Somatic Mimics: How Anxiety Tricks the Body

By now, we are probably all familiar with the concept that “the body keeps the score,” originated by Bessel van der Kolk in his book of the same name. But what does this really mean in terms of anxiety and the body? Enter the concept of “somatic mimics,” the idea that when the body responds to anxiety, the resultant symptoms can mimic more serious physical conditions. For example, a person who is very anxious feels tightness in his chest and concludes that he is having a cardiac problem, when, actually, the tightness is merely his body’s response to the anxiety.

As you can imagine, this type of somatic mimicry can create confusion in regard to what to do: Some people will rush to the emergency room, while others may experience even greater anxiety as they focus and fixate on the sensations in their body. Either way, anxiety-driven physical sensations that mimic more serious conditions can wreak havoc on an individual’s peace of mind and sense of physical health and safety. It can also drive them to taking unnecessary emergency measures.

The body does indeed respond to emotional stimulus such as anxiety and stress, so we can understand van der Kolk’s point that the body keeps score—but what if sometimes the game is rigged by anxiety? The physical sensations are the result of emotional stimulus, rather than the other way around: The anxiety causes the physical symptoms rather than the physical symptoms causing the anxiety. The chest tightness is not an alarm that something is systemically wrong in the body, but rather a physical manifestation of the anxious feelings.

While this can seem like the chicken and the egg, if we are looking specifically at somatic mimicry, the emotional stimulus always comes first, and the physical manifestation follows. The confusion that arises as a result is for a very normal and human reason: We don’t like to feel pain or discomfort, and we want to get it checked out, diagnosed, tested, and fixed as soon as possible. Thus, we seek immediate care for symptoms that are, actually, not threatening or dangerous. In doing so, we utilize unnecessary medical visits, undergo unneeded tests and scans, spend money on medical procedures, and drive ourselves into a further state of worry, which continues the anxious cycle.

Differentiating Between a True, Emergent Physical Symptom and Somatic Mimic

So, how can we differentiate between a true, emergent physical symptom and one that is merely a somatic mimic, brought on by anxiety? First and foremost, patient education is key. According to D'Souza and Hooten (2023), “prompt treatment of psychiatric comorbidities and addressing life stressors may improve somatic symptoms.” Essentially, if we understand the possibility of somatic mimics and how they work, we can begin to differentiate between those sensations that indicate tangible medical problems and those that are anxiety-driven. Furthermore, as D'Souza and Hooten point out, we must learn to pay attention to our life stressors and extenuating circumstances that may cause anxiety and, thus, a physical response to the anxiety. This can help us to understand that physical discomfort may be more present when we are experiencing stressors and life transitions.

Second, a reasonable medical response to uncomfortable physical sensations is necessary; D'Souza and Hooten posit that “extensive testing introduces the risk of false-positive results, which can subsequently lead to additional interventional procedures, its associated risks, and increased costs.” So, even though a common anxious response is to seek immediate and emergency care for symptoms, this is not only not always necessary but also sometimes an act that worsens anxiety and can cause financial distress.

3 Skills to Challenge Unhealthy Responses to Physical Sensations

To reduce the confusion and reactivity that somatic mimicry can cause, it is important to implement specific skills to help recognize when a physical feeling is a mimic caused by anxiety and stress rather than an emergency situation. The following three skills can challenge unhealthy responses to physical sensations:

1. Letting go of automatic assumption: While it is human nature to immediately attach meaning to things, in terms of physical sensations, this is not always helpful. If every time we felt a headache, we jumped immediately to the conclusion that we have a brain tumor, we would spend our lives on a treadmill of worry, not to mention likely spend undue time and money undergoing tests and scans. So, learning to challenge automatic assumptions of what our physical sensations mean can help us to limit anxiety-driven responses to physical sensations. Sometimes, a headache is just a headache.
2. Understanding your personal physical responses: While we all inhabit a physical body, each body is unique, and its responses to anxiety and stress can manifest differently. I have learned, for instance, that my anxiety tends to go directly to my chest: When I am stressed, fatigued, and overwhelmed, I often feel discomfort in my chest in the form of slight palpitations or vague pain. This is just my personal physical response to anxiety and overwhelm. I have learned that though I don’t like these feelings, they also do not require immediate or emergency care. They typically dissipate once I have allowed myself to rest or taken a break from an overwhelming situation. Understanding your unique physical response to anxiety can help you to know when you are experiencing a somatic mimic rather than a true medical problem.
3. Being attentive without fixating: Through a mindfulness approach, we can learn to pay attention to our bodies without unhealthily fixating on sensations and physical feelings. If we fixate, we are likely to increase our anxiety and worry and to take reactive rather than thoughtful action. For example, in the headache example, if a person becomes overly attentive to the feeling, he may convince himself that a visit to the emergency room is necessary. On the other hand, if he is able to pay attention to the sensation but not get stuck on it, he will likely be able to function despite the headache, not seek unnecessary medical care, and, eventually, notice that the sensation has lessened or passed.