POTS and Anxiety: Why They're Often Confused (and Why That Matters)
Racing heart. Shortness of breath. A wave of dread that hits out of nowhere. If you live with POTS, you already know this list — and so does anyone who's ever had a panic attack. The overlap is so significant that it's become one of the most common ways POTS gets missed, minimized, or misdiagnosed entirely. You mention your symptoms, and somewhere along the way, "anxiety" gets written in your chart instead of "dysautonomia."
This isn't just a labeling issue. It changes what treatment you're offered, whether you're believed, and how you start to understand your own body.
Why the Symptoms Overlap in the First Place
POTS (Postural Orthostatic Tachycardia Syndrome) involves a rapid heart rate increase when you stand up, along with symptoms like dizziness, brain fog, shakiness, and a racing or pounding heart. Anxiety and panic attacks can produce nearly identical physical sensations: a fast heartbeat, lightheadedness, a feeling of doom.
The difference isn't always obvious from the symptom list alone. It often comes down to the trigger. POTS symptoms are frequently tied to a physical event such as standing up, being in heat, standing in line, or taking a hot shower, and can occur regardless of your emotional state. Anxiety symptoms are more often tied to a thought, worry, or stressor, though the two can absolutely happen at the same time and even feed into each other.
When "It's Just Anxiety" Becomes a Problem
Many people with POTS are told their symptoms are anxiety long before they ever receive a proper diagnosis. This isn't necessarily malicious, but it can significantly impact treatment, trust in the medical field, and care. It's a symptom of a medical system that's more familiar with anxiety than with dysautonomia. The impact is a misdiagnosis of anxiety is real. Patients start to doubt their own physical experience. Some stop mentioning symptoms altogether because they're tired of the same response. Others develop genuine anxiety about their symptoms, not because they were anxious to begin with, but because living in an unpredictable body, and not being believed about it, is genuinely distressing.
This is sometimes called medical gaslighting, and it can leave a lasting mark on how safe you feel advocating for yourself in medical spaces.
Can You Have Both POTS and Anxiety?
Yes, and that's part of what makes this so complicated. Living with a chronic, unpredictable illness is, understandably, anxiety-provoking. It makes sense to feel anxious about symptoms that show up without warning and disrupt your ability to function. The goal isn't to prove that anxiety doesn't exist or isn't valid. It's to make sure it isn't used as a catch-all explanation that prevents proper diagnosis and treatment of the physical condition underneath it.
How Therapy Can Help — Without Dismissing Your Body
A therapist who understands POTS won't ask you to "calm down" your way out of a racing heart that has a physiological cause. Instead, therapy can help with:
Untangling which symptoms are physiological versus anxiety-driven, in partnership with your medical team
Processing the toll of being repeatedly dismissed or misdiagnosed
Learning nervous system regulation tools that support (not replace) medical treatment
Coping with the unpredictability and grief that often comes with chronic illness
Rebuilding trust in your own body and your own judgment
You don't have to choose between "it's physical" and "it's emotional." For some people living with POTS, it's both — and both deserve real support. However, the distinction between anxiety and POTS can create real concerns and working with a chronic illness-informed counselor with knowledge of POTS can help you navigate the difference. It’s important to understand the root cause of the symptoms to create a treatment plan tailored to you while also keeping in mind the real, physical symptoms of POTS.
Syntropy Counseling is one of the few clinics that offers individual telehealth counseling across Washington state, with specialized experience supporting people living with POTS and chronic illness. If you're tired of your symptoms being explained away, reach out to schedule a session.