Feeling Like You Are Going to Faint: Light-Headedness in Anxiety vs Real Fainting

Is feeling like you are going to faint a sign of anxiety? Learn why light-headedness hits in crowds, how it differs from real fainting and what to do.

You are queuing at the bank. There are twelve people ahead of you, the ventilation isn't working, someone is talking loudly on the phone. Suddenly your head feels empty, your ears ring, the picture seems to darken at the edges and your knees go weak. There is a single sentence in your mind: "I'm going to collapse right here, in front of everyone." You leave the queue, walk to the door and lean against the wall for a few minutes in the fresh air outside. You don't faint. But the following week, when you need to go to the bank, the same fear grips you again. Feeling like you are going to faint is one of the most frightening yet least discussed faces of anxiety. In this article I explain light-headedness in anxiety, how it differs from real fainting and how you can stop this fear from narrowing your life.

What Does Feeling Like You Are Going to Faint Mean?

The pre-fainting state, called "presyncope" in medicine, is when a person feels as though they are about to lose consciousness but does not. Commonly described symptoms are:

• A feeling of emptiness, lightness or dizziness in the head
• Blurring, darkening or tunnel-like narrowing of vision
• Ringing in the ears or sounds seeming far away
• Weakness in the knees and legs
• Nausea, hot flushes or cold sweats
• Tingling in the face or hands
• A sense of unreality, as if your surroundings were a film set

Many of these symptoms can occur both before a real faint and during anxiety and panic. This is exactly where the confusion comes from: the body appears to be speaking the same language, but the mechanisms behind it are quite different.

Why Does Feeling Like You Are Going to Faint Happen in Anxiety?

During anxiety and panic the body switches into "fight or flight" mode. In this mode the heart speeds up, blood pressure mostly rises, muscles tense and breathing speeds up. A large part of the light-headed feeling comes from this rapid breathing.

Rapid breathing and a light head

An anxious person often breathes fast and shallowly without realising it, sighs frequently or tries to take deep breaths. In this case, the level of carbon dioxide in the blood falls. A fall in carbon dioxide can cause some narrowing of the blood vessels in the brain, tingling in the hands and around the lips, and a pronounced feeling of light-headedness. The person interprets this as "I'm fainting", becomes frightened and breathes even faster.

Attention locking onto the body

Someone who has once experienced light-headedness scans their body in similar settings: Is my head spinning, are my legs steady, is my vision clear? This scanning makes even ordinary small fluctuations look like a great danger. A slight dizziness turns within seconds into the thought "here it comes".

Panic and real fainting: an important distinction

Here is a piece of information that brings relief to many people: because blood pressure generally rises during panic and anxiety, it is not common for anxiety alone to lead to a real faint. One of the most common forms of real fainting occurs with a sudden drop in blood pressure and heart rate. In anxiety, by contrast, the body is in the opposite state, sped up and tensed. That is why anxiety-related light-headedness usually remains "feeling like you are going to faint".

This information is not a hard and fast rule, and it is shared not so that you can diagnose yourself but so that you can understand your body a little better. If you have actually lost consciousness, a medical assessment is a must.

An exception: fear of blood and needles

The situation is different in people who are afraid of seeing blood, of needles or of images of injury. In this fear, the body first goes through a brief acceleration, after which blood pressure and heart rate may drop suddenly. That is why real fainting can occur while blood is being taken or when faced with the sight of an injury. A significant proportion of people who faint while having blood taken or feel faint in a hospital corridor belong to this group. The good news is that there is a technique specific to this picture, called "applied tension", which teaches you to support your blood pressure by tensing your muscles, and it is frequently used in therapy.

Other Causes of Real Fainting

Feeling like you are going to faint can have many causes other than anxiety, and these should be assessed by a doctor:

• Standing for long periods, hot and stuffy environments
• Going without food or not drinking enough fluids; for example, during long fasting days or the hot summer months
• Standing up quickly from a sitting or lying position
• Anaemia, low blood sugar, low blood pressure
• Heart rhythm disorders and some heart conditions
• Some medications
• A period of weakness after an illness

That is why, when you feel light-headed, it is not right to say "it's definitely anxiety" either. Physical causes should be ruled out first, and only then should the role of anxiety be considered.

Fear of Fainting in Crowds, Queues and on Public Transport

In Turkey, the places where the fear of fainting is most often experienced are right in the middle of everyday life: a packed journey on the metrobus or metro, the hospital registration queue, a crowded wedding hall, the mosque courtyard during the Bayram (religious holiday) prayer, the street market, the checkout queue at the shopping centre. What these settings have in common is that they can be hot and stuffy, and that they carry the feeling of "not being able to get out immediately".

Over time, many people with this fear take a series of precautions: always standing near the door, carrying water and sugar, sending someone else rather than queuing, taking a taxi instead of public transport even if it is expensive, finding excuses not to go to weddings. These precautions bring relief at the time, but over time they feed the belief "I can only stay on my feet with these precautions" and the space in which life is lived shrinks. When this narrowing goes further, it can turn into the picture called agoraphobia; I describe it in detail in the article on agoraphobia.

Imagine you are a twenty-nine-year-old engineer who felt faint on the metrobus on a hot summer's day a year ago. Since that day you haven't taken the metrobus to and from work, even though it means changing twice. Your journey has become longer, you get up earlier in the mornings, and your tiredness has increased. When your friends invited you to a concert, you didn't go, saying "it'll be crowded". In this example, the real burden is no longer the light-headedness itself, but the huge system built to protect yourself from it.

