Symptoms of Anxiety — Check List
Read through the list and notice which symptoms you experience right now, or which appear when you feel most anxious. Awareness is the first step toward regulation.
The list below consists of common manifestations of anxiety, organised according to the framework used in Intensive Short-Term Dynamic Psychotherapy (ISTDP). Some of these symptoms might also be caused by other health-related issues, so persistent or severe symptoms should also be discussed with a doctor.
It is normal to have some level of anxiety (the lower end of this list) when excited, or when talking about emotionally significant issues. This checklist aims to help you become more aware of your own signs of anxiety — and, as a result, to regulate it better. Only with well-regulated anxiety is it possible to fully experience emotions and work through emotional issues in therapy.
Why Anxiety Shows Up in the Body: The Three Pathways
In ISTDP, anxiety is understood as physiological arousal that gets discharged through one of three pathways — or a combination of them. Recognising which pathway your anxiety tends to travel through can be useful both for self-awareness and for therapy.
| Body area | Manifestations |
|---|---|
| Hands | Movement of the thumb, fidgeting fingers, gripping or wringing the hands, clenching and unclenching a fist |
| Mouth & jaw | "Rabbit-like" mouth movements, lip pressing or pursing, clenched jaw, grinding teeth, tightness around the chin |
| Forearms & arms | Clenching the fist, tension running through the forearm, crossing arms tightly, gripping objects (pens, phones, armrests) harder than necessary |
| Shoulders & neck | Raised or hunched shoulders, tightness across the upper back, stiff or "locked" neck, reduced range of motion when turning the head |
| Face | Tension in the forehead or around the eyes, furrowed brow, tight cheeks, a "held" facial expression that doesn't soften |
| Vocal cords & throat | Tightness in the voice, voice becoming higher-pitched or strained, clearing the throat repeatedly, a sense of constriction when speaking |
| Chest & ribs | Tension in the intercostal muscles, frequent sighing, a feeling of a tight band around the chest |
| Abdomen | Tightening or "knotting" in the belly, holding the stomach in, a sense of bracing in the core |
| Lower back | Tension or stiffness in the lower back muscles, an urge to shift position frequently |
| Legs & feet | Restless legs, jiggling or bouncing a leg, tension running from hip to foot, curling or tensing the toes |
| Whole body | A general sense of tension "from head to toe," difficulty sitting still, an overall feeling of being braced or on guard |
| Symptom | What it feels like |
|---|---|
| Sympathetic reactions ("accelerator") | |
| Dry mouth and throat | A cottony, parched feeling, difficulty swallowing comfortably |
| Dry eyes | Eyes feeling gritty, needing to blink more, mild burning sensation |
| Sweating | Sweaty palms, sweating in the armpits, sometimes a cold sweat across the back or forehead |
| Cold hands | Hands (and sometimes feet) feeling noticeably cold even in a warm room |
| Blushing | Sudden flushing or reddening of the face, neck, or chest |
| Feeling warm | A sudden wave of heat through the body, even in a cool environment |
| Increased heart rate and force | Heart pounding, racing, or feeling unusually strong in the chest |
| Shivering or trembling | A fine tremor in the hands, voice, or whole body, even without feeling cold |
| Vaginal dryness | A physiological response to autonomic arousal, relevant for some clients |
| Parasympathetic reactions ("brake") | |
| Light-headedness, dizziness, or fainting | A sense of the head feeling "floaty," the room tilting, or a feeling of being about to pass out |
| Gastrointestinal urgency | Sudden constipation, diarrhea, or an urgent need to urinate |
| Nausea | Queasiness or a churning stomach |
| Stomach acid | Over-secretion of digestive acid, heartburn, or a burning sensation in the stomach or chest |
| Wobbly or "jelly" legs | Legs feeling weak, shaky, or like they might give way — limp presentation |
| Sudden tearfulness | Eyes welling up or tears coming on quickly, sometimes without a clear emotional trigger the person can identify in the moment |
| Symptom | What it feels like |
|---|---|
| Confusion | A general sense of not knowing where you are, what is happening, or what was just said |
| "Blanking out" of thoughts | Mind going suddenly empty, losing the thread of conversation mid-sentence |
| Foggy thinking | Thoughts becoming slow, heavy, or difficult to access — like thinking through mud |
| Disturbances in thought process | Thoughts becoming incoherent, jumbled, delayed, or racing too quickly to follow |
| Disturbances in thought content | Difficulty staying oriented to time, place, or the people around you; losing track of the conversation or context |
| Visual disturbances | Tunnel vision, blurred vision, or visual "floaters" |
| Auditory disturbances | Tinnitus (ringing in the ears), or sounds feeling muffled or distant |
| Dissociation | A sense of unreality, feeling detached from your body or surroundings, or feeling like you're watching yourself from outside |
| Hallucinations | In rare, extreme cases — perceiving things that aren't there. If persistent, this should be discussed with a mental health professional promptly |
How to Use This Checklist
Go through each section and notice which symptoms feel familiar — both right now, and during moments when you know you've felt anxious in the past. You don't need to "have" every symptom in a category for it to be relevant; even one or two recurring patterns can be meaningful.
