Sweating from Stress: Are Sweaty Palms and Underarms Linked to Anxiety?

Why does stress make you sweat, and how does it differ from excessive sweating disorder? Learn the cycle of fear of sweating, hiding behaviours and what helps.

The door of the room where the job interview is to take place opens, and the person in front of you smiles and holds out their hand. And in that second you think of only one thing: "My hand is wet." The palm you tried to wipe on your trousers stays under the table throughout the meeting. You never take off your jacket, to hide the growing patch under the arms of your shirt. Sweating from stress may look like a minor inconvenience at first glance, but for many people who experience it, it can be a burden that narrows daily life, leading them to avoid crowds, handshakes and presentations. In this article I explain why anxiety makes you sweat, how you can tell this apart from excessive sweating disorder, how the fear of sweating turns into a cycle and what can be done to get out of it.

What Is Sweating from Stress?

The main job of sweating is to cool the body. On a hot summer day, when climbing stairs or during an illness with a fever, we sweat to regulate body temperature. This sweating usually spreads over the whole body.

Then there is emotional sweating. At moments of excitement, fear, embarrassment or anxiety, regardless of the surrounding temperature, the palms, the soles of the feet, the underarms and the forehead in particular start to sweat. This sweating is triggered by the nervous system that manages the stress response. As the body prepares itself for danger, the sweat glands spring into action too. Some researchers think that the sweating of the palms helped increase grip during evolution; in other words, the body is preparing to flee or to climb.

Everyone experiences emotional sweating. Palms becoming damp before an exam, during an important phone call or when speaking in front of a group is entirely natural. The problem begins with the intensity of the sweating and the meaning the person attaches to it.

Some everyday factors can also make this response easier to trigger. Cups of tea and coffee one after another, hot and spicy food, alcohol, too little sleep and hot, stuffy settings make the sweat glands more primed. For example, sweating is more likely in a meeting you enter after two cups of coffee and a sleepless night than on a rested, calm morning. Knowing these factors helps you understand sweating as the body's response to conditions rather than as an entirely personal "flaw".

Sweating from Stress or Excessive Sweating Disorder?

Not everyone who complains of sweating is in the same situation. There are several different pictures that doctors assess:

Primary excessive sweating: This mostly begins in childhood or adolescence. It appears on the palms, the soles of the feet, the underarms or the face, usually symmetrically on both sides. A similar history in the family is common. The person may sweat even when calm; however, sweating during sleep usually does not occur. It is important to know that this picture is a dermatological condition and that dermatological treatment options exist. Anxiety can increase this sweating but is not its sole cause.

Secondary sweating: This is sweating linked to another medical condition. An overactive thyroid gland, the menopause, drops in blood sugar, some infections and some medications can increase sweating. Sweating that begins newly in adulthood, spreads over the whole body or soaks the sheets during sleep at night must always be shown to a doctor. If night sweats are accompanied by fever, unexplained weight loss or fatigue, seek help without delay.

Sweating that increases with anxiety: In some people, sweating appears only, or markedly, in social and stressful situations. While there is no problem at home alone, at a meeting, a wedding or a presentation the palms become soaking wet.

If sudden cold sweating is accompanied by chest pain, shortness of breath or feeling as if you are about to faint, this is an emergency; call 112 (emergency services).

These three pictures are not separated by sharp lines. Someone with primary excessive sweating may, over time, develop social anxiety because of their sweating; and someone with social anxiety sweats more with anxiety. That is why the assessment should cover both the dermatological and the psychological side.

Fear of Sweating: Anxious Because You Sweat, Sweating Because You Are Anxious

The most wearing aspect of sweating from stress is that it sets up a cycle that feeds itself:

1. The person faces a social situation: a meeting, an introduction, a presentation.
2. Before the situation has even begun, a thought goes through their mind: "What if I sweat? What if they notice?"
3. This thought increases anxiety, and anxiety starts the sweating.
4. The person turns their attention to their body; they check their palm, their underarm, their forehead. Noticing the sweating increases the anxiety even further.
5. The person thinks that others have noticed their sweating and are judging them: "They think I'm nervous, clumsy, dirty."
6. After leaving the situation, they replay what happened in their mind over and over and go into the next one even more anxious.

