How to Tell If Your Anxiety Is Physical, Mental—or Both

🌀 Introduction: When Anxiety Doesn’t Fit in a Box

If you live with anxiety—especially alongside a condition like Multiple Sclerosis (MS)—you may often ask yourself:

“Is this in my head?”
“Is something physically wrong with me?”
“Why does my body feel like it’s panicking when I’m calm?”

Anxiety isn’t just a mental health issue. It can feel deeply physical, even when your thoughts are quiet. At the same time, chronic physical symptoms (like pain, fatigue, or MS flare-ups) can trigger emotional distress—creating a loop that’s hard to break.

Understanding whether your anxiety is physical, mental, or both is a powerful first step in managing it. This article breaks it down with compassion, science, and practical tools to help you feel more in control of your mind-body experience.

Looking for online therapy? Click here.

🤔 What Is Anxiety, Really?

At its core, anxiety is your body’s natural alarm system. It prepares you to deal with danger by:

Speeding up your heart rate
Sharpening your senses
Releasing adrenaline and cortisol
Heightening vigilance

This system evolved to help us survive—but in modern life, the “danger” might be a work deadline, a social event, or a symptom flare. And in people with chronic illness or trauma, the alarm can get stuck in the “on” position.

🧠 Mental Anxiety: What It Feels Like

Mental anxiety shows up primarily in your thoughts and emotions. It often includes:

Racing thoughts
Catastrophic thinking (“What if…?”)
Obsessing over symptoms, the future, or mistakes
Feeling trapped, worried, or doomed
Irrational fears
Trouble concentrating
Avoiding certain situations

You may notice:

Repetitive worry you can’t shut off
A hyper-focus on control or outcomes
Constant scanning for danger or disapproval

Even if your body feels relatively calm, your mind is on overdrive.

💓 Physical Anxiety: What It Feels Like

Physical anxiety shows up primarily in your body, sometimes without conscious fear or panic. It can mimic symptoms of illness—or MS itself.

You might experience:

Pounding heart or palpitations
Tight chest or difficulty breathing
Shaking, trembling, or muscle tension
Sweating or cold hands
Nausea, dizziness, or “jelly legs”
Tingling or numbness (especially in MS)
Digestive issues (IBS, urgency, cramps)
A sudden surge of adrenaline or sense of impending doom

In these cases, your nervous system is activated—even if your thoughts aren’t especially anxious.

🔄 When It’s Both: The Anxiety Loop

For many people—especially with MS—anxiety is both mental and physical. It often follows this cycle:

Something triggers stress (a symptom, social situation, or bad memory)
Your body reacts (faster heart, tension, fatigue)
You interpret the body sensations as dangerous (“Something’s wrong”)
That thought triggers more anxiety, worsening the symptoms
You feel trapped, hyperaware, or exhausted

🧠 + 💓 = a feedback loop that’s hard to escape.

🌡️ Anxiety vs. MS Symptoms: Why It’s Confusing

Anxiety and MS share many overlapping symptoms:

Anxiety	MS
Dizziness	Dizziness or vertigo
Numbness/tingling	Neuropathy or paresthesia
Fatigue	MS fatigue
Brain fog	Cognitive dysfunction
Muscle tension	Spasticity or nerve pain
Shortness of breath	Chest tightness or dysautonomia
GI issues	IBS, medication side effects

That’s why it’s easy to ask:

“Is this my anxiety—or my MS acting up?”

It’s often both—or one mimicking the other.

🧭 How to Tell Which One You’re Experiencing

Here are a few reflective questions to help you pinpoint what’s going on:

🔍 1. Did the sensation start in your body or your thoughts?

If it began with worrying, spiraling, or overanalyzing, it may be mentally-driven anxiety.
If it began with sweating, racing heart, numbness, or dizziness, it may be physically-driven anxiety (or MS).

📝 Journal the sequence: “First I felt ____, then I thought ____.”

🔍 2. Does distraction or grounding make it ease up?

If focusing on something else or practicing a calming ritual helps, it’s likely anxiety-related.
If symptoms persist regardless of mental focus, they may be more neurological or MS-related.

Try a 5-minute grounding exercise and check if the symptoms shift.

🔍 3. Are there predictable triggers?

Mental anxiety often spikes before a presentation, confrontation, or doctor’s visit.
Physical anxiety may hit during hormone changes, poor sleep, or after caffeine.

If you start tracking triggers, patterns will emerge.

🔍 4. What helps relieve it?

Deep breathing, mindfulness, or therapy? → more mental
Magnesium, rest, medication, or stretching? → more physical

Both kinds respond to care—but in different ways.

🔍 5. Is there fear attached to the sensation?

People with health anxiety often fear their physical symptoms, making them worse.

Example:

“My heart is racing… What if I’m having a heart attack?”
This fear reinforces the cycle.

Learning to observe symptoms without catastrophizing is key.

🧘 How to Calm Mental Anxiety

If your thoughts are racing or spiraling, try:

🧩 Cognitive Behavioral Techniques:

Identify anxious thoughts
Ask: “Is this 100% true?”
Replace with something grounded: “I’m safe. I’ve felt this before.”

💬 Affirmations:

“This feeling is temporary.”
“I don’t need to solve everything right now.”
“It’s okay to not know what’s next.”

✍️ Journaling Prompts:

“What am I afraid will happen?”
“What do I need to feel safer?”
“How can I be gentle with myself today?”

🌀 Mindfulness & Meditation:

Focus on breath, sound, or body sensations to anchor yourself in the now.

💆 How to Calm Physical Anxiety

If your body feels wired, tense, or panicked, try:

🌬️ Breathwork:

Box breathing: 4-in, 4-hold, 4-out, 4-hold
Diaphragmatic breathing with hand on belly
Want to try Breathwork? Click here.

🧘 Progressive Muscle Relaxation:

Tense and release each muscle group to release held tension

🧴 Cold/Heat Stimulation:

Splash face with cold water
Warm compress on neck or shoulders
Weighted blanket
Want a cold plunge? Click here.

🎧 Nervous System Soothers:

Calm ambient music
Guided body scan
Vagus nerve stimulation (humming, chanting, or gargling)

💡 When to Use Both

When you’re unsure where your anxiety is coming from, treat both the mind and the body:

Ground yourself with breath or touch
Then challenge your thoughts
Then soothe the physical tension again

This loop helps untangle the mental-physical spiral.

⚠️ When to Talk to a Professional

Don’t self-blame if you can’t sort out your anxiety alone. Seek help if:

Anxiety affects your sleep, appetite, or relationships
You’re having frequent panic attacks
Your symptoms are worsening, or interfering with daily life
You can’t distinguish between physical illness and anxiety

A therapist, neurologist, or psychiatrist can help you build a plan that honors both your mind and body.

🧘 Tools for Mind-Body Awareness

To better understand your anxiety patterns, try:

📓 Symptom Journal:

Log daily entries with:

Time of day
Trigger
Physical symptoms
Thoughts or emotions
Relief method used

You’ll start seeing whether it skews physical, mental, or both.

📱 Apps:

Insight Timer (for meditation)
Rootd (for anxiety panic tools)
Curable (for mind-body chronic pain and anxiety)
Bearable (for symptom and mood tracking)

💬 Real Voices

“Sometimes I wake up with my heart pounding and my legs tingling. I used to panic that it was an MS flare. But over time, I learned it was anxiety. Now I breathe through it and it passes.”
— Sasha, 34, living with RRMS

“When I start overthinking, my stomach cramps up and my hands sweat. That’s when I know my anxiety is mental and physical. I do a CBT check-in and then stretch my shoulders.”
— Miguel, 42, living with SPMS