Do symptoms like nausea, heartburn, bloatedness have psychological causes i.e. anxiety?

The emotional status of a person is closely related to symptoms from the digestive tract. These symptoms include:

• pain,
• bloating,
• nausea,
• vomiting,
• constipation
• and diarrhoea.

As stress is known to induce more acid production and gastric spasms, acid reflux and heartburn may potentially get worse as well.

Feeling stressed, anxious and depressed at times are emotional states many of us face on a day-to-day basis. Understanding this relationship between symptoms from the digestive tract and the mind, also widely known as the gut-brain-axis, is important for one to manage his or her symptoms.

Identifying and managing your mood swings can help you manage the symptoms to a large extent. However, if your problem persists, do consider seeing your family doctor to exclude other significant problems from your digestive tract.

Anxiety can manifest in many ways and it can certainly show up in the form of physical symptoms. Below is a list of the physical symptoms of anxiety:

• stomach pain, nausea, or digestive trouble
• headache
• insomnia or other sleep issues (waking up frequently, for example)
• weakness or fatigue
• rapid breathing or shortness of breath
• pounding heart or increased heart rate
• sweating
• trembling or shaking
• muscle tension or pain

Specific types of anxiety might have additional physical symptoms.

For someone who has a panic attack, he or she may:

• have fears of going to die
• have trouble breathing or feel as if the person is choked
• have numb or tingling sensations in parts of the body
• have chest pain
• feel lightheaded, dizzy, or as if the person may pass out
• feel overheated or have chills

What is anxiety?

Anxiety, the body’s response to stress, is how the body alerts a person to threats and helps him get ready to deal with the challenges. This is called the fight-or-flight response.

Tensed muscles may prepare a person to get away from danger quickly, but muscles that are constantly tense can result in pain, tension headaches and migraines.

The hormones adrenaline and cortisol are responsible for increased heartbeat and breathing, which can help when facing a threat. But these hormones also affect digestion and blood sugar.

A mental health professional will ask you about all of your symptoms, physical and emotional, to determine whether you have an anxiety disorder. They’ll also want to know how long you’ve had symptoms and if they’ve increased in severity or were triggered by a specific event.

There are important facts to share with your therapist:

• Are you using drugs or other substances?
• Have you been hurting yourself or are you having thoughts of hurting yourself or others?

Either of these things can impact diagnosis and treatment. Many people have anxiety along with another mental health condition, such as depression. As anxiety and depression symptoms increase, it becomes more likely a person will have:

• asthma
• heart problems
• migraines
• vision problems
• back problems

Research has further linked asthma and anxiety. Anxiety is associated with an increased risk for heart disease, heart failure, and stroke, though it has not been determined that anxiety is a specific risk factor for these conditions.

Treatment for anxiety

Therapy and medication are the two main treatments for anxiety. If a person experiences physical symptoms of anxiety, talk therapy or medication that improves the anxiety often leads to improvement of these symptoms.

Cognitive behavioural therapy (CBT) is one of the most common and effective therapy options for anxiety. Some persons may find that therapy on its own is helpful while others often prefer medications to help them manage anxiety better. Oftentimes people do well with a combination of medications and talk therapy.

Helping yourself

It will be useful to learn how to control anxiety whenever one experiences it. The following tips may be useful in making a person calm:

• Use proven techniques to help you calm down, such as slow breathing, mindfulness or relaxation. Guided imagery and deep breathing are two practices that can help your body relax. Meditation and yoga can also benefit you. These techniques are considered safe, but it is possible to experience increased anxiety as a result.
• Think carefully about how realistic your worries are. How likely is it that the thing you are afraid of will happen? Or if you're telling yourself you 'must' do something, is this really true?
• Try to distract yourself by doing something you enjoy. For example, have an in-depth conversation with someone, read a book, swim or go for a walk.
• Do you have a practical problem that you might be able to do something about? Try brainstorming to come up with some solutions and choose the best solution to try out and see if it is feasible.
• Are you dealing with your anxiety by drinking too much alcohol or taking drugs? This can cause even more problems. Alcohol, cigarettes and drugs can make anxiety worse.
• Prioritise sleep. Sleep issues often accompany anxiety. Try to get as much sleep as you can. Feeling rested can help you cope with anxiety symptoms.

In short, yes.

Anxiety as an emotional state causes a person to be more sensitive in all of their senses, even the internal awareness of your own body.

This is why when patients are anxious, they will report that their heart rate has increased, but when we measure their heart rate, it is usually within the normal range.

I advise my patients not to just take my word for it, and get a basic smartwatch that can track their heart rate and observe it on their own. They are usually bemused by what anxiety can cause them to (subjectively) feel!

On non-specific symptoms:

Nausea, heartburn and bloatedness are what the medical community call non-specific symptoms (i.e. taken alone, a symptom).

For example, heartburn, does not point definitively to a pathology/diagnosis (eg. gastrointestinal reflux).

However, medical professionals have to do our due diligence and rule out such pathology by asking further questions, performing specific phsycial exam, or order further investigations to confirm these are not there before we attribute the symptoms to a psychological cause.

A visit to your friendly family doctor/polyclinic will be a good first step if these symptoms are bothering you.

Here's more on how to get help if you have anxiety issues in Singapore.