Anxiety symptoms are among the most common complaints encountered in clinical settings.

However, a variety of underlying medical conditions can present with anxiety-like features, complicating accurate diagnosis and management.

Differentiating primary anxiety disorders from medical mimics is critical for appropriate treatment and patient safety.

<h3>Neuroendocrine Disorders: The Silent Anxiety Imitators</h3>

Neuroendocrine imbalances frequently manifest symptoms overlapping with anxiety, such as palpitations, sweating, and restlessness. Conditions like pheochromocytoma, a rare catecholamine-secreting tumor, provoke episodic hypertension and panic-like attacks. Similarly, hyperthyroidism increases metabolic activity, leading to tremors, nervousness, and irritability, often mistaken for generalized anxiety disorder.

Dr. David S. Cooper, an endocrinologist, emphasizes, "When anxiety symptoms are present without a clear cause, it is critical to conduct a comprehensive thyroid and adrenal evaluation before making a psychiatric diagnosis."

<h3>Cardiopulmonary Causes: When the Heart and Lungs Mimic Panic</h3>

Cardiovascular and pulmonary disorders can evoke symptoms resembling anxiety. For example, arrhythmias, especially supraventricular tachycardia, produce rapid heartbeat and dizziness, common features in panic episodes.

Chronic obstructive pulmonary disease (COPD) or pulmonary embolism can cause dyspnea and chest discomfort, easily misattributed to anxiety attacks. Clinicians must carefully differentiate by obtaining electrocardiograms and pulse oximetry in patients presenting with acute anxiety-like symptoms.

<h3>Metabolic and Electrolyte Imbalances: Hidden Triggers of Anxiety Symptoms</h3>

Imbalances in glucose, calcium, or electrolytes may provoke neuropsychiatric manifestations. Hypoglycemia triggers adrenergic responses such as sweating, shaking, and confusion. Hyponatremia or hypocalcemia can cause irritability and cognitive disturbances, mimicking anxiety states.

<h3>Neurological Disorders: Overlapping Presentations with Anxiety</h3>

Neurological conditions including temporal lobe epilepsy, multiple sclerosis, and migraine disorders may produce symptoms like episodic confusion, sensory changes, or autonomic disturbances similar to panic or anxiety. Particularly, temporal lobe seizures can cause intense fear sensations and autonomic symptoms, often misread as psychiatric panic attacks.

Neurologist Dr. V. S. Ramachandran notes, "When anxiety symptoms present with sudden onset or focal neurological features, EEG and neuroimaging are crucial in differentiating neurological causes from psychiatric conditions."

<h3>Substance-Induced and Medication-Related Anxiety Mimics</h3>

Numerous medications and substances can cause anxiety-like symptoms through pharmacological effects or withdrawal syndromes. Stimulants such as caffeine, amphetamines, or corticosteroids often induce nervousness and agitation.

Conversely, withdrawal from benzodiazepines, or opioids can provoke marked anxiety and agitation, complicating clinical assessment. Detailed medication and substance use histories remain cornerstones in evaluating anxiety presentations.

<h3>Autoimmune and Inflammatory Disorders: The Overlooked Causes</h3>

Emerging evidence links autoimmune conditions like systemic lupus erythematosus (SLE) and Hashimoto's encephalopathy with neuropsychiatric symptoms that resemble anxiety. Cytokine-mediated inflammation can alter neurotransmitter pathways, contributing to mood and anxiety symptoms.

The complex interplay between physical illnesses and psychiatric symptoms necessitates a multidisciplinary approach to patients with anxiety presentations. Misdiagnosis risks inappropriate treatment and adverse outcomes, underscoring the need for thorough clinical, laboratory, and sometimes imaging assessments.

Collaboration among psychiatry, internal medicine, neurology, and endocrinology specialists fosters accurate diagnosis and tailored treatment plans.