Recognizing Autonomic Dysfunction
Why It’s Often Mistaken for Anxiety and What to Do If You Suspect It
In recent years I’ve developed a growing interest in autonomic dysfunction, largely because I’ve encountered more teens in my practice with symptoms that seem connected to it. Reflecting on their experiences made me realize something surprising: I’ve likely been dealing with similar symptoms myself since my teenage years.
For years I didn’t have a name for the clammy, dizzy sensations that would hit me without warning. At one time I thought they were panic attacks, but they weren’t initiated by any stressors, and I don’t suffer from anxiety in general. Instead, I found relief through simple adjustments like staying hydrated and keeping a water bottle on my nightstand to drink before getting up in the morning, eating salty foods, getting enough sleep, exercising regularly, wearing compression socks, and practicing deep breathing when I felt an episode coming on.
This personal journey has deepened my understanding of autonomic dysfunction and the need for proper diagnosis and care. I strive to offer better guidance than I received as a college student when a dismissive physician left me feeling like there was no treatment for these “odd” symptoms, though I am still unable to offer a “fix” because no cure exists.
Autonomic dysfunction symptoms can be misinterpreted as panic attacks, or they can lead to anxiety and panic. I’ve been more intentional when I hear people complain of panic attacks to try to identify triggers to be sure it is an anxiety-driven panic attack and not unrecognized autonomic dysfunction, but it is still easy to be unsure due to the symptom overlap and autonomic dysfunction leading to anxiety.
Symptoms of panic attacks include sweating, overwhelming feelings of fear, shortness of breath, chest pain, nausea, dizziness, fear of dying or doom, and numbness. Symptoms of autonomic dysfunction can include abnormal sweating, shortness of breath or feeling winded, chest pain, dizziness and fainting when standing, constipation or diarrhea, urinary problems, sexual dysfunction, and more.
If you suspect you’re dealing with autonomic dysfunction, understanding the unique signs and seeking the right care is crucial. And if your symptoms are thought to be anxiety but don’t improve with anxiety management, don’t hesitate to advocate for yourself. It’s always good to reassess if you don’t respond to treatment. Maybe autonomic dysfunction, ADHD, or something else needs to be addressed.
The first part of advocacy is knowledge, so read on to learn!
What is the Autonomic Nervous System?
The autonomic nervous system (ANS) controls many “automatic” functions, like heart rate, blood pressure, and digestion. There are two parts of the autonomic nervous system.
The sympathetic nervous system prepares the body for a stressful situation. This is often called the body’s “fight, flight, or freeze” response. The sympathetic nervous system directs energy to processes that can help a person respond to a threat while slowing down other processes that are less important during an emergency.
The parasympathetic nervous system helps to relax the body and conserve energy. This is known as the “rest and digest” state.
What is Autonomic Dysfunction?
Autonomic dysfunction, or dysautonomia, occurs when the ANS doesn’t work properly. Since the ANS controls many “automatic” functions, its dysfunction can lead to disruption of many organ systems and a wide range of symptoms.
The ANS is responsible for regulating all the things that happen in your body that you don’t need to think about. These include regulating heart rate, blood pressure, temperature control, sweating, and digestion. When the ANS is not functioning properly, these systems can become unpredictable.
Common Symptoms of Autonomic Dysfunction
The symptoms of autonomic dysfunction can affect multiple organ systems. Here are some common signs to look for, but there are others:
Cardiovascular Symptoms:
Rapid heartbeat (especially when standing up)
Dizziness, lightheadedness, or fainting (especially upon standing or with quick posture changes)
Fluctuations in blood pressure, either too high or too low
Head Symptoms:
Headache
Brain fog or problems concentrating
Vision changes
Gastrointestinal Symptoms:
Nausea, bloating, and abdominal pain
Constipation or diarrhea
Trouble swallowing
Temperature and Sweat Regulation Issues:
Inability to sweat normally or excessive sweating
Feeling unusually hot or cold in typical temperatures
Flushing
Color changes in hands or feet
Respiratory Symptoms:
Shortness of breath, even with mild exertion
Sleep-Related Symptoms and Fatigue:
Trouble sleeping
Sleep cycle changes leading to poor sleep quality
Daytime sleepiness and fatigue
When the cause of fatigue is not from another identifiable factor, persists for at least 6 months, and is associated with malaise (discomfort, unease, or pain) after even mild exertion or effort, it may be categorized as myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS)
Persistent tiredness or exhaustion
Muscle weakness or feelings of heaviness
It’s important to keep in mind that any of these symptoms can happen in people without autonomic dysfunction due to other causes, such as dizziness upon standing due to dehydration. Work with your physician to rule out other causes, such as low iron, thyroid dysfunction, sleep apnea, and more.
