Anxiety and physical illness

Content provided by the Faculty of the Harvard Medical School

Understanding and treating anxiety can often improve the outcome of chronic disease.

With headlines warning us of international terrorism, global warming, and economic slowdown, we're all likely to be a little more anxious these days. As an everyday emotion, anxiety — the "fight or flight" response — can be a good thing, prompting us to take extra precautions. But when anxiety persists in the absence of a need to fight or flee, it can not only interfere with our daily lives but also undermine our physical health. Evidence suggests that people with anxiety disorders are at greater risk for developing a number of chronic medical conditions. They may also have more severe symptoms and a greater risk of death when they become ill.

The anatomy of anxiety

Anxiety is a reaction to stress that has both psychological and physical features. The feeling is thought to arise in the amygdala, a brain region that governs many intense emotional responses. As neurotransmitters carry the impulse to the sympathetic nervous system, heart and breathing rates increase, muscles tense, and blood flow is diverted from the abdominal organs to the brain. In the short term, anxiety prepares us to confront a crisis by putting the body on alert. But its physical effects can be counterproductive, causing light-headedness, nausea, diarrhea, and frequent urination. And when it persists, anxiety can take a toll on our mental and physical health.

Anxiety as illness

Research on the physiology of anxiety-related illness is still young, but there's growing evidence of mutual influence between emotions and physical functioning. Yet anxiety often goes unidentified as a source of other disorders, such as substance abuse or physical addiction, that can result from attempts to quell feelings of anxiety. And it's often overlooked in the myriad symptoms of chronic conditions like irritable bowel syndrome (IBS) or migraine headache.

Nearly two-thirds of the estimated 57 million adults with anxiety disorders are women. What people with these disorders have in common is unwarranted fear or distress that interferes with daily life (see chart). Anxiety also plays a role in somatoform disorders, which are characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause. Somatoform disorders include hypochondriasis, body dysmorphic disorder, pain disorder, and conversion disorder.

Anxiety has now been implicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, and gastrointestinal conditions. When people with these disorders have untreated anxiety, the disease itself is more difficult to treat, their physical symptoms often become worse, and in some cases they die sooner.

Anxiety disorders and their symptoms

Disorder

Symptoms

Generalized anxiety disorder

Exaggerated worry about health, safety, money, and other aspects of daily life that lasts six months or more. Often accompanied by muscle pain, fatigue, headaches, nausea, breathlessness, and insomnia.

Phobias

Irrational fear of specific things or situations, such as spiders (arachnophobia), being in crowds (agoraphobia), or being in enclosed spaces (claustrophobia).

Social anxiety disorder (social phobia)

Overwhelming self-consciousness in ordinary social encounters, heightened by a sense of being watched and judged by others and a fear of embarrassment.

Post-traumatic stress disorder (PTSD)

Reliving an intense physical or emotional threat or injury (for example, childhood abuse, combat, or an earthquake) in vivid dreams, flashbacks, or tormented memories. Other symptoms include difficulty sleeping or concentrating, angry outbursts, emotional withdrawal, and a heightened startle response.

Obsessive/compulsive disorder (OCD)

Obsessive thoughts, such as an irrational fear of contamination, accompanied by compulsive acts, such as repetitive hand washing, that are undertaken to alleviate the anxiety generated by the thoughts.

Panic disorder

Recurrent episodes of unprovoked feelings of terror or impending doom, accompanied by rapid heartbeat, sweating, dizziness, or weakness.

Your Guide to Anxiety


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More than 18 percent of American adults have some form of anxiety disorder-the most common mental illness in the United States.