Anxiety can cause all sorts of physical symptoms, like a headache or an upset stomach. It can also make you cough.
Do you live with anxiety and have a persistent cough? If so, you might suspect that your anxiety could be causing your cough.
Evidence suggests that anxiety can indeed induce a cough, although research in this area is very limited.
Anxiety-induced coughing is known as somatic coughing syndrome. It was previously known as a psychogenic cough.
We often think of anxiety as an emotional or mental symptom, but anxiety can show itself in our physical bodies, too. You may be familiar with the feeling of a lump in your throat, butterflies in your stomach, or anxiety making you blush or tremble.
A somatic cough is one in which there’s no physical explanation, and where psychiatric reasons appear to be the source. When psychological distress leads to physical symptoms, this is known as somatization.
So, how might anxiety lead to a cough? Researchers have a few theories:
- Anxious breathing. When we’re anxious, our breathing often becomes shallow and rapid (hyperventilation). This can cause a dry or irritated throat, which can trigger coughing.
- Acid reflux. A
2018 studyinvolving more than 19,000 people found that anxiety and stress may contribute to acid reflux, or gastroesophageal reflux disease (GERD). If the stomach acid reaches the esophagus, it can cause coughing.
- The immune system. Anxiety and high levels of stress may lower your immune system response. This could make you more susceptible to irritants or infections that can cause coughing.
- Stress affecting the vagus nerve. Chronic stress can affect the vagus nerve — a major nerve that runs from the brain stem to several organs, including the lungs. Some
researcherssuggest this might be the cause of some unexplained coughing.
There’s a complex association between mental health issues and chronic cough. These two symptoms can contribute to or worsen each other.
While anxiety can sometimes result in a persistent cough, having a chronic or untreatable cough (from any cause) can also lead to anxiety.
A chronic cough can have physical, social, and emotional effects, all of which can cause anxiety. For example, a person with a chronic cough may avoid daily activities, have relationship problems, have urinary incontinence, or avoid talking (to avoid triggering a cough).
In general, there seems to be a link between coughing and several types of psychological symptoms.
- somatic symptoms
- social dysfunction
- severe depression
There’s some confusion regarding what type of cough can be seen in a somatic cough disorder.
Experts have long believed that a barking or honking cough is a central feature of somatic coughing syndrome, but the latest guidelines suggest that healthcare professionals shouldn’t use this when making a diagnosis.
While a barking or honking cough may be present, this could be due to other reasons, like the common cold.
Also, while coughing tends to stop at night in somatic cough disorder, other cough disorders also have this feature. Therefore, it’s no longer used in diagnosis.
Coughing varies from person to person, and there’s no single type of cough related to anxiety. Still, the cough is likely to be dry and nonproductive.
Symptoms of an anxiety-induced cough may include the following features (but not necessarily):
- coughing when feeling anxious or nervous
- less coughing while feeling relaxed
- a persistent dry cough
- difficulty taking a deep breath without coughing
- a tickling sensation in the throat or lungs causing you to cough
- a persistent nonproductive cough
- a barking or honking sound
- no coughing while sleeping
Coughing symptoms may be sporadic or persistent. Many of these symptoms overlap with other conditions, so it’s important to see a healthcare professional for a correct diagnosis.
What’s the difference between a cough caused by anxiety and a tic disorder?
Telling them apart can be complicated, but in general, a person with a tic cough would likely show signs of other tic behaviors.
Tics are defined as rapid and repetitive muscle contractions that manifest as involuntary movements or sounds. A tic cough would likely include the presence of an urge sensation just before the tic with attempts to suppress it.
Tics can happen at random. Sometimes they’re related to stress, tiredness, or anxiety. Other causes include provisional tic disorder or Tourette disorder.
There are many causes of coughing that do not involve anxiety. Coughs can present in a variety of ways and for different reasons, such as:
- Asthma. An asthma-related cough often causes wheezing. This will sound like a whistling sound on exhalation.
- A viral infection. The common cold, flus, and other chest infections are common causes of cough.
- Allergies. If your cough gets worse when you’re around pollen, dust, or animals, you might have allergies.
- Whooping cough. Also called pertussis, this is caused by a bacterial infection. It’s characterized by back-to-back coughing followed by a deep inhale that makes a “whooping” sound.
- Air quality. You might cough due to cold air, tobacco smoke, or air pollution.
The American College of Chest Physicians (ACCP) guidelines recommend that a diagnosis of somatic cough syndrome — a part of somatic symptom disorder — only be made after:
- an extensive exam has been given
- uncommon causes of cough have been ruled out
- the person meets the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria
The DSM-5 criteria for somatic symptom disorder include:
- One or more somatic symptoms are distressing or lead to notable disruption to daily living.
- There may be constant or disproportionate thoughts about how serious the symptoms are, high levels of anxiety about the symptoms, or significant time and energy devoted to the symptoms.
- Symptoms are persistent, usually lasting more than 6 months.
Diagnosis may be difficult in a person who has a chronic cough and a history of psychological symptoms. According to a
If this is the case, the healthcare professional should confirm any causality in this relationship and not assume the psychological issues are causing the cough.
The distinction between somatic cough syndrome and other similar diagnoses is not entirely clear, according to the same
Other potential diagnoses for cough without a known physical source or that persist despite treatment include:
- idiopathic cough, or unexplained cough
- cough hypersensitivity syndrome
- laryngeal hypersensitivity
While underlying mental health symptoms may be contributing factors in some of these types of chronic cough, an unexplained cough can occur in people without psychological symptoms.
Since research is lacking in somatic cough syndrome, there’s no sufficient evidence regarding which types of treatments are most effective.
Some approaches that may be
- receiving mental health support
- suggestion therapy
- appropriate medications
Approaches to reduce anxiety may also help. These can include:
- eating a balanced diet
There are a number of steps you can take at home to provide relief for a persistent cough. These include the following:
- Try drinking warm, soothing liquids, like warm lemon and ginger tea, or another tea that can ease a cough.
- A spoonful of honey may soothe the throat and reduce coughing.
- Stay hydrated and avoid dehydrating foods and drinks, like alcohol, salty foods, and sugary drinks.
- Humidify the air. If you don’t own a humidifier, place a shallow bowl of water near a heat source to let the water slowly evaporate into the room.
- Take time to rest. Your body needs time to recover and recharge. Get at least 8 to 10 hours sleep at night, and avoid strenuous exercise for a few days.
If you’re experiencing a persistent cough, it’s important to seek the opinion of a healthcare professional. Together, you can discuss whether anxiety or another reason is triggering your cough.
If you find that anxiety is the probable cause of your cough, it might help to engage in stress-reducing activities, such as meditation or yoga.
You might also consider making an appointment with a counselor or psychiatrist to discuss other options for managing your anxiety.