In this article
One of the questions I got constantly during my six years with anxiety, and one I still hear from people every single week, is this one.
“How do I know if what I’m feeling is anxiety or something actually wrong with me?”
And for me personally, the version that tortured me the most was the nausea.
Every single time that sick, about-to-vomit, feeling showed up, I’d go into this spiral.
“Is this anxiety making me feel sick?”
“Or am I actually sick and about to throw up in public?”
I’d run through the evidence. I’d monitor the sensation. I’d try to figure out the difference.
Which, if you know anything about how anxiety works by now, is exactly how you make both the anxiety and the nausea significantly worse.
So let’s talk a little about this today. Because I think the answer is going to surprise you.
The Question Everyone Asks
And I get why people ask it. It seems important.
If you know it’s anxiety, you can respond properly and not worry. If you know it’s something real, you can do something about it.
So the distinction feels crucial. Like everything depends on getting it right.
But consider this for a second.
You might be feeling dizzy.
Is it anxiety or low blood pressure?
You might be exhausted.
Is it anxiety or the fact that you’re seven months pregnant?
Your hands might be shaking.
Is it anxiety or the four coffees you had this morning?
Your head might be pounding.
Is it anxiety or the flu coming on?
There are so many different possible answers to all of these questions. And sometimes, genuinely, you cannot know. Symptoms overlap. The human body doesn’t come with labels.
And when you’ve had anxiety for a while, you know that it can produce basically any physical sensation you can think of, which makes the guessing game even more impossible.
And the crazy thing is, it doesn’t actually matter. (!)
Why It Doesn’t Matter
If your head hurts because of anxiety, you take a painkiller and remind yourself it’s anxiety.
If your head hurts because you have the flu, you take a painkiller and remind yourself it’s the flu.
The solution is the same in both cases. So you don’t actually need to know the cause.
If your hands are shaking from too much coffee or from anxiety, neither situation requires you to focus intensely on the shaking.
If you feel nauseous because of anxiety or because you ate something questionable, staring at the feeling and analyzing it obsessively doesn’t make either version better. In both cases, the most useful thing you can do is let it be there and carry on.
And this is where it really gets interesting!
Anxiety has a way of telling on itself.
When you respond properly and stop fighting a sensation, anxiety symptoms tend to fade over time. A real physical condition doesn’t work that way.
A stomach bug is going to run its course regardless of your response. Hormonal changes are going to do what they do. A medication side effect is going to be there until the medication changes.
But (and this is the key thing) resisting those real conditions DOESN’T MAKE THEM GO AWAY FASTER EITHER!!
SORRY FOR CAPSLOCK
Fighting a flu doesn’t cure a flu.
Obsessing over nausea from food poisoning doesn’t settle your stomach any quicker.
So in both cases, the most productive thing you can do is the same: acknowledge what’s happening, don’t resist it, and carry on with what you were doing. Allow the sensation to be there.
Don’t add extra stress onto the discomfort that’s already there.
The response stays the same. Whatever the cause.
When I Actually Threw Up
I want to tell you something that I think is important here, and also genuinely funny in hindsight.
For years, the fear that I might actually vomit in public was one of my biggest anxiety triggers.
That sick feeling would arrive and I’d immediately start running the analysis.
Anxiety or real?
Real or anxiety?
And virtually every single time, it turned out to be anxiety. The nausea would pass on its own, no vomiting, just a lot of unnecessary suffering and monitoring.
And then one day it wasn’t anxiety.
I was in my car. I’d eaten something that clearly disagreed with me, and the nausea that showed up this time was different. It had a different quality to it, more urgent, more specific, less vague. And before I knew what was happening, I threw up. In my car. All over myself. At a stoplight… (yikes)
While a van full of construction workers pulled up next to me and stared.
I don’t know what they expected to see when they looked over. It was not that.
Boys got trau-ma-tized, I can tell you!
I drove home, got in the shower, and you know what? I started laughing.
Because the thing I had spent years being terrified of had finally happened. The actual catastrophe materialized. And I was fine. I drove home. I had a shower. I laughed about it. The construction workers presumably told the story at dinner that evening.
The catastrophe, when it finally arrived, was just… a thing that happened. Embarrassing and unpleasant, yes. Life-ending? Nope.
It wasn’t even as bad as I pictured it for years. What a waste!!
You Can’t Control Everything.
We spend so much energy trying to determine the cause of every sensation because we believe that if we know the cause, we can control what happens next.
If it’s anxiety, we can respond properly and feel better. If it’s something real, we can fix it or prepare for it.
But life doesn’t work that way. There will always be an element of uncertainty.
You will not always know why your body is doing what it’s doing. And the attempt to figure it out, to get absolute certainty before deciding how to feel about something, is itself one of the biggest drivers of anxiety.
You cannot think your way to certainty. And the pursuit of certainty keeps you in your head and focused on your body instead of out in your life.
If you have a chronic illness and are under the care of a doctor, you take your medication, you follow the advice, and you don’t spend the rest of your day catastrophizing about every sensation.
No doctor has ever said “take this twice a day and spend twelve hours analyzing how you feel.”
The medical part is the medical part. The mental part is your job.
And for the sensations that fall in the gray area, where you genuinely can’t tell what’s causing them, the response is still the same. Allow it. Don’t resist it. Carry on. Let the body do what it needs to do, and trust that if something genuinely needs attention, it will make that clear and you can take productive action towards it.
My nausea made it pretty clear.
The 1 Question To Ask
The next time a symptom shows up and your brain immediately wants to know the cause, I want you to try asking a different question instead.
Not “is this anxiety or is this real?” but “does knowing the answer actually change what I should do right now?”
Most of the time, it doesn’t. The response is the same. The discomfort is already there.
Allow it, don’t resist it, refocus, carry on. And if a symptom is genuinely persistent, unusual, or outside your normal experience of anxiety, go and get it checked out. That’s the responsible thing to do, and it takes the guessing game off the table.
But if you’ve been checked, if you know what you’re dealing with, if this is a familiar sensation wearing a new costume or an old one, you already know what to do.
The immediate thing is to respond properly, and if there’s anything else you can do, like taking a painkiller or visiting your doctor, do that.
The construction workers watching me vomit into my steering wheel was the worst outcome I’d spent years imagining. And it turned out to be a funny story.
Most of what you’re afraid of is going to work out the same way.
Either way, you won’t be adding a LOT of unnecessary stress on top of it.
Last updated
This article is for education and is based on lived experience. It is not medical advice and does not replace a doctor or therapist. If you have new or changing symptoms, get them checked by a doctor. If you are in crisis, contact your local emergency number.
