As a clinician, I’ve lost count of how many times I’ve seen “stress” blamed for physical symptoms—only to later discover that the real cause was postural orthostatic tachycardia syndrome (POTS) or another form of dysautonomia, Ehlers-Danlos syndrome (EDS) or hypermobility spectrum disorder (HSD), or mast cell activation syndrome (MCAS).

This misattribution happens often, in part because stress is a universal human experience—and because these conditions themselves can create physiological changes that mimic or trigger anxiety-like symptoms.

The Problem With the “It’s Just Stress” Assumption

When someone reports dizziness, palpitations, fatigue, or gastrointestinal (GI) distress, it’s easy for healthcare providers to attribute these symptoms to stress, anxiety, or depression—especially if standard tests come back “normal.”

While mental health conditions can and do cause real physical symptoms, not ruling out underlying medical conditions can be dangerous. The consequences of a missed diagnosis may include:

Years of ineffective treatment for the wrong condition
Progression of the true underlying disorder
Emotional distress from feeling dismissed or misunderstood

How Stress and These Conditions Overlap

POTS, EDS/HSD, and MCAS all affect the body in ways that can produce sensations similar to anxiety or panic, including:

Rapid heartbeat
Shortness of breath
Dizziness or lightheadedness
GI discomfort
Temperature dysregulation
Shakiness or tremors

It’s no wonder these symptoms are often confused with stress-related responses. However, the physiological mechanisms are different—and that distinction matters for treatment.

Stress Is Real—But It’s Not Always the Cause

Stress and chronic illness have a bidirectional relationship:

Living with POTS, EDS/HSD, or MCAS can increase stress through daily symptom management, unpredictability, and social or occupational limitations.
Stress itself can worsen symptoms, creating a feedback loop that makes it difficult to tell cause from effect.

But critically—these conditions are not caused by stress or anxiety. Treating them as if they are can delay correct diagnosis and care.

A Red Flag: When Anxiety Treatment Doesn’t Work

One important clinical clue: When anxiety symptoms do not improve despite long-term, evidence-based treatment, it’s time to look deeper. Persistent symptoms may point to:

Undiagnosed autonomic dysfunction (such as POTS)
Connective tissue disorders (such as EDS/HSD)
Immune dysregulation or mast cell disorders (such as MCAS)

Early recognition and evaluation by a clinician familiar with these conditions can prevent years of unnecessary suffering.

Stress is real, and mental health matters. But not every symptom that looks like anxiety is anxiety. If your symptoms are persistent, unexplained, or resistant to treatment, it’s worth asking your healthcare provider to consider underlying causes like POTS, EDS/HSD, or MCAS.

Correct diagnosis is a game-changer—and can be the difference between years of uncertainty and a path toward effective management.

Disclaimer: This blog post is for informational purposes only and shall not be construed as behavioral health or medical advice. It is not intended or implied to supplement or replace treatment, advice, and/or diagnosis from your own qualified healthcare provider.

When It’s Not “Just Stress”