Most people find that their anxiety tends to follow a fairly consistent pattern — for example, always starting in the jaw and shoulders (Level 1), or quickly moving into nausea and dizziness (Level 2 parasympathetic). Becoming familiar with your own pattern is one of the most useful things you can bring into therapy, because it gives both you and your therapist a concrete, observable signal of when anxiety is rising — often before you're consciously aware of feeling "anxious" at all.
What Happens in Session When Anxiety Reaches Level 2 or 3
When your therapist notices signs of Level 2 or Level 3 anxiety during a session — such as palpitations, dizziness, dissociation, or cognitive fog — they will pause the emotional work and guide you through an emergency version of Jakobson's technique: deliberately tensing all the muscles of the body at once, holding briefly, then releasing. This is repeated several times until anxiety returns to the somatomotor pathway (Level 1), where productive therapeutic work can resume.
Remember this exercise from your sessions and use it on your own whenever you recognise anxiety at Level 2 or 3 in daily life — you don't need to wait for a session. The sooner you intervene, the faster your nervous system can return to a workable state.
The Clinical View — What This Checklist Is Based On
In ISTDP, anxiety is understood not as a primarily cognitive process, but as an unconscious neuro-physiological activation pattern (Davanloo, 2005). Anxiety reactions can be triggered by a realistic external threat — but also by the mobilisation of complex feelings arising in close relationships, including the therapeutic relationship. Anxiety and fear are physiologically the same phenomenon: fear relates to an external stimulus, anxiety to an internal one.
An understanding of the different physiological manifestations of anxiety is important because patients have often not accurately labelled their symptoms as anxiety. For the patient, accurate identification and labelling of symptoms is the first step in mastering anxiety (ten Have-de Labije, 1999, 2006).
Patients with higher ego-adaptive capacity tend to show a higher proportion of somatomotor and sympathetic nervous manifestations, low parasympathetic symptoms, and an absence of cognitive-perceptual disruption — meaning their anxiety stays in Level 1, where it is most workable. One of the aims of ISTDP is to help patients build this capacity over time.
Recommended next step · Body-based regulation
Jakobson's Progressive Muscle Relaxation Training
Once you've identified your anxiety level, use this guided practice to start releasing physical tension and bring your nervous system back toward the somatomotor pathway.References
- Davanloo, H. (1990). Unlocking the Unconscious. Chichester: John Wiley & Sons.
- ten Have-de Labije, J. (2006). When Patients Enter With Anxiety on the Forefront. Ad Hoc Bulletin of Short-Term Dynamic Psychotherapy, 10(1).
- Neborsky, R. J., & Lewis, S. (2010). Understanding and Treating Anxiety from the Perspective of Attachment-Based ISTDP. Ad Hoc Bulletin of Short-Term Dynamic Psychotherapy.
- Abbass, A. (2013). Key Clinical Processes in Intensive Short-Term Dynamic Psychotherapy. Centre for Emotions and Health, Dalhousie University.