In this cycle, the thought that the sweating will be "seen" and "judged" is as decisive as the sweating itself. Many people are surprised when they compare how little others actually notice their sweating with the intensity they feel from the inside.

You are the one who notices your sweating most; others usually see only the effort you put into hiding it.

Safety Behaviours: A Problem That Grows the More You Try to Hide It

People who are ashamed of their sweating develop various ways of hiding or preventing it. These bring relief in the short term but maintain the anxiety in the long term:

• Wearing dark colours or layers summer and winter, never taking off the jacket
• Avoiding handshakes, or secretly wiping the hand before shaking hands
• Constantly carrying tissues in a pocket, pressing the arms against the body
• Gripping the lectern during presentations, avoiding holding paper
• Not going to crowded and hot places, public transport or weddings
• Giving up coffee and tea entirely, staying away from social meals

The common result of these behaviours is that the person never gets to experience "even if I sweat, it is not a disaster". What is more, some safety behaviours, such as not taking off the jacket, increase sweating. A person sitting in a tense posture with their arms pressed against their body may also look more anxious to those around them. In this way, the very thing the person fears most, looking nervous, becomes more likely because of their own precautions. These behaviours also carry a hidden cost: someone who is constantly monitoring themselves cannot be fully present in the conversation, misses what is being said and feels even more of an outsider.

If the fear of sweating is part of a broader pattern of fearing other people's judgement, the article on social phobia may feel familiar.

Sweating from Stress in Everyday Life

In Turkey, many rituals of social life bring a particular challenge for someone with sweating anxiety. Kissing the hands of elders during the bayram (religious holiday), shaking hands one after another at funerals and condolence visits, standing in front of everyone while pinning gold on the couple at a wedding, getting up to join the halay (a traditional line dance), shaking hands with every newcomer at work, travelling standing up on a packed bus in the August heat... Each of these situations can be a source of worry that starts days in advance for someone who is self-conscious about sweating.

Let's say you are a newly graduated engineer in your mid-twenties. Your hands have been sweating since your high school years; you still remember the chalk slipping in your hand when you were called up to the board in class. Now your job applications are getting positive replies, but you cannot sleep the night before every interview. The question on your mind is not the technical questions but "Will they realise my hand is wet when we shake hands?" You have even skipped a few interviews, making up excuses. In this fictional example, sweating has turned into an anxiety that has begun to steer career decisions. You can also find general suggestions on pre-interview anxiety in the article on interview stress.

Sweating anxiety is not seen only in young people. A woman whose face flushes and sweats with menopausal hot flushes during a work meeting, or a shopkeeper with beads of sweat forming on his forehead while sitting at the table with a customer, may experience a similar shame.

Practical Steps for Coping with Sweating

The suggestions below can be applied after your sweating has been medically assessed, in addition to your dermatologist's recommendations.

Support your body

Choose cotton and breathable fabrics. Carrying a spare T-shirt or pair of socks can be a simple reassurance that reduces the worry "What if I sweat?"; but carry it to use if needed, without turning it into a safety behaviour. For underarm sweating, use the products your doctor recommends, in the way they recommend.

Slow down the physiology of anxiety

Before a stressful situation, do a slow breathing exercise that lengthens the out-breath for a few minutes. Holding cold water against the inside of your wrists for a short time also helps some people. These steps do not completely prevent sweating, but they can reduce how quickly anxiety escalates.

Turn your attention outwards

If during a conversation your attention is constantly on your palm, consciously direct it to the person in front of you, to what they are telling you, and to the colours and sounds around you. Attention locked onto the body magnifies sweating; attention opened outwards calms anxiety.

