chest pains and anxiety

Can Anxiety Cause Chest Pain?

Photo by 
Jonathan Borba



 times asthma.  

Can anxiety cause chest pain?

Many of my clients who have anxiety will complain of chest pain. This symptom is often due to their anxiety. When experiencing anxiety, a woman can have chills, dizziness, or stomach problems. The body and mind are not separate.It’s frustrating to see this as referred to as psychosomatic in medical journals. It is not! Stress and anxiety put the body in fight or flight and cause these symptoms. They are genuine and you are not crazy. But, they usually aren’t dangerous.

Chest pain and panic disorder

As many as 44% of patients with chest pain who come to hospital emergency rooms have panic disorder ( Foldes et al. 2019). 


One reason might be people with panic disorder have increased muscular activity in the chest wall following carbon dioxide inhalation. It is scary and feels like a heart attack. You may become convinced you are dying. People with anxiety may be more sensitive to pain. Research shows gender also plays a role. Women with anxiety seem more sensitive to this pain and anxiety cycle. ( Keough 2004) Katerndahl D. A. (2008).

Chest pain and generalized anxiety disorder

People with generalized anxiety disorder( gad) also have chest pain as an anxiety symptom. One study showed half of people with gad reported chest palpitations (Hoehn-Saric, R. (2007).


Many women I see have physical symptoms due to their anxiety and stress. They aren’t psychosomatic but are real. IBS, asthma, headaches, and fibromyalgia are all commonly associated with anxiety.

If I have chest pain and anxiety, does it mean my heart is fine?
Not always. 

Doctors have to take it seriously because you can have anxiety and chest pains and still have something wrong with you. 


Doctors use factors to determine if chest pain and anxiety are the main issues rather than heart problems or other issues. 

There are some  factors  used by doctors to determine if chest pain and anxiety are the main issue rather than a heart problem. 

  • 1. The absence of coronary heart disease
  • 2. An atypical quality to the pain
  • 3. A young age for heart pain
  • 4. A high level of anxiety reported by the client
  • 5. Client being a female ( though this is debatable)

 Doctors are refining protocols to recognize panic disorder and anxiety in patients who present with chest pain through screening tools and to refer patients for appropriate treatment for their anxiety because many do not get identified. Additionally, there is an overlap between depression and chest pain. 


It’s essential to consult a doctor first if you have chest pain issues. If your doctor determines it’s anxiety, It may be important to get some help. Unfortunately, many medical providers will not refer you to therapy. It is more likely they and may prescribe anxiety medication, especially if you are a woman.

If I have Chest Pain and Anxiety How is it Treated in Therapy?


If anxiety is causing my chest pain, how can a mental health professional help?

When women come to see a therapist with chest pain and anxiety, treatment is unique to that client. 


Ruling out medical conditions


It is essential to rule out medical conditions. Treatment hinges on allowing your reactions in your body to happen and recognizing them as a false alarm. 


It would be unethical for a therapist to work with a client to convince them that the anxiety is a false alarm if it isn’t.


In my practice, I refer a client to a cardiologist or other doctor before beginning treatment or get a clean bill of health.


Treatment for panic attacks requires decreasing the reaction to fearful thoughts, physical symptoms, and avoidance. 


In the absence of a medical condition, reducing emergency room visits or urgent care visits may be a treatment goal. 


There isn’t anything shameful about being afraid and going to the ER. It’s scary to feel like you are dying! With help and support, you can learn to rely less on this strategy of dealing with your anxiety. As you get stronger, these visits decrease, and panic subsides. 


Learning about how panic works and causes the chest pain


Working on understanding and learning about panic and anxiety helps. It can decrease pain and increase safety. Mindfulness and acceptance-based therapy, relaxation exercises, cognitive-behavioral strategies help. 



If anxiety and pain disrupts sleep, work, school or relationships, medication can be helpful. 

It is important to remember that panic and anxiety are treatable through therapy! You can reduce your physical symptoms and the disruption to your life. 


Learn about panic attacks 

    • References


  • Foldes-Busque, G., Denis, I., Poitras, J., Fleet, R. P., Archambault, P., & Dionne, C. E. (2013). A prospective cohort study to refine and validate the panic screening score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open, 3(10), e003877. doi:10.1136/bmjopen-2013-003877
  • Foldes-Busque, G., Denis, I., Poitras, J., Fleet, R. P., Archambault, P., & Dionne, C. E. (2019). A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain.

    Journal of Health Psychology24
    (6), 717–725.
  • Huffman, J. C., & Pollack, M. H. (2003). Predicting panic disorder among patients with chest pain: An analysis of the literature. Psychosomatics, 44(3), 222-236. doi:10.1176/appi.psy.44.3.222
  • Hoehn-Saric, R. (2007). Treatment of somatic symptoms in generalized anxiety disorder.Psychiatric Times, 24(3), 34.
  • Katerndahl D. A. (2008). Chest pain and its importance in patients with panic disorder: an updated literature review.

    Primary care companion to the Journal of clinical psychiatry10
    (5), 376–383.
  •  Keogh,E  Hamid,R  Hamid, S &Ellery,D ( 2004) Investigating the effect of anxiety sensitivity, gender and negative interpretative bias on the perception of chest pain. Pain,Volume 111, Issues 1–2,2004,Pages 209-217,ISSN 0304-3959,


Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.

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