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Anxiety & ALPIMS

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How Anxiety Interacts With ALPIMS Domains

Anxiety is often described as a mental health condition, but research shows it also involves multiple body systems, including the nervous system, immune system, gut, and sensory processing.¹²

Because of this, anxiety symptoms may appear differently depending on which body systems are involved.

The ALPIMS framework (Autonomic, Laxity, Pain, Immune, Mood, Sensory) can help explain why anxiety can show up across many different conditions.

A — Autonomic Regulation

How this domain relates to anxiety

The autonomic nervous system controls fight-flight-freeze responses and regulates heart rate, breathing, and stress hormones.

When this system becomes overactive or unstable, people may experience strong body-based anxiety symptoms.³⁴

Conditions where anxiety may appear

• Postural Orthostatic Tachycardia Syndrome. (Health Direct)
• Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
• Panic Disorder (Health Direct)
• Orthostatic Intolerance

Possible symptoms

  • racing heart
  • dizziness
  • breathlessness
  • adrenaline surges
  • feeling faint or unstable

What may help

Support strategies often focus on stabilising the nervous system:

• pacing activity and rest
• slow breathing or relaxation techniques
• gentle movement when tolerated
• hydration and salt (when medically appropriate)
• reducing sudden posture changes

These approaches can support autonomic regulation and recovery capacity.³

L — Laxity / Body Stability

How this domain relates to anxiety

People with connective tissue differences often experience greater muscle tension and instability during stress.

Research shows individuals with hypermobility conditions may have higher rates of anxiety, possibly due to autonomic differences and body awareness changes.⁵

Conditions where anxiety may appear

• Joint Hypermobility Syndrome
• Hypermobile Ehlers-Danlos Syndrome
• Temporomandibular Joint Disorder

Possible symptoms

  • muscle guarding
  • jaw clenching
  • neck and shoulder tension
  • fatigue from stabilising joints

What may help

Helpful supports may include:

• physiotherapy focused on joint stability
• gentle strengthening exercises
• posture and ergonomic supports
• relaxation of chronically tense muscles
• pacing physical activity

These approaches can help reduce physical stress signals that may amplify anxiety.

P — Pain

How this domain relates to anxiety

Stress and anxiety can increase central pain sensitivity, meaning the brain becomes more responsive to pain signals.⁶

Pain conditions can also increase anxiety through fear of flare-ups or loss of function.

Conditions where anxiety may appear

• Migraine
• Fibromyalgia
• Chronic Headache

Possible symptoms

  • migraine triggered by stress
  • tension headaches
  • muscle pain flares
  • increased sensitivity to pain

What may help

Helpful strategies may include:

• regular sleep and routines
• pacing activity levels
• gentle movement or stretching
• pain management plans
• relaxation or stress-reduction techniques

Supporting overall regulation may help reduce pain amplification.

I — Immune / Gut / Inflammation

How this domain relates to anxiety

The immune system and gut communicate closely with the brain through the gut-brain axis.

Inflammation and immune signalling can influence mood, stress responses, and anxiety symptoms.⁷⁸

Conditions where anxiety may appear

• Mast Cell Activation Syndrome
• Irritable Bowel Syndrome
• Asthma

Possible symptoms

  • nausea or digestive upset
  • allergic or inflammatory flares during stress
  • fatigue after immune activation
  • mood changes during illness

What may help

Supportive approaches may include:

• managing known food triggers
• balanced nutrition
• gentle gut-friendly eating patterns
• asthma and allergy management, or inflammation management
• reducing environmental stressors where possible

Stabilising immune and gut function can sometimes reduce body-driven anxiety symptoms.

M — Mood / Cognitive

How this domain relates to anxiety

This domain involves emotional regulation and cognitive processing.

Psychological stress, trauma, and rumination patterns can contribute to persistent anxiety responses.⁹

Conditions where anxiety may appear

• Generalized Anxiety Disorder
• Social Anxiety Disorder
• Post-Traumatic Stress Disorder

Possible symptoms

  • excessive worry
  • rumination
  • irritability
  • emotional overwhelm
  • difficulty concentrating

What may help

Helpful supports may include:

• psychological therapies (such as CBT)
• trauma-informed therapy when relevant
• stress management skills
• supportive relationships
• gradual exposure to feared situations

These approaches help support emotion regulation and coping skills.

S — Sensory Processing

How this domain relates to anxiety

Sensory systems influence how the brain interprets environmental signals.

When sensory systems are very sensitive, environments can become overwhelming or unpredictable, triggering anxiety responses.¹⁰

Conditions where anxiety may appear

• Autism Spectrum Disorder
• Sensory Processing Disorder
• Migraine

Possible symptoms

  • sensitivity to noise or light
  • sensory overload
  • feeling overwhelmed in busy environments
  • strong startle responses

What may help

Helpful supports may include:

• reducing unnecessary sensory load
• quiet recovery spaces
• predictable routines
• sensory tools (earplugs, soft lighting, etc.)
• pacing social or environmental exposure

These strategies can help reduce sensory stress on the nervous system.

Key Message

Anxiety does not only affect emotions.

It can interact with:

  • nervous system regulation
  • pain processing
  • immune and gut function
  • sensory processing

Because of this, people with ALPIMS-type conditions may experience anxiety symptoms across several body systems simultaneously.

Understanding these connections may help support more balanced and supportive approaches to care.

References

  1. National Institute of Mental Health. Anxiety Disorders.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
  3. Thayer JF, Lane RD. Neurovisceral integration model of emotion regulation. Journal of Affective Disorders.
  4. Raj SR. Postural tachycardia syndrome. Circulation.
  5. Bulbena A et al. Anxiety disorders in the joint hypermobility syndrome. Psychiatry Research.
  6. Institute of Medicine. Relieving Pain in America.
  7. Mayer EA. Gut-brain axis and stress. Nature Reviews Gastroenterology & Hepatology.
  8. Dantzer R et al. Inflammation and mood disorders. Nature Reviews Neuroscience.
  9. American Psychological Association. Anxiety Disorders.
  10. Green SA, Ben-Sasson A. Anxiety and sensory over-responsivity. Autism Research.