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Centuries ago, when women complained of trouble sleeping, irritability or other problems, their physical ailments were often ignored and filed away as signs of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480686/" target=_blank>“hysteria</a>,” a condition that doctors believed was caused by the uterus moving around the body.

Fast-forward to today, when hysteria is no longer a go-to label, but women are <a href="https://onlinelibrary.wiley.com/doi/10.1002/brb3.497/abstract;jsessionid=83EDFFA49AF80E29292577FA363F232C.f02t04" target=_blank>almost twice as likely as men to be diagnosed with an anxiety disorder</a>, according to a 2016 systematic research review published in the academic journal Brain and Behavior.

The reasons for this are complicated, but one thing is clear: Women may struggle to get diagnoses for health problems — including sleep apnea, thyroid issues and certain heart conditions — early enough if their symptoms are misattributed to anxiety. Sorting out whether a symptom stems from anxiety or something else is essential, experts say, adding that women shouldn’t be afraid to ask questions and advocate for themselves.

Women often have somatic, or physical, symptoms, like a racing heart, muscle tension or diarrhea, said Stacy Doumas, a psychiatrist and chair of the department of psychiatry at Jersey Shore University Medical Center. This can make it difficult to determine whether their symptoms are caused by anxiety, another medical condition, or both, Doumas said.

“It’s tricky for female patients but also for the doctors who are trying to figure it out,” she adds.

If anxiety interferes with your daily life, happens very frequently or is really intense, you might have generalized anxiety disorder (GAD) or another anxiety disorder, Doumas said. GAD affects 3.4 percent of adult women and 1.9 percent of adult men, according to the <a href="https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder#:~:text=Prevalence%20of%20Generalized%20Anxiety%20Disorder%20Among%20Adults,-Based%20on%20diagnostic&text=An%20estimated%205.7%25%20of%20U.S.,some%20time%20in%20their%20lives." target=_blank>National Institute of Mental Health (NIMH)</a>.

A GAD diagnosis typically requires experiencing symptoms (which include excessive worry, difficulty sleeping, trouble concentrating, restlessness and fatigue) for six months, said psychiatrist Meitra Doty, associate professor and director of the women’s mental health fellowship at the University of Texas Southwestern Medical Center in Dallas.

Anxiety can also present with physical symptoms including diarrhea, numbness or tingling, muscle tension, a racing heart, lightheadedness and migraines, all of which can also be symptoms of other medical conditions.

Hormones like <a href="https://pubmed.ncbi.nlm.nih.gov/38472517/" target=_blank>estrogen</a> and progesterone can play a role in anxiety, said Lily Brown, a clinical psychologist and director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. Rates of anxiety disorders skyrocket around the time of first menstruation in puberty, Brown said.

There are also cultural and social forces at play, said Christine Crawford, an assistant professor of psychiatry at Boston University and associate medical director at the National Alliance on Mental Illness. “There’s a lot of pressure being placed upon the shoulders of women in today’s society,” she said. “They are more likely to experience anxiety just given the significant load they have to carry in professional spaces, academic spaces, socially and at home with their families.”

Women also report <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870285/" target=_blank>higher rates of childhood trauma</a>, including sexual assault, than men, which can significantly increase the chances of having an anxiety disorder later in life, said Sohye Kim, co-chair of the women’s mental health special interest group at the Anxiety and Depression Association of America. She is also an assistant professor of psychiatry, pediatrics and OB/GYN at UMass Chan Medical School.

There’s also a self-reporting bias, because men are less likely to report their anxiety than women. But, Kim said, “the reporting bias doesn’t erase sex differences. Anxiety rates are higher in women than men, even when reporting bias is accounted for.”

<a href="https://www.medscape.com/viewarticle/504598_5" target=_blank>One small study</a> published in the journal Progress in Cardiovascular Nursing found women with symptoms of coronary heart disease were often misdiagnosed until they had a heart attack — some study participants said their doctors attributed their symptoms to nervousness and anxiety.

Another <a href="https://pubmed.ncbi.nlm.nih.gov/29029561/" target=_blank>2017 study</a> published in the Scandinavian Cardiovascular Journal found women with paroxysmal supraventricular tachycardia (PSVT), a type of arrhythmia, were more likely to be misdiagnosed and referred for treatment later than men. Their symptoms, the study authors write, were “often incorrectly diagnosed as panic attacks, stress, anxiety or depression.”

Women are also less likely to get a diagnosis for sleep apnea than men, Brown said, which is relevant because sleep issues and anxiety often overlap. “Men are more likely to have sleep apnea than women, but when women do have it, they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461585/" target=_blank>tend not to have a diagnosis of it</a>, which is pretty serious because you’re not breathing during your sleep,” she said.

Certain pain disorders, in particular, endometriosis, are often misdiagnosed as anxiety as well, said Vaile Wright, a licensed clinical psychologist and senior director of health care innovation at the American Psychological Association.

Doumas adds that it can also be tricky for women to get an accurate diagnosis for thyroid conditions and pheochromocytomas (rare adrenal gland tumors) because the symptoms can be similar to those of anxiety.

Here are some tips to help you sort out whether it’s anxiety or something else that’s causing problems.

See a doctor after four weeks of new symptoms. Doty recommends making an appointment with a physician if you’ve had any new or concerning symptoms for four weeks, regardless of whether you already have an anxiety disorder diagnosis. “There are [tests] they can do to just really quickly rule [things] out,” she said. For example, cardiac lab work or an EKG could rule out a heart problem, whereas an MRI could rule out a neurological condition.

Trust your gut. Advocate for yourself when you notice a change in your health, Doumas said. If your anxiety feels different than in the past, “it’s definitely worth advocating and getting that full medical work-up before saying this is just anxiety,” Doumas said.

Keep a journal. Because it can be difficult to determine whether certain symptoms are due to anxiety or another medical cause, it’s often beneficial to track your symptoms, said Carolyn Ponting, a clinical psychologist and postdoctoral fellow at the University of California at San Francisco who studies women’s mental health. “It can help to track when physiological symptoms start and stop,” she said. “Is a racing heart or shortness of breath occurring at particular times of day, or in response to a stressor, or are they out of the blue?”

Share your family history. Ponting also recommends sharing your family history with your physician. This can help show whether you’re at a higher risk for certain medical conditions. For example, if your symptoms are primarily gastrointestinal, it would be helpful for them to know if your sibling or parent has celiac disease. Or, if you’re having heart palpitations, it would be good to share if your parents, siblings or children have a heart condition.

Don’t be afraid to ask questions. The onus is on your doctor to figure out what’s wrong, but you can still be assertive and advocate for yourself, said Jill Stoddard, a clinical psychologist and founder and director of the private Center for Stress &amp; Anxiety Management in San Diego. If you feel that your physician isn’t answering your questions or taking your concerns seriously, Stoddard recommends getting a second opinion.

If a doctor rules out a medical cause for your symptoms, consider consulting a therapist. “Therapy doesn’t necessarily help with every single psychiatric disorder, but anxiety is one of them that it helps immensely with, as well as medications,” Doty said. “It never hurts to at least pursue an evaluation by a therapist.”

Jamie Friedlander Serrano 

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