This fear also has a shame side. Many people fear not so much fainting as falling to the ground in front of everyone, people gathering around them and the questions "what happened, what happened?" The fear of shame can make the light-headed feeling even more intense. Yet in such a moment most people try to help, and within a few minutes the incident is out of everyone's mind; the person who remembers it longest is the one who went through it.

What to Do in the Moment When You Feel Like You Are Going to Faint

Get into a safe position

When light-headedness comes on, the first thing is to make yourself safe. If there is somewhere to sit, sit down and bend your head slightly forward. Where this is not possible, lean against a wall. If there is a chance of real fainting, lying down and raising the legs slightly increases the blood flow to the brain. These steps are safe whatever the cause of the light-headedness.

Slow your breathing

If rapid breathing is increasing the light-headedness, try breathing in slowly through your nose and out even more slowly through your mouth. Rather than trying to take deep breaths, focus on lengthening the out-breath. Within a few minutes you may notice the tingling and light-headedness easing.

Tense your muscles slightly

Especially in situations involving blood and needles, or light-headedness due to standing for a long time, squeezing and relaxing your leg and buttock muscles for a few seconds can support blood pressure. Moving your toes up and down helps in a similar way.

Direct your attention to your surroundings

Where you are, try to see five things, hear four sounds and feel three points of touch. This simple exercise moves attention from inside the body to the outside world and can ease the sense of unreality that accompanies light-headedness.

Say a sentence to yourself

"This feeling is unpleasant but it will pass. I've felt like this before and it passed." This sentence slows the mind's catastrophe scenario a little.

How to Cope with the Fear of Fainting in the Long Term

Immediate measures are important, but real change begins when you look at how the fear shapes your life.

• Meet your basic needs: Not skipping meals, drinking enough fluids during the day and regulating your sleep reduce the likelihood of light-headedness from physical causes.
• List your safety precautions: Write down habits such as standing near the door, the water bottle or constantly looking for somewhere to sit. These are goals to be reduced over time.
• Return gradually to the places you avoid: Starting with the situation you fear least, move forward with short periods and repetition. For example, first two stops on public transport at a half-empty time, then three stops at a slightly busier time.
• Note the thoughts that accompany the light-headedness: Writing down thoughts such as "If I faint everyone will stare at me", "No one will help" or "I'll never come round again" makes it easier to look at them from a distance.

Then there is the role of your loved ones. If your partner or mother comes with you so as not to send you anywhere alone, waits in the queue for you or keeps asking "are you all right?", these caring behaviours can unwittingly keep the fear going. Sharing your plan to return to the places you avoid with them, and deciding together how they can support you, helps. For example, if they are with you during the first attempts and wait a little further away in later steps, this makes it easier for you to regain trust in your own body step by step.

For more information on anxiety-related dizziness and light-headedness, you can also read the article on anxiety and dizziness.

When Should You Seek Professional Support?

If you have actually lost consciousness, if fainting happened during exercise or while lying down, if it was accompanied by chest pain, palpitations or shortness of breath, if you fell and injured yourself, or if there is a history of sudden cardiac death in your family, be sure to see a doctor. In the case of symptoms such as sudden speech disturbance, drooping of the face, or loss of strength in an arm or leg, call 112 (emergency services) without waiting.

After a medical assessment, getting support from a mental health professional may be helpful in the following situations:

• If you cannot go to certain places because of the fear of fainting,
• If you avoid public transport, queues, crowds or enclosed spaces,
• If you experience sudden and intense waves of fear,
• If you are putting off health check-ups because you are afraid of having blood taken, vaccinations or tests.

How Is the Fear of Fainting Addressed in Therapy?

In cognitive behavioural therapy, the person's experience of light-headedness is first understood in detail: In which situations does it start, with which bodily sensations does it come, what goes through the person's mind, and what do they do afterwards? Then the meaning given to the light-headedness is examined together. The difference between "If my head is spinning, I'm going to faint" and "My head is spinning because I'm breathing fast and I'm tense" can radically change the person's experience.

An important part of therapy is for the person to encounter the bodily sensations they fear in a safe setting. For example, creating the feeling of light-headedness by breathing fast in a controlled way and experiencing that this feeling passes can reduce the power of the fear. A gradual return to avoided situations is also planned together. In fear of blood and needles, the applied tension technique is taught and practised step by step.

Light-headedness feels like a warning, but very often it is simply the voice of a tired body on high alert; getting to know that voice is far more liberating than running from it.

You can find more information about individual work on anxiety and panic on the anxiety and panic page.

Frequently Asked Questions

Can you really faint from anxiety?

Because blood pressure generally rises during anxiety and panic, real fainting is not common; most people feel as if they are going to faint but don't. Fear of blood and needles is an important exception to this. If you have lost consciousness, a medical assessment is essential.

Are feeling like you are going to faint and a panic attack the same thing?

Not always. Light-headedness can be one of the symptoms of a panic attack, but it can also be experienced for physical reasons such as hunger, dehydration, heat or low blood pressure. When the symptoms are assessed together, the distinction can be made more clearly.

I feel faint every time I have blood taken. What can I do?

Tell the healthcare worker taking the blood about this beforehand and, if possible, give blood lying down. Squeezing and relaxing your leg muscles at intervals while blood is being taken may help. If this fear is disrupting your health check-ups, it can be addressed in therapy with specific techniques.

Because of this fear I can't use public transport. Will it pass?

As long as avoidance continues, fear usually grows; returning to avoided places gradually and in a planned way, however, can reduce it. If doing this on your own feels hard, moving forward step by step with a professional makes the process easier. If this fear has reduced the places you can go, it is possible to find support that will accompany you as you step back into them.

• #light-headedness
• #fear of fainting
• #panic
• #anxiety symptoms

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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