Symptoms in only one organ system would suggest the problem is not autonomic dysfunction. Symptoms from multiple organ systems increase the odds that the autonomic nervous system may be the root cause.
Why Autonomic Dysfunction is Often Mistaken for Anxiety
Autonomic dysfunction and anxiety can produce overlapping symptoms, especially related to the cardiovascular system, such as a racing heart, dizziness, and sweating.
Here’s why they are frequently mistaken for one another:
Similar Symptom Presentation*:
Both conditions can lead to palpitations, sweating, shortness of breath, and dizziness. *For a complete list, see below.The Role of the Autonomic Nervous System:
In anxiety, the sympathetic branch of the ANS is activated as part of the “fight, flight, or freeze” response. This also occurs in autonomic dysfunction, though the trigger is not psychological but rather physiological, meaning the body’s response is due to a functional disorder of the ANS, not to anxiety.Diagnostic Challenges:
The overlap in symptoms can lead healthcare providers to assume anxiety is the cause. Because autonomic dysfunction isn’t always recognized, patients may undergo unnecessary treatments for anxiety rather than for the underlying dysfunction.Psychological Impact:
Living with unrecognized autonomic dysfunction can lead to actual anxiety. The unpredictable symptoms can make people feel out of control, anxious, and worried about when symptoms will strike, which can further complicate diagnosis and treatment.
Recognizing the Signs of Autonomic Dysfunction vs. Anxiety
Differentiating autonomic dysfunction from anxiety can be challenging. Here are a few indicators that your symptoms may be rooted in autonomic dysfunction rather than purely psychological causes:
Symptom Triggering:
Symptoms that are triggered by physical activities or positional changes, like standing up, may point more toward autonomic dysfunction.
Anxiety often arises in response to emotional or situational triggers.
Persistence and Pattern of Symptoms:
Autonomic dysfunction symptoms often follow a predictable, physical pattern—such as worsening after meals, heat exposure, or prolonged standing—that doesn’t align with typical anxiety patterns.
Response to Relaxation Techniques:
Anxiety symptoms may subside with deep breathing, relaxation exercises, or mental distraction.
Autonomic dysfunction symptoms are less likely to respond to these techniques because they arise from physiological dysregulation rather than psychological stress.
If autonomic dysfunction leads to symptoms, it may help to do deep breathing or relaxation exercises if the symptoms lead to anxiety.
Use screening tools to help learn what the root cause of symptoms is:
Anxiety: Use validated tools like the GAD-7 (Generalized Anxiety Disorder-7), or SCARED (Screen for Child Anxiety Related Disorders) to assess for anxiety.
Autonomic Dysfunction: Use the COMPASS-31 questionnaire (Composite Autonomic Symptom Score) to quantify autonomic symptoms.
Steps to Take if You Suspect You Have Autonomic Dysfunction
If you’re experiencing symptoms that don’t fit a typical anxiety profile or don’t improve with anxiety treatments, it’s worth investigating further.
Steps to consider and discuss with your doctor:
Track Your Symptoms:
Keep a journal documenting when symptoms occur, their severity, and any triggering factors (like standing, eating, or physical exertion). Include details about heart rate, blood pressure, and other physiological signs if possible.
Use this record to help you and your doctor understand the pattern of your symptoms, identify triggers, and better manage symptoms.
Change Eating Habits:
Make it a goal to drink 3 to 4 liters of non-caffeinated fluid every day (caffeine is a diuretic, which means it pulls water out of your body).
Eat salty foods and snacks or drink beverages that include salt in them, like sport drinks (but avoid sugars in these).
