If you’ve ever had a racing heart, dizziness, shortness of breath, and a wave of dread when you stand up too quickly, you might assume you’re dealing with anxiety. For thousands of people, that assumption turns out to be wrong — or only half right. The real cause is Postural Orthostatic Tachycardia Syndrome, known as POTS: a form of dysautonomia where the autonomic nervous system struggles to regulate blood flow and heart rate when you change position, especially moving from lying or sitting to standing.
The trouble is, POTS and anxiety share so much symptom overlap that people are routinely misdiagnosed — sometimes for years — with a panic or generalised anxiety disorder, when what they actually have is a physical, measurable cardiovascular condition. Understanding the difference matters, because the two need very different management approaches, and getting it wrong can leave someone medicated for the wrong thing while the real issue goes untreated.
Why POTS Looks Like Anxiety
POTS symptoms are driven by an autonomic nervous system that isn’t constricting blood vessels properly when you stand, causing blood to pool in the legs and the heart to compensate by beating faster — often 30+ beats per minute above your resting rate within ten minutes of standing. That physiological response produces sensations that are almost identical to a panic attack: pounding heart, breathlessness, light-headedness, trembling, and a surge of adrenaline as the body tries to correct the blood pressure drop.
Because these episodes can strike suddenly and feel frightening, it’s easy — for the person experiencing them and sometimes for clinicians too — to read them as psychological rather than cardiovascular in origin. Anxiety can also be a genuine *consequence* of living with POTS, since unpredictable, disorienting symptoms naturally make people anxious about when the next episode will hit. This creates a difficult loop: POTS can trigger real anxiety, while anxiety symptoms can mask or be mistaken for POTS.
Overlapping Symptoms: POTS vs Anxiety
Symptom | Common in POTS | Common in Anxiety | Key distinguishing clue
– Rapid heart rate | Yes — specifically triggered by standing/postural change | Yes — can occur at rest or with a specific trigger/thought | POTS heart rate spikes are position-dependent and measurable on standing |
– Dizziness / light-headedness | Yes — often severe, worse on standing | Yes — can occur during panic | POTS dizziness improves when lying down; anxiety-related dizziness doesn’t reliably follow position |
– Shortness of breath | Yes | Yes | POTS breathlessness often comes with visible pallor or leg pooling |
– Trembling / shaking | Yes | Yes | Overlaps almost completely; not a reliable differentiator alone |
– Brain fog / difficulty concentrating | Yes — common and often prominent | Yes — during high anxiety states | POTS-related brain fog is often worse after standing/exertion, not tied to worry |
– Nausea | Yes | Yes | POTS nausea often clusters with meals or heat exposure |
– Fatigue | Yes — often profound and persistent | Yes — can follow anxiety episodes | POTS fatigue is usually constant, not just post-episode |
– Feeling of impending doom | Occasionally reported | Classic symptom | More specific to anxiety/panic, though some POTS patients report it during severe episodes |
– Sweating | Yes | Yes | Not distinguishing on its own |
– Fainting or near-fainting | Yes — common, tied to standing | Rare, usually only in severe panic | Fainting on standing is a strong pointer toward POTS |
– Exercise intolerance | Yes — often marked | Sometimes, due to avoidance | POTS intolerance is physiological, not fear-based |
The pattern worth noticing is *triggers and timing*. Anxiety symptoms tend to track with thoughts, stressors, or specific fears. POTS symptoms tend to track with posture, heat, meals, dehydration, and time of day — regardless of what’s going on emotionally.
Why a GP Diagnosis Is Essential
None of the above is a substitute for proper diagnosis, and this distinction genuinely can’t be made from symptoms alone. POTS is formally diagnosed through objective testing — typically a tilt table test or an active stand test, which measures heart rate and blood pressure changes over ten minutes of standing, alongside a clinical history and ruling out other causes.
If you recognise this pattern in yourself, the right next step is a conversation with a GP, who can arrange appropriate testing or refer you to cardiology or autonomic specialists. Self-diagnosing either POTS or an anxiety disorder — and especially assuming one explains away the other — risks missing the actual underlying cause and delaying the right treatment. It’s also worth knowing that the two aren’t mutually exclusive: someone can have both POTS and an anxiety disorder, and untangling that combination is exactly the kind of nuanced work a GP or specialist is positioned to do.
The Three Types of POTS
POTS isn’t a single uniform condition — it’s generally grouped into three (sometimes overlapping) subtypes, and understanding which one applies can shape both treatment and how symptoms present day to day.
– **Neuropathic POTS**: caused by partial dysfunction of the peripheral nerves that control blood vessel constriction in the legs and abdomen, leading to blood pooling on standing. This is thought to be the most common subtype.
– **Hyperadrenergic POTS**: driven by an excessive release of adrenaline (noradrenaline) on standing. This subtype often produces more pronounced tremor, anxiety-like symptoms, high blood pressure on standing, and can feel especially close to a panic response — making it the subtype most prone to misdiagnosis as an anxiety disorder.
– **Hypovolemic POTS**: linked to lower-than-normal blood volume, meaning there’s simply less blood to circulate effectively when gravity pulls it downward on standing. This subtype often responds well to increased fluid and salt intake as part of management.
Many people don’t fit neatly into one box, and subtypes can shift or overlap — another reason clinical assessment matters more than self-categorisation.
Living With the Uncertainty: How Sian Helps
Even after a proper diagnosis, living with POTS often comes with a very real layer of anxiety — not necessarily a clinical anxiety disorder, but the ordinary, understandable worry that builds up around an unpredictable condition: *Will I feel faint if I stand up at this event? Can I manage a full day at work? What if I have an episode somewhere I can’t sit down?*
This is where Sian focuses its support: not on diagnosing or treating POTS itself, but on helping people build practical, day-to-day strategies to manage the anxiety that so often accompanies it. That looks like:
– Helping people separate “this is a POTS symptom” from “this is anxiety about a POTS symptom,” so each can be addressed on its own terms
– Building manageable routines around triggers — hydration, salt intake, pacing, and heat management — so symptoms feel less random and more anticipated
– Supporting practical coping tools for high-anxiety moments, like grounding techniques that work alongside physical management (e.g. sitting or lying down) rather than replacing it
– Encouraging and normalising the step of seeking a GP diagnosis, rather than people trying to manage an unconfirmed condition alone
– Providing a space to process the emotional weight of a chronic, often invisible illness — including the frustration of past misdiagnosis
The goal isn’t to replace medical care, but to sit alongside it — helping people feel more in control of the anxiety layered on top of a genuinely challenging physical condition, so they can engage with treatment and daily life with a bit more steadiness.
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*This article is for general information only and is not a substitute for a medical diagnosis. If you recognise these symptoms in yourself, please speak to your GP.*
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