When Anxiety isn't Just Anxiety

My last post was about how anxiety can be mistaken for physical ailments, like headaches and stomachaches.

Today I want to talk about some medical conditions that can be mislabeled as anxiety. As I covered last week, anxiety in kids can be a master of disguise. It doesn’t always show up as a nervous child saying, "I feel anxious." Instead, it might look like stomach aches before school, big emotional reactions and irritability to minor things, or bedtime battles that last for hours. But what if what looks like anxiety isn’t just anxiety?

Sometimes underlying medical conditions can mimic or even contribute to anxious behaviors in both kids and adults. Let’s explore some common culprits so you can get a better idea of when to schedule with your physician to dig deeper.

1. Thyroid Disorders:

The thyroid is like the body's speedometer: Too fast, and everything revs up. Too slow, and things start dragging. Either way, it can mimic anxiety.

• Hyperthyroidism (Overactive Thyroid): Can cause racing thoughts, restlessness, difficulty sleeping, and a pounding heart. Sounds like anxiety and panic, right?

• Hypothyroidism (Underactive Thyroid): Leads to fatigue, brain fog, moodiness, and sluggishness, which can sometimes be mistaken for depression, withdrawal, or anxiety.

2. Iron Deficiency:

Iron helps carry oxygen through the body. When levels are low, the body compensates by increasing heart rate, which can feel like anxiety.

• When low on iron you may feel lightheaded, weak, or have a racing heart. The racing heartbeat can lead to worry about your heart, increasing anxiety.

• Restless legs — the feeling that you have to move your legs (or that there are bugs crawling on them) when you’re trying to fall to sleep — can be a sign of low iron. This can lead to sleep deprivation, which adds to emotional dysregulation.

3. Hypoglycemia (Low Blood Sugar):

Have you ever seen a child go from "perfectly fine" to "absolute meltdown" in minutes? Blood sugar crashes can look a lot like panic attacks or anxiety spikes.

This can be especially common in kids on stimulant medications. If they don’t eat much mid-day due to appetite suppression, as the medication wears off their brain is suddenly not able to focus well and impulsivity returns just as they start to feel hungry. This adds up to shakiness, sweating, dizziness, irritability, difficulty concentrating, and feeling overwhelmed and panicked.

If meltdowns vanish after a snack, hanger might be the real culprit.

4. POTS (Postural Orthostatic Tachycardia Syndrome):

POTS affects blood flow and heart rate, often causing dizziness, brain fog, nausea, and a racing heart when standing. It’s a form of dysautonomia, a disorder of the autonomic nervous system. It is characterized by an abnormal increase in heart rate that occurs upon standing or sitting up, accompanied by symptoms such as lightheadedness, dizziness, fatigue, and palpitations (heart flutters).

• Many people with POTS report feeling panicky due to their heart racing and lightheadedness.

• They might avoid standing for long periods or suddenly need to sit down, sometimes misinterpreted as social avoidance or school refusal.

Dysautonomia can be mistaken as panic attacks, so if you suffer with panic attacks, I encourage you to learn more from a past post on autonomic dysfunction.

5. GI Issues (Like Acid Reflux, Food Intolerances, Constipation, or IBS):

An upset stomach before school could be anxiety — or it could be an underlying digestive issue making anxiety worse.

• Acid reflux can cause chest discomfort and worries about heart problems, sometimes leading to feelings of panic.

• Food intolerances can cause bloating, nausea, and headaches. This can make people feel "off" and more emotionally reactive.

• Constipation can cause significant abdominal pain and decreased appetite. Constipated kids may show behaviors like toilet avoidance, withholding stool, or straining, which can be misinterpreted as anxiety. Anxiety can be directly related to constipation too: after a painful bowel movement, kids may fear the pain of pooping and develop anxiety around toileting.

• Irritable Bowel Syndrome (IBS) can lead to unpredictable bathroom trips, which can create anxiety around leaving home.

6. Sleep Disorders:

Poor sleep doesn’t just lead to tiredness — it can completely disrupt a person’s ability to regulate emotions.

• Sleep apnea (often from enlarged tonsils or nasal issues) can lead to night waking, leaving kids feeling exhausted and irritable during the day.

• Restless legs syndrome makes falling asleep a battle, leading to "wired but tired" behaviors that resemble hyperactivity or anxiety. (This is often related to iron deficiency as discussed above.)

• Insomnia creates a cycle where you get anxious about not sleeping, making it even harder to fall into dreamland.

• Delayed sleep phase syndrome can lead to trouble falling to sleep and getting up at conventional times. During puberty, the body's natural sleep-wake cycle (circadian rhythm) tends to shift later, meaning melatonin (a hormone that regulates sleep) is released later in the evening. This can delay feeling tired and falling to sleep for several hours.

• ADHD is strongly associated with sleep problems in kids, teens, and adults. This may be related to symptoms of ADHD itself (hyperactivity and impulsivity) as well as medication side effects and other potential causes.

7. ADHD:

ADHD and anxiety often look similar — fidgeting, difficulty focusing, and restlessness are common in both.

• People with ADHD might seem (or become) anxious because they struggle with organization and forgetfulness. “I can’t forget to turn in my homework again!”

• The emotional dysregulation of ADHD can lead to sudden outbursts that look like panic but stem from frustration instead.

• Trouble falling asleep due to a "racing mind" might be ADHD-related rather than pure anxiety.

8. Sensory Processing Issues:

For kids with sensory sensitivities, everyday environments can feel overwhelming.

• Bright lights, loud noises, scratchy clothing, or certain textures can trigger distress that looks like anxiety. If getting dressed, fixing hair, or noisy environments seem to trigger big emotions, consider this.

• Avoidance of social situations, meltdowns in crowded places, or picky eating can sometimes be more about sensory overload than worry.

Learn more from a past post on Sensory Processing.

When to Dig Deeper

If "anxiety" is persistent, doesn’t respond to typical coping strategies, or seems to come with other unexplained physical symptoms, it might be worth checking in with your pediatrician.

• Keep a symptom journal — track patterns, triggers, and times of day symptoms occur.

• Rule out medical causes with blood work or other tests if symptoms point to a specific underlying source.

• Consider therapy AND medical evaluation — both approaches together give the clearest picture. Make sure your therapist and physician are able to communicate with one another. If they’re working independently they won’t have the full picture of what’s going on.

The Takeaway: Anxiety Isn’t Always What It Seems

While anxiety is very real, it doesn’t always stand alone. Sometimes, there’s an underlying condition making things worse — or even causing the whole thing. Understanding the medical side of the story can make all the difference in finding the right support for your child.

So next time your child seems anxious, take a step back, look at the big picture, and remember—you’re not just managing anxiety, you’re solving a mystery. And with the right clues, you’ll find the answers you need!

Does any of this sound familiar? If so, you’re not alone. Life is full of detective work, but trust yourself. You know yourself or your child best. And if something feels "off," don’t hesitate to seek answers. Talk to your doctor about your concerns!

As always, remember: You’ve got this!