Anxiety & ALPIMS
Anxiety is real — but it does not always happen in isolation.
Body symptoms, autonomic changes, pain, sensory overload, illness, fatigue, uncertainty and reduced capacity can all interact with how anxious someone feels.
Anxiety can have more than one layer
ALPIMS does not assume that every feeling of alarm, distress or unease has the same cause.
Sometimes anxiety begins with thoughts or emotions. Sometimes the body feels alarmed first. Sometimes anxiety increases because someone is in pain, exhausted, overloaded, unwell or struggling to predict what will happen next.
More than one of these things can be happening at the same time.
Explore what may be interacting with anxiety
Open any domain that seems relevant. You may recognise more than one.
Anxiety & Autonomic Emotional alarm, autonomic symptoms and POTS can overlap.
Anxiety can involve physical changes such as a racing heart, sweating, nausea, shaking, breathlessness or a feeling of alarm.
Dysautonomia can also cause symptoms such as dizziness, palpitations, nausea, heat intolerance, weakness, fatigue and difficulty tolerating being upright.
POTS — Postural Orthostatic Tachycardia Syndrome — is a form of dysautonomia.
Some symptoms of POTS and dysautonomia can overlap with symptoms commonly associated with anxiety or panic. This means physical autonomic symptoms may sometimes be mistaken for anxiety.
Anxiety can also occur alongside dysautonomia or POTS. Physical symptoms can understandably feel frightening, and anxiety may then add another layer of autonomic activation.
Consider physical needs, position, temperature, hydration, meals, standing time and exertion where relevant. Autonomic regulation, emotional support, reducing uncertainty and appropriate assessment may all have a role depending on what is contributing.
Anxiety & Laxity / Connective Tissue Hypermobility, pain, instability and autonomic symptoms can add load.
Joint hypermobility can be associated with pain, instability, muscle fatigue and uncertainty about how the body will respond to activity.
In some people, joint hypermobility and hypermobility-related conditions can also occur alongside orthostatic intolerance or POTS.
This creates an important connection between the Laxity & Connective Tissue and Anxiety & Autonomic domains.
Someone may experience joint symptoms as well as dizziness, palpitations, weakness, nausea, fatigue or difficulty being upright. Some of these symptoms can overlap with sensations associated with anxiety or panic.
Anxiety may also develop around pain, injury, activity, leaving home, standing for long periods or uncertainty about whether the body will cope with what is planned.
Appropriate physical care, pacing, supportive equipment where needed, comfortable positioning, reducing unnecessary physical strain and considering possible dysautonomia or POTS when upright symptoms are present.
Anxiety & Pain / Bodily Sensitivity Pain can create both physical load and understandable worry.
Pain itself is stressful.
Repeated or unpredictable pain can also create worry about symptoms, sleep, activity, plans, work, relationships or whether something is wrong.
When pain is high, the brain may also have less spare capacity for coping with uncertainty or emotional demands.
Appropriate pain treatment, comfort, positioning, rest, sensory support, pacing, reducing unnecessary demand, emotional support and strategies for managing fear around symptoms without dismissing the symptoms themselves.
Anxiety & Immune / Inflammatory Illness, fatigue and unpredictable reactions can shrink available capacity.
Feeling physically unwell can make the whole system less able to tolerate additional demand.
Fatigue, headache, gastrointestinal symptoms, reactions, post-viral symptoms or environmental sensitivities may also create uncertainty about what someone can safely or comfortably do.
This may increase vigilance and anxiety, particularly when symptoms are unpredictable.
Treating relevant health problems, pacing, rest, predictable routines, reducing exposures or triggers where appropriate, having a symptom plan and reducing pressure to push through when capacity is low.
Anxiety & Mood / Mental Health Thoughts, emotions, experiences and ongoing stress matter too.
Anxiety may involve worry, fear, rumination, panic, avoidance, trauma responses or difficulty managing uncertainty.
Anxiety can also become harder when someone is dealing with grief, depression, repeated stress, relationship difficulties or frightening past experiences.
Emotional regulation can help someone work with strong feelings without needing to suppress them.
Emotional regulation, appropriate psychological support, DBT or other suitable skills, grounding, reducing immediate demands, supportive connection, problem-solving when ready and treating significant anxiety when appropriate.
Anxiety & Sensory / Neurodevelopmental Overload, uncertainty and executive demand can look or feel like anxiety.
Noise, light, smells, touch, crowds, social demands or too much information can place the nervous system under significant load.
Neurodivergent people may also experience anxiety around uncertainty, transitions, communication, unexpected changes, executive demands or environments that require continuous adaptation.
Sometimes reducing the sensory or cognitive demand is more useful than adding another anxiety-management exercise.
Sensory adjustments, predictable routines, advance notice, fewer decisions, clear communication, adapted emotional regulation strategies, recovery time and environments that fit the person’s needs more closely.
Start with what is happening now
Anxiety does not always need the same response. Open whichever sounds most relevant.
My body feels alarmed
Notice what the body is doing before deciding what the feeling means.
Is there dizziness, a racing heart, nausea, hunger, dehydration, pain, overheating, illness, exhaustion, sensory overload or difficulty being upright?
If symptoms are particularly related to standing or being upright, it may be worth considering dysautonomia or POTS as part of the picture.
My thoughts won’t stop
Rumination can become harder when the brain is overloaded or trying to solve too many uncertain problems at once.
It may help to reduce decisions, write things down, identify one next step or deliberately postpone a problem that cannot be solved right now.
Everything feels too much
Before adding another coping technique, try reducing the amount your system has to handle.
Less noise, less talking, fewer choices, fewer tasks, more predictability or moving somewhere quieter may help.
The fear or anxiety feels emotionally overwhelming
Strong anxiety may need emotional regulation and distress-tolerance support.
The aim is not necessarily to make the emotion disappear. It may be to become steady enough to stay safe, understand what is happening and decide what to do next.
Anxiety gets much worse when I am tired
Low capacity can make normal levels of uncertainty, sensory input, emotion and decision-making much harder to tolerate.
Sometimes rest and reduced demand need to come before trying to reason with anxious thoughts.
I am anxious because I don’t know what is going to happen
Uncertainty can itself use a lot of cognitive and emotional capacity.
A simple plan, knowing the next step, clearer communication, a backup option or a familiar routine may reduce some of that load.
I need someone to help
Another person may help by listening, being predictable, reducing questions, helping with one practical problem or simply staying nearby.
Support does not have to mean taking over.
Anxiety is affecting a lot of my life
If anxiety is frequent, severe, causing significant avoidance, interfering with daily life or becoming difficult to manage, appropriate professional support may be useful.
It can also be worth looking for patterns across physical symptoms, autonomic symptoms, sensory load, sleep, activity, stress, environment and life demands rather than looking at anxiety on its own.
Anxiety symptoms are real, but not every symptom that occurs alongside anxiety is necessarily caused by anxiety.
Pain, migraine, dysautonomia, POTS, sensory overload, illness, fatigue and other physical symptoms can increase distress and can sometimes overlap with sensations associated with anxiety.
It is also possible for anxiety and physical or autonomic symptoms to occur together and influence one another.
ALPIMS encourages looking at the whole pattern: what needs regulation, what needs practical support, what needs reduced load, and what may need assessment or treatment?
Anxiety may be one part of a bigger picture
Sometimes working directly with anxiety is important.
Sometimes the most helpful first step is reducing pain, supporting autonomic symptoms, meeting a physical need, changing the environment, reducing sensory input, making something more predictable or allowing the body to recover.
The question is not only “How anxious am I?” It is also “What might be making this harder?”