47 underlying illnesses that can seem like anxiety

There's recently been a growing awareness surrounding what anxiety is and how difficult it can be to manage, thanks in large part to people sharing stories about mental health. This is great; fighting stigma and giving people space to be vulnerable is always helpful. But, as it turns out, sometimes what seems like it's anxiety can actually be a sign of a separate medical illness.

The New York Times recently flagged a "partial listing" published by Psychiatric Times of 47 medical illnesses that can first show up as anxiety in a person.

See them right here:

The conditions span a wide range and are categorized in seven groups. Health issues that may seem like anxiety can be cardiac, endocrine, GI-related, inflammatory, metabolic, neurological, and respiratory. Within those groups, conditions that might first present like anxiety include irritable bowel syndrome, cardiac arrhythmias, hypoglycemia, and rheumatoid arthritis. Psychiatric Times also lists 30 categories of medications that can cause anxiety, including antidepressants and NSAIDs like naproxen. Here's the list of all 47 illnesses that may seem like anxiety, and here are the 30 kinds of medications that may cause it.

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The lists were part of an article called "Managing Anxiety in the Medically Ill," and they were designed to flag for mental health professionals that some of their patients might seem like they have anxiety when they may actually have an underlying medical condition. That medical condition and its resulting side effects might lead to anxiety, or they may simply mimic anxiety symptoms. Either way, the condition would have to be addressed before the patient's anxiety or symptoms of anxiety could get better.

This is actually common knowledge in the medical field, so any doctors you see are likely well aware of how many conditions can cause anxiety-related symptoms.

It sounds surprising, but Miami-area licensed clinical psychologist Erika Martinez, Psy.D., tells SELF that mental health professionals are trained to look out for these things. That is, you don't need to immediately worry that any doctor treating you for anxiety may have missed something big!

One of the first things a good therapist will do is something called a biopsychosocial assessment, Dr. Martinez says. In it, a mental health professional will do a thorough screening of a patient's social and medical history to see if there are any red flags that a patient's anxiety might actually be caused by an underlying medical condition. But every mental health professional approaches this differently. For example, psychologist Paul Coleman, Psy.D., author of Finding Peace When Your Heart Is In Pieces, tells SELF that, as a general rule, he wants his patients with anxiety to be evaluated medically to rule out underlying medical problems like thyroid issues.

Women's health expert Jennifer Wider, M.D., tells SELF that the reason that anxiety manifests itself as a symptom of a larger medical issue depends on the illness. For example, with hyperthyroidism (an overproduction of hormones by the thyroid), a person can experience a racing heart, restlessness, and difficulty sleeping, which are also symptoms of anxiety. "Once the underlying illness is treated, the anxiety-like symptoms will subside," she says.

Any illnesses that affect the autonomic nervous system—the system that regulates your breathing, heart rate, metabolism, and body temperature—could be mistakenly assumed to be anxiety, licensed clinical psychologist Alicia H. Clark, Psy.D., tells SELF. This is especially true if you're worried about these symptoms (which is only natural).

Arousal of your sympathetic nervous system, which activates your fight or flight response, is part of the normal threat response to danger, and is often a hallmark of acute anxiety, Dr. Clark explains—but it is also a complicated physiological system that connects many other bodily systems, including cardiac, endocrine, gastrointestinal, metabolic, neurological, and respiratory systems. "The brain-body connection makes it tricky to tease apart what is the root cause, and a careful review of all possibilities is critical to getting the right care," Dr. Clark says.

Unfortunately, the difference between "regular" anxiety and symptoms of anxiety related to an underlying illness aren't always easy to suss out without medical guidance.

However, some conditions may leave little clues that can tell experts what's going on. For example—heart attack pain is often intense and coupled with other pain in the upper body, while chest pain related to anxiety is more targeted and usually comes after stressful thoughts, Dr. Clark says.

While anyone can be vulnerable to anxiety, another sign someone might be suffering from an underlying medical illness if they are experiencing anxiety but don't have first-degree relatives who have had the condition, Simon Rego, Psy.D., chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, tells SELF. But again, he stresses that a medical exam is really the best way to go.

Dr. Martinez says it's often a process of elimination. "It's just a good rule of thumb that the clinician always recommends and rules out the biological stuff first and makes sure that's being addressed, and then address the emotional part," she says. Of course, people who have what seems like anxiety due to an underlying medical issue won't get better until that illness is addressed. But Dr. Rego says it's possible to help the person be less troubled by the anxiety during the treatment process so they don't inadvertently add to it.

Bottom line: If you suspect that you have anxiety, it might not hurt to flag it for your general practitioner before you see a mental health professional. Your doctor could do some tests to help rule out other causes before you seek help from a therapist.

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