Introduction
We specialize in identifying and treating anxiety in adolescents and young adults — but anxiety symptoms don’t always originate from a mental health diagnosis alone.
In some cases, underlying medical or neurological conditions can either mimic anxiety or coexist with it, complicating diagnosis and treatment. Misattributing physical symptoms to a psychiatric cause can lead to delays in care and increased distress for patients and families.
This post explores some of the most common medical and neurological conditions that can present like anxiety, and offers guidance on when to consider a medical evaluation as part of a comprehensive treatment plan.
1. Neurological Conditions
Tics & Tourette Syndrome
Motor or vocal tics — especially sudden, repetitive movements or sounds — may be mistaken for anxiety-related behaviors, such as nervous habits. Tourette Syndrome, a condition characterized by multiple motor and at least one vocal tic, often co-occurs with anxiety disorders. However, tics are neurological in origin and may not improve with anxiety treatment alone.
Seizure Disorders
Certain types of seizures, especially focal seizures or absence seizures, can appear similar to dissociative episodes or panic attacks. Symptoms like staring spells, unresponsiveness, or sudden behavioral changes may be misread as anxiety, particularly in adolescents. An EEG or neurological referral may be warranted if episodes are unexplained or don’t respond to standard treatments.
2. Endocrine & Metabolic Conditions
Thyroid Disorders (Hyperthyroidism/Hypothyroidism)
Overactive thyroid (hyperthyroidism) can cause restlessness, heart palpitations, irritability, and insomnia — all hallmark symptoms of anxiety. Conversely, hypothyroidism may contribute to depression, fatigue, and cognitive sluggishness. Simple blood tests (TSH, T3, T4) can rule out thyroid dysfunction.
Hypoglycemia or Blood Sugar Dysregulation
Low blood sugar can lead to shakiness, dizziness, confusion, and sweating — sensations that overlap with panic attacks. For patients with suspected anxiety who also struggle with disordered eating or irregular meal patterns, evaluating blood glucose may provide insight.
Anemia
Iron-deficiency anemia can cause fatigue, shortness of breath, and palpitations, which may mimic or exacerbate symptoms of generalized anxiety or panic. A complete blood count (CBC) can detect anemia and should be considered when fatigue is prominent.
3. Other Common Medical Mimics
POTS (Postural Orthostatic Tachycardia Syndrome)
This condition involves abnormal increases in heart rate upon standing and can include dizziness, chest pain, and fainting — symptoms often mistaken for panic disorder. Many individuals with POTS are misdiagnosed with anxiety before receiving a correct diagnosis from a cardiologist or neurologist.
Asthma
Breathing difficulties, especially during an asthma attack, can lead to sensations of choking or suffocating — often confused with panic attacks. If patients report chest tightness or wheezing, a pulmonary evaluation is critical.
4. When Mental Health Is Medical Health
Mental health conditions like anxiety and depression are legitimate medical conditions, often with neurobiological and physiological components. However, they may coexist with or be influenced by physical health issues. It’s crucial that clinicians rule out medical causes before attributing symptoms solely to a psychological disorder.
When to Consider a Medical Workup
- New onset of symptoms with no clear psychological trigger
- Symptoms that don’t respond to evidence-based mental health treatment
- Presence of physical signs (weight loss, hair loss, temperature intolerance)
- History of autoimmune, endocrine, or neurological issues
- Cyclical or episodic symptom patterns
Conclusion
We take a holistic approach to adolescent and young adult mental health — one that considers the full picture.
Collaborative care between mental health providers, primary care physicians, psychiatrists and specialists ensures our clients receive accurate diagnoses and effective treatment.
If you’re a parent or provider working with a teen whose symptoms don’t align neatly with traditional anxiety, we encourage a multidisciplinary assessment. Early recognition of medical mimics can change the course of treatment — and transform a young person’s quality of life.