Run small experiments

Choose one of your safety behaviours and try dropping it. For example, one day take off your jacket, or do not wipe your hand before shaking hands. Beforehand, predict what will happen ("Everyone will notice and pull a face"); afterwards, note what actually happened. The difference between the prediction and reality gives your mind new information.

Review your inner voice

When you catch the thought "If I sweat, I'll be humiliated", ask yourself: "If I noticed that someone else's hand was damp, what would I think of them?" Most people's answer is "They must be nervous", or nothing at all. Try showing yourself the same understanding.

When Should You Seek Professional Help?

Medical assessment first: If your sweating has started newly in adulthood, spreads over your whole body, happens during sleep at night or is accompanied by other symptoms, see a doctor. For intense sweating that has gone on since childhood, it is also useful to discuss dermatological treatment options.

Working with a mental health professional can be helpful in the following situations:

• If you avoid job interviews, presentations, introductions or invitations because of the fear of sweating
• If you start worrying about social situations days in advance and then replay them in your mind for days afterwards
• If hiding behaviours take up a significant part of your day
• If, besides sweating, you also fear symptoms such as blushing, trembling or a shaky voice
• If this anxiety noticeably restricts your work, education or relationships

Whether medication is needed is decided by your dermatologist or psychiatrist.

How Is Sweating from Stress Addressed in Therapy?

The aim in therapy is to change not so much the sweating itself as the pattern of fear and avoidance woven around it. If the sweating is linked to a dermatological condition, therapy accompanies that treatment.

Cognitive Behavioural Therapy (CBT): The approaches used in social anxiety also work here. The person's thoughts about how visible their sweating is and how others judge it are examined. Work is done on attention locking onto the body and the habit of replaying situations in the mind afterwards.

Behavioural experiments and exposure: The person enters the situations they avoid gradually while reducing safety behaviours. For example, first shaking hands with a close friend, then with a colleague, then speaking in a small group. At each step, predictions and actual outcomes are compared.

Seeing oneself from the outside: In some cases, a recording of a short talk given by the person is watched. The person sees with their own eyes that at moments when they feel "soaking and tense" from the inside, they often look much calmer from the outside.

Relaxation and body awareness: Breathing and relaxation skills that can be used before and during stressful situations are practised. However, these skills are used not to "definitely prevent" sweating but to slow the escalation of anxiety. Otherwise relaxation can also turn into a new safety behaviour.

Working with shame: Beliefs that interpret sweating as "dirtiness", "weakness" or a "flaw", and their origins, are addressed. The aim is for the person to be able to look at their body with more compassion.

This process can be carried out face to face or online; you can find the framework of individual work on the individual therapy page.

Frequently Asked Questions

How does sweating from stress go away?

Anxiety-related sweating often eases as the anxiety itself decreases. For this, the fear of sweating and avoidance behaviours need to be addressed. If there is primary excessive sweating, running dermatological treatment and psychological support together can give a more balanced result.

Why do my palms sweat the most?

The palms and the soles of the feet are areas dense with the sweat glands that react fastest to emotional stimuli. That is why they are usually the first and most noticeable places to sweat at moments of excitement and anxiety.

I also worry about body odour from sweat; is this the same thing?

Sweat released under stress can come from different glands from sweat released in heat, and its odour can be more noticeable. However, odour anxiety is often bigger in the person's perception than in reality. Constantly checking for odour, frequent showers and using too much perfume can feed the anxiety; this can also be addressed in therapy.

What should I do if I have to shake hands while my hand is wet?

Rather than trying to wipe your hand secretly, acting naturally is often the way that draws the least attention. If you like, you can mention it with a short, relaxed sentence: "I'm a bit nervous." Most people respond with understanding and the conversation carries on naturally.

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• #social anxiety
• #sweaty hands
• #anxiety

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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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