Some people with dysautonomia find that their symptoms are worse after eating, especially large meals or those high in carbohydrates. It can be helpful to eat smaller meals more frequently throughout the day to reduce changes in symptoms after eating. Avoid high-carbohydrate meals.
Get Basic Cardiovascular and Neurological Assessments:
Initial tests like orthostatic vital signs and basic laboratory studies can help rule out other conditions and establish baselines.
Because people with hypermobility conditions are at risk for autonomic dysfunction, assess joint hypermobility.
Consult a Specialist:
Autonomic dysfunction is best evaluated by someone familiar with this condition. If your primary care physician is not able to help you get control of symptoms, a neurologist or cardiologist with experience in dysautonomia may be helpful.
Specialists may conduct specialized tests, such as the tilt table test (to assess blood pressure and heart rate response to posture changes), heart rate variability testing, or sweat tests to help get better management.
Unfortunately, there are few specialists, especially pediatric specialists, for this condition and even cardiologists and neurologists are not always well versed in this.
Treatments with Lifestyle and Medications:
Lifestyle adjustments are the primary treatment for most people with autonomic dysfunction.
Increase salt and water intake
Wear compression garments
Get sufficient sleep
Managing stress
Exercise carefully — pace yourself but exercise regularly within your limits
See this fabulous booklet from the Mayo Clinic for more details.
Medications may be prescribed to help regulate heart rate, blood pressure, and blood volume if lifestyle adjustments are not sufficient.
Seek Support and Information:
Living with autonomic dysfunction can be challenging, and it’s common to feel isolated.
Support groups, both online and in-person, can connect you with others who understand the condition.
These communities can also be excellent sources of information on coping strategies and the latest research.
*Symptoms commonly shared between panic attacks and autonomic dysfunction
Both conditions activate the autonomic nervous system (ANS), which controls heart rate, blood pressure, and respiration, leading to overlap in symptoms. However, panic attacks typically have a clear psychological component (such as fear or an emotional trigger), whereas autonomic dysfunction symptoms often occur without an emotional cause and may be triggered by physical factors, like standing or digesting food.
Cardiovascular Symptoms
Rapid or pounding heart rate (tachycardia)
Chest discomfort or tightness
Feeling faint or dizzy, especially upon standing or in crowded spaces
Respiratory Symptoms
Shortness of breath or feeling smothered
Hyperventilation (rapid or shallow breathing)
Gastrointestinal Symptoms
Nausea or upset stomach
Abdominal discomfort or cramps
Temperature Regulation Symptoms
Sweating or hot flashes
Chills or cold hands and feet
Neurological Symptoms
Lightheadedness or feeling like you might pass out
Trembling or shaking
Tingling or numbness in the hands, feet, or face
Generalized Symptoms
Fatigue or weakness
Feeling detached or “unreal” (a sensation known as depersonalization)
Psychological Symptoms
Sense of impending doom or fear of losing control (often more common in panic attacks but can appear in autonomic dysfunction due to unpredictability of symptoms)
Putting It All Together
Recognizing autonomic dysfunction can be life-changing, especially if it’s been misdiagnosed as anxiety.
Understanding the distinct symptoms, tracking your experiences, and consulting a specialist can help get to the root of the issue and lead to effective management strategies.
By raising awareness of autonomic dysfunction, I hope to empower others to find the answers and support they need. You’re not alone. It’s possible to reclaim control over your health by regularly practicing self-cares, such as getting sufficient sleep, staying hydrated, and recognizing symptoms for what they are so you don’t get unnecessarily anxious from the symptoms.
It’s essential to advocate for yourself if you feel your symptoms aren’t being fully addressed. With the right diagnosis and treatment, many people with autonomic dysfunction can regain control over their health and find ways to manage their symptoms effectively.
Remember, you’ve got this!
For More:
Related post:
I wrote an e-book on dizziness as part of a promotional series. Sign up for it here: Dizziness in teens
The Dysautonomia Project is a fabulous resource for anyone with dysautonomia and healthcare providers wanting to learn more.
This podcast on IBS and autonomic dysfunction is helpful for anyone with GI symptoms: IBS Questions Explained By GI Doctor | Irritable bowel syndrome treatment | Do I have IBS quiz