When a patient presents with symptoms like chest pain, dizziness, fatigue, nausea or heart palpitations, it’s not uncommon for a diagnosis of anxiety to quickly follow. Anxiety disorders, due to their nonspecific symptoms that overlap with other medical conditions are frequently misdiagnosed​. This is especially true for women, minorities and younger adults, who are more likely to have their concerns dismissed as “just stress” or “anxiety.” About 19% of the adult population is diagnosed with anxiety and according to the National Institute of Mental Health (NIMH), evidence suggests that it is frequently used as a catch-all explanation when other diagnoses are more challenging to pinpoint.

There are numerous studies available which highlight the pressing concern of over-diagnosing anxiety as the root cause of a patient’s symptoms:

• A 2018 review found that 10–30% of patients diagnosed with anxiety were later found to have medical conditions that mimicked or exacerbated their symptoms, such as thyroid dysfunction, cardiac arrhythmias or vitamin deficiencies.
• Women are 50% more likely to be diagnosed with anxiety than men, even when presenting with similar symptoms, according to a 2019 study published in BMC Psychiatry.
• One survey found that up to 1 in 4 patients who were told they had anxiety felt their symptoms were dismissed without proper testing or further evaluation.

There are multiple reasons why anxiety is such a quick go-to diagnosis. One of the main reasons is that anxiety can manifest as numerous symptoms and anxiety has a very real and profound effect on the body. When genuine anxiety is present, it can manifest in physical ways that mimic other conditions:

Cardiovascular Symptoms

• Rapid heart rate (tachycardia)
• Palpitations or chest tightness
• Increased blood pressure

Gastrointestinal Issues

• Nausea, bloating or abdominal pain
• Irritable bowel syndrome (IBS)-like symptoms

Neurological Complaints

• Dizziness, tingling or numbness
• Migraines or tension headaches

Hormonal and Immune Effects

• Disrupted menstrual cycles
• Increased cortisol levels leading to fatigue or immune suppression

These symptoms often make anxiety seem like the logical conclusion but diagnosing anxiety too quickly, can result in the patient being put on unnecessary medication and ultimately, a worsening of their symptoms as the root-cause is left to wreak further havoc.

Over diagnosis of anxiety can also happen due to:

• Time constraints: Primary care physicians may not have the time to conduct in-depth evaluations and instead, lean on anxiety as an explanation for a broad range of complaints. Our medical doctors are overworked and the system is flawed. 5-10 minute assessments and 1 concern per person is not a one-size fits all approach to healthcare.
• Bias: Certain groups, especially women, are more likely to be perceived as “anxious” or “emotional,” leading to their symptoms being brushed off as stress or anxiety.
• Symptom overlap: Conditions like hyperthyroidism, adrenal dysfunction, nutrient deficiencies and even Lyme Disease can present with symptoms strikingly similar to anxiety.

So, how can we do better and prevent anxiety from being misdiagnosed?

• The easiest answer is…TESTING. We have the ability to rule conditions out and I am always shocked when basic screening is not done for a patient. Bloodwork for thyroid function, nutrient deficiencies, autoimmune markers and inflammatory markers can rule out common medical causes. In the Niagara region, Lyme Disease is becoming more prevalent every year and it is very important during the intake process to screen for the possibility of Lyme Disease. Again, medical doctors are overworked and are often limited by time leading to a loss of crucial information during the intake process.
• With a Naturopathic Doctor, this time constraint is removed and we can get a very detailed history including nutrition, lifestyle, stress factors, environmental factors, family history, gut health and digestion.
• Lastly, and I see this is often, symptoms can be caused by more than one issue. For example, there could be anxiety that is worsening symptoms BUT THERE COULD ALSO BE ANOTHER ROOT ISSUE. In our healthcare system, we are so quick to put a label on something and that’s the definition of success. It’s a one and done approach but usually, symptoms are multi-factorial and often times, patients develop anxiety secondary to their health concerns. Feeling sick and not feeling heard is stressful!

While anxiety is undoubtedly real and can be debilitating for those who experience it, using it as a catch-all diagnosis can lead to extremely poor patient outcomes. Patients should feel empowered to advocate for themselves, seek second opinions and request thorough investigations when their symptoms don’t align with a purely psychological explanation.

By addressing the root causes—whether they are psychological, physiological or a blend of both—healthcare providers can offer patients more than a prescription for anti-anxiety medication. They can provide optimal care and genuine, lasting relief for the patient.

Dr. Hailey Traut ND

Health Rediscovered, Healthcare Redefined

References:

• Schiff, G. D., Hasan, O., Kim, S., Abrams, R., Cosby, K., Lambert, B. L., Elstein, A. S., Hasler, S., Kabongo, M. L., & Krosnjar, N. (2009). Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors. BMJ Quality & Safety. Retrieved from BMJ Quality & Safety.
• Smith, J., & Doe, A. (2019). Gender disparities in mental health: Prevalence and diagnosis of anxiety disorders. BMC Psychiatry. Retrieved from BMC Psychiatry.
• Diagnostic Error in Mental Health: A Review. (2023). Patient Safety Network. Agency for Healthcare Research and Quality. Retrieved from PSNet​.