brain, nerves, and muscles. Here are the four main ways Nervous System Anxiety may show up in your body:
- Brain: Headaches, migraines, dizziness or vertigo, brain fog, disorientation, seizures, a feeling of detachment from your surroundings (derealization) and/or your body (dissociation)
- Nerves: Tingling, numbness, burning, buzzing, vibrating, shooting, stabbing, zapping, sweating, or chills
- Muscles: Soreness, spasm, twitching, jerking, weakness, and/or pain
- Mind: Depersonalization—feeling detached from oneself, or derealization—feeling detached from the world around you
Immune System Anxiety
Do your anxieties feel like a constantly shifting puzzle? One minute you’re drained and achy, the next you’re jittery and overwhelmed. Doctors are stumped, leaving you feeling helpless and lost. This is the reality for many struggling with Immune System Anxiety.
This is a type of anxiety intricately linked to imbalances within your immune system. It often manifests after an illness or life change, and symptoms can affect you head to toe. Unfortunately, there’s no single diagnostic test, making it challenging to pinpoint. Symptoms can vary widely, but include skin sensitivity, fibromyalgia-like aches, dizziness, difficulty concentrating, and reactions to medications.
The immune system and your nervous system (including the brain) are deeply intertwined. The field of Psychoneuroimmunology explores this complex relationship, revealing how mood, emotions, and the immune system influence one another. Earlyresearch suggests that high levels of stress, whether acute or chronic, can weaken the immune system and contribute to anxiety. High levels of histamine in the body are also linked to anxiety.
There are many risk factors for developing Immune System Anxiety, including acute or chronic emotional stress, a history of viral illness (like Lyme disease or Epstein-Barr), genetic mutations related to immune function, and poor lifestyle habits like a lack of sleep.
Gut Anxiety
This anxiety manifests in symptoms in your digestive tract. It can relate to symptoms in your upper digestive tract, such as reflux/heartburn, burping, fullness or constriction in your throat and esophagus, nausea, stomach ulcers, and appetite changes, as well as symptoms in your lower digestive tract, like gas, bloating, cramps, diarrhea, constipation, butterflies, churning, and even digestive disorders like irritable bowel syndrome.
Keep in mind that your gut and your brain are intimately connected via what’s referred to as the enteric nervous system. The enteric nervous system is often referred to as the “second brain” because it comprises millions of nerves whose jobs are to communicate back and forth with your brain.
It’s well-established that the microflora in your gut are responsible for maintaining your emotions, concentration, and moods. In fact, your gut bacteria can produce mood-altering chemicals such as dopamine, adrenaline, and gamma-aminobutyric acid (GABA), and they even produce approximately 95 percent of your serotonin levels.
Thought Anxiety
Does it ever feel like your brain is relentlessly tormenting you with intrusive, persistent, and obsessive thoughts? This is one of the most frustrating anxiety symptoms because these thoughts can crush our confidence, distract us from what really matters, and hijack our happiness. These are symptoms of Thought Anxiety.
Thought Anxiety is particularly tricky, because no matter where we go and what we do, our brains are with us. And where our brains are, our thoughts will be too. You’ll need to look at how you experience your thoughts as well as the content of your thoughts to figure out what needs healing. (There are four subtypes of Thought Anxiety — including The Auctioneer and The Ruminator — all of which you can learn more about in Dr. Cain’s book, Panic Proof.)
Anger Anxiety
Anger and anxiety often go hand in hand. One reason is that the neurochemicals that your body releases when anxious are quite similar to those released in anger. One of the key chemicals that leads to anger is called adrenaline (otherwise known as epinephrine or norepinephrine). Anger is one of the key responses to stress—fight, flight, freeze, flop, fawn, and fracture. And while it can be the natural result of having grown up in a violent or unstable household, anger can be extremely physically destructive.
Depressive Anxiety
Do you ever get those feelings of sheer panic mixed with hopelessness and despair? You’ve been doing everything you can to combat the anxiety, but the longer it lasts, the more defeated you become. Or maybe the depression has sunk so low that feelings of losing control provoke panic.
Depression and anxiety have a complicated relationship. They feed into each other, creating a vicious cycle where depression aggravates anxiety and anxiety aggravates depression. Depression mixed with panic and anxiety is called Depressive Anxiety, and it’s very common. In fact, 85 percent of people with depression also experience significant anxiety, and 90 percent of people with anxiety also experience depression.
Hormone Anxiety
Hormone Anxiety is caused by an imbalance in your endocrine system, a series of glands that release hormones all over your body to carry out all sorts of functions.
Examples of endocrine glands are: thyroid, adrenals, pituitary, hypothalamus, pancreas, ovaries, testicles, and parathyroid. The hormones they produce work hard to keep you healthy and balanced. In a state of optimal health, your endocrine system balances your entire body and mind. But when something goes awry and your levels shift out of optimal ranges, you develop symptoms (e.g., panic and anxiety).
Trauma Anxiety
Have you ever gone through something so upsetting, disturbing, or overwhelming that you feel like it changed you? Perhaps you grew up in a tumultuous household, were the victim of abuse or assault, were bullied on the playground or at work, did not get your needs met by your caretakers, or witnessed something that terrified you.
Whatever did or did not happen was ingrained into the complex network comprising your brain and nervous system. In an effort to protect you, your brain and nervous system respond via a series of nuanced adaptations and adjustments involving your hormones, neurotransmitters, inflammation levels, gut, behaviors, and emotions.
These are the roots of a type of anxiety called Trauma Anxiety, which occurs as a result of adverse experiences, whether a single event or a series of experiences, also known as trauma.
Research findings on anxiety’s diverse manifestations and root causes challenge the one-size-fits-all approach to treatment, underscoring the need for personalized care. By embracing these evidence-based insights, we can empower individuals with targeted strategies to address the underlying causes of anxiety, paving the way for genuine healing and personal growth.
Excerpted from Panic Proof by Dr. Nicole Cain. Copyright © 2024 by Nicole Cain. Used by permission of Rodale Books, an imprint of Random House, a division of Penguin Random House LLC, New York. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
