Beyond Excessive Worry: The Hidden Symptoms of Perinatal Anxiety
When we think of anxiety during pregnancy or the postpartum period, excessive worry typically comes to mind. However, recent research from the International Maternal Mental Health Consortium reveals that many women experiencing perinatal anxiety disorders present with physical symptoms that are frequently overlooked or misattributed to normal pregnancy or postpartum changes.
This oversight can lead to delays in diagnosis and treatment, prolonging suffering for new and expectant mothers who might not recognize their physical symptoms as manifestations of anxiety.
The Physical Face of Perinatal Anxiety
According to the research, which analyzed data from over 5,000 women across 12 countries, the following physical symptoms were commonly reported by women later diagnosed with perinatal anxiety disorders:
Gastrointestinal Symptoms
- Persistent nausea not explained by morning sickness
- Digestive disturbances (beyond normal pregnancy changes)
- Changes in appetite unrelated to pregnancy
- Feeling of a "knot" in the stomach
Cardiovascular Symptoms
- Heart palpitations or racing heart
- Chest tightness or pain
- Shortness of breath unrelated to physical exertion
- Hot flashes or chills not explained by hormonal changes
Neurological Symptoms
- Dizziness or lightheadedness
- Numbness or tingling in extremities
- Headaches or migraines
- "Brain fog" or difficulty concentrating
Musculoskeletal Symptoms
- Muscle tension, especially in the neck, shoulders, or jaw
- Unexplained aches and pains
- Restlessness or inability to relax physically
Sleep Disturbances
- Difficulty falling asleep despite exhaustion
- Inability to return to sleep after night wakings
- Restless or unrefreshing sleep
Why These Symptoms Go Unrecognized
Several factors contribute to the underrecognition of these physical manifestations of anxiety:
Symptom Overlap
Many physical symptoms of anxiety overlap with normal pregnancy or postpartum experiences, making it easy to attribute them to the expected physical changes of this life stage rather than to anxiety.
Focus on the Baby
Both women and their healthcare providers often focus primarily on the baby's wellbeing, leaving less attention for maternal symptoms that don't directly impact the child.
Lack of Provider Education
Many healthcare providers receive limited training on perinatal mental health and may not recognize the connection between physical symptoms and anxiety disorders.
Stigma Around Mental Health
Some women may find it easier to report physical symptoms than emotional ones due to persistent stigma around mental health concerns.
"What we're seeing is that anxiety often speaks through the body," explains Dr. Sophia Roberts, a researcher involved in the study. "Many women come to their providers with physical complaints and leave with recommendations for antacids or suggestions to rest more, when what they really need is mental health support."
The Danger of Missed Diagnosis
Untreated perinatal anxiety can have serious consequences for both mother and baby, including:
- Increased risk of developing postpartum depression
- Potential impacts on maternal-infant bonding
- Interference with breastfeeding due to stress and tension
- Heightened risk of chronic anxiety extending beyond the perinatal period
- Negative effects on partners and family dynamics
Additionally, women who don't recognize their symptoms as anxiety may undergo unnecessary medical tests and treatments while their underlying condition remains untreated.
Improving Recognition and Treatment
The research points to several promising approaches for better identifying and addressing perinatal anxiety:
Comprehensive Screening
Expanding screening tools to include questions about physical symptoms of anxiety, not just emotional ones.
Provider Education
Increasing training for OB/GYNs, midwives, and pediatricians about the physical manifestations of anxiety disorders.
Integrated Care Models
Creating stronger connections between obstetric care and mental health services to facilitate referrals and collaborative treatment.
Patient Education
Providing information about the full spectrum of anxiety symptoms as part of routine prenatal education.
Effective Treatment Approaches
The good news is that perinatal anxiety responds well to treatment. At Bloom Psychology, we offer several evidence-based approaches:
- Cognitive Behavioral Therapy (CBT): Helps identify and change thought patterns that contribute to anxiety and its physical manifestations
- Mindfulness-Based Interventions: Teach present-moment awareness and techniques to reduce physiological stress responses
- Acceptance and Commitment Therapy (ACT): Focuses on accepting difficult sensations while pursuing valued life activities
- Body-Oriented Approaches: Address the physical symptoms directly through techniques like progressive muscle relaxation and diaphragmatic breathing
When necessary, we also collaborate with healthcare providers on medication options that are compatible with pregnancy and breastfeeding.
Listen to Your Body
If you're experiencing persistent physical symptoms during pregnancy or postpartum that don't have a clear medical explanation, consider whether anxiety might be playing a role. Mentioning all your symptoms—both physical and emotional—to your healthcare provider can help ensure you receive appropriate care.
Remember that addressing anxiety isn't just beneficial for you—it creates a foundation for the healthy, connected relationship you want to build with your baby.
Dr. Jana Rundle
Licensed Clinical Psychologist
