POTS or Anxiety?: Avoiding Misdiagnosis

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Diagnosing medical conditions can sometimes be challenging, especially when symptoms overlap between different disorders. This is particularly true for POTS and anxiety, conditions that can share similar symptoms. While these symptoms may seem alike, the underlying causes are quite different, and a correct diagnosis is crucial for effective treatment. Understanding the distinctions and taking proactive steps can help avoid misdiagnosis and ensure proper care.

What Is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the autonomic nervous system, which controls involuntary functions in the body, such as heart rate and blood pressure. People with POTS experience a sudden increase in heart rate when they move from lying down to standing up. This is often accompanied by symptoms like dizziness, lightheadedness, and even fainting. This happens because their bodies struggle to regulate blood flow properly when changing positions, causing blood to pool in the lower extremities and reducing blood flow to the brain.¹

Doctors don’t fully understand the cause of POTS but can link it to various factors, including viral illnesses, genetic predisposition or other chronic conditions. The symptoms can vary widely among individuals and may include fatigue, nausea, headaches, and difficulty concentrating.¹

Treatment often involves a combination of lifestyle changes, such as increasing fluid and salt intake, wearing compression stockings, avoiding triggers, and gradually increasing movement. Medications can also help manage symptoms.¹

What Is Anxiety?

Anxiety is your body’s response to stress or perceived danger that causes worry, nervousness, or fear. It’s a common human emotion everyone experiences from time to time. For instance, if you have a job interview coming up, you may feel nervous leading up to the day; this is completely normal.

However, when anxiety becomes excessive, persistent, or interferes with daily activities, it may be classified as an anxiety disorder. Symptoms include a racing heart, sweating, trembling, difficulty breathing, and a sense of impending doom or panic.

Anxiety disorders include a range of conditions, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. The cause can be complex, often involving a combination of genetic, environmental and psychological factors.

Treatment may involve therapy such as cognitive-behavioral therapy, which helps individuals identify and change negative thought patterns, as well as medication to manage symptoms. Lifestyle changes like regular exercise, mindfulness and stress management can also reduce feelings of anxiety.

How Do the Two Differ?

While both POTS and anxiety can involve symptoms like rapid heartbeat and dizziness, they’re conditions with different underlying causes and mechanisms. POTS is primarily a disorder of the autonomic nervous system, which controls involuntary functions. It’s triggered by changes in body position — particularly when moving from lying down to standing up — abnormally increased heart rate and physical symptoms related to poor blood circulation.¹ On the other hand, anxiety is a psychological condition characterized by excessive worry, fear, or nervousness. It can be triggered by a range of factors, including stress, trauma, or certain life situations.

Despite their differences, POTS and anxiety can sometimes overlap in terms of symptoms, making it challenging to distinguish between the two without careful medical evaluation. For instance, both conditions can cause symptoms such as heart palpitations, lightheadedness and a sense of unease.²

However, in POTS, these symptoms are mainly due to physiological changes in the body’s regulation of blood flow. In anxiety, they’re more often a response to perceived threats or stressors. It’s also common for people with POTS to experience increased anxiety as a result of the distressing nature of their physical symptoms and the impact on daily life.¹

The approach to treating POTS and anxiety differs significantly. POTS management typically involves strategies to improve blood circulation.¹ In contrast, anxiety treatment often focuses on psychological therapies and medications like antidepressants or anxiolytics.

Misdiagnosis Challenges

Misdiagnosis occurs when these symptoms overlap. Both conditions present similar symptoms, making it difficult for health care providers to distinguish between them based solely on symptoms.

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Since anxiety is more commonly recognized and understood, there can be a tendency to attribute physical symptoms to anxiety, especially if they appear during stressful situations. This can result in doctors overlooking POTS as a possibility, delaying appropriate treatment for the underlying cause.³

Another challenge in correctly diagnosing these conditions is the variability in symptom presentation. POTS symptoms can fluctuate in severity and may be influenced by factors such as hydration, temperature, and time of day, leading to inconsistent symptom reporting. This variability can complicate the diagnostic process, especially if the symptoms aren’t present during a medical evaluation.

Similarly, anxiety can manifest in various forms, from generalized anxiety to panic attacks, each with distinct characteristics. Accurate diagnosis requires a comprehensive evaluation — including detailed medical history, symptom tracking, and often specialized testing—to differentiate between the two conditions and ensure that patients receive the correct treatment.

How to Avoid Misdiagnosis

If you’re concerned you may have one of these conditions, you can do the following to avoid misdiagnosis:

• Keep a detailed symptom log. Keep a diary of any symptoms, noting when they occur, their severity, duration, and any triggers. Include information on physical symptoms like dizziness and psychological symptoms like fear or worry.
• Document triggers and patterns. Identify anything you think may be related to your symptoms. For example, note if symptoms worsen when standing up or in specific stressful situations.
• Seek specialized care. Consider consulting with specialists who have experience with autonomic disorders or anxiety, such as cardiologists or psychiatrists. They can provide an in-depth evaluation and testing.
• Request comprehensive testing. Ask for detailed tests that can help differentiate between POTS or anxiety, such as a tilt table test or psychological evaluations.
• Communicate clearly. Clearly communicate your symptoms and concerns to health care providers, emphasizing any physical sensations and emotional experiences.
• Consider a second opinion. If there’s any uncertainty or you feel doctors aren’t adequately addressing your symptoms, seek a second opinion.
• Educate yourself. Do some research on POTS and anxiety to better understand your symptoms. This knowledge can empower you to ask informed questions and ask for appropriate care.

It’s common for symptom overlap to lead to misdiagnosis, which may delay appropriate treatment and relief. By keeping a detailed symptom log and advocating for comprehensive testing, individuals can increase their likelihood of receiving an accurate diagnosis.

Understanding the distinctions between these conditions is crucial for effective treatment and improved quality of life. Whether it’s POTS, anxiety, or both, proper diagnosis and management can make a significant difference in patient outcomes.

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