Anxiety and Dysautonomia — Understanding the Physiological Feedback Loop
Few experiences in the dysautonomia patient journey are as damaging as being told that anxiety is causing your symptoms. The framing implies a psychological origin — that something is wrong with how you think or feel, that the right mindset would resolve the racing heart, the lightheadedness, the breathlessness, the sense of impending doom. For patients who have been through this and know their symptoms are physiological, having a clinician reduce the experience to anxiety is more than frustrating. It is a diagnostic failure with real consequences.
Dr. Nicholas DePace and Dr. Joseph Colombo's book Do You Have Anxiety and Dysautonomia? does something important: it explains the mechanism that makes that framing wrong, and it does so in clinical terms that can be understood by patients who are willing to engage with the physiology.
The Loop Is Physiological, Not Psychological
The central insight of this book — and the research behind it — is that the autonomic nervous system and the brain's threat-detection system are not separate systems that happen to interact. They are the same system. The circuits that generate the sensation of anxiety overlap substantially with the circuits that regulate heart rate, vascular tone, respiration, and gut motility. When autonomic regulation is disrupted, the brain's threat-monitoring apparatus receives abnormal signals — and it responds to them the way it is designed to respond to threat signals: with anxiety.
This is not a metaphor. It is a measurable physiological sequence. Dysautonomia creates a physiological feedback loop with anxiety because misregulated autonomic output generates the same internal signals that a genuine threat would generate. The brain cannot easily distinguish between "I am in danger" and "my autonomic system is misfiring" — both produce elevated heart rate, altered breathing patterns, vascular changes, and the felt sense of threat. The body's anxiety response is real. What is incorrect is the assumption that the patient's psychology produced it.
Why This Distinction Matters Clinically
Misattributing autonomic symptoms to anxiety does not just delay diagnosis. It also sends patients into treatment pathways — psychotherapy, anxiolytics, antidepressants — that address the downstream psychological experience while leaving the upstream physiological dysregulation untreated. For some patients, those interventions may reduce the distress of the feedback loop without correcting the mechanism generating it. The loop continues. The patient continues to suffer.
DePace and Colombo approach this not as a critique of mental health treatment, but as a call for accurate mechanistic understanding. If the anxiety is downstream of autonomic dysregulation, then treating the autonomic dysregulation is the appropriate primary intervention. That requires clinical tools — autonomic testing, physiological measurement — not just symptom management.
The book also addresses the reverse direction of the loop. Once anxiety is established — whether it originated from autonomic dysregulation or from psychological sources — it feeds back into autonomic function. Sustained sympathetic activation from anxiety further disrupts the regulatory balance. This bidirectionality is why patients often feel trapped: their symptoms cause anxiety, and their anxiety worsens their symptoms. Understanding that this is a physiological cycle rather than a character flaw changes how patients can relate to and work with the experience.
What the Book Provides
The book is written for a general audience rather than specialists, but it does not oversimplify the physiology. DePace lays out the anatomy of the autonomic nervous system, the mechanisms by which it interacts with the central nervous system's stress and threat-detection circuits, and the clinical presentations that result when that interaction is dysregulated. There is substantial attention to the parasympathetic system — the vagal component of autonomic function that is often underdiscussed relative to sympathetic activation.
Practical sections address what autonomic testing looks like and what it can reveal, as well as treatment approaches that target the physiological loop rather than just its psychological consequences. These sections are less technically dense than the mechanistic chapters and serve as a useful orientation for patients navigating the clinical system.
The book also addresses how the brain reads internal body signals and why the accuracy of that signal processing matters so profoundly for symptom experience. When interoceptive signals are distorted or misregulated, the brain's interpretations of body state go wrong — and the felt consequences range from vague unease to full panic responses with no identifiable external trigger.
Who This Book Is For
This book is specifically valuable for three groups. First, patients who have been told their symptoms are anxiety-driven and want a scientific framework to understand why that framing is incomplete — and, in many cases, incorrect. Second, family members and caregivers who find it hard to understand why someone who "seems fine" keeps experiencing distress. The physiological loop described here is real and involuntary; this book provides language for that reality. Third, clinicians in primary care and psychiatry who encounter patients with complex somatic presentations and want a more mechanistically complete picture than the standard anxiety diagnosis provides.
The patient experience described in this book — repeated reassurance that nothing is physically wrong, referrals to mental health services, the frustration of having real symptoms dismissed — is both common and well-documented in the dysautonomia literature. DePace and Colombo take that experience seriously and respond to it with science rather than sympathy alone. That combination makes this a genuinely useful resource.