Anxiety disorders appear to be independently associated with several physical conditions including thyroid disease and migraine headaches
Anxiety disorders appear to be independently associated
with several physical conditions including thyroid disease, respiratory disease,
arthritis, and migraine headaches, according to an article in the October 23 issue
of the Archives of Internal Medicine. This co-occurrence of disorders may significantly
increase the risk of disability and negatively affect quality of life.
Although depression has long been linked to physical
illness, evidence supporting an association between anxiety disorders and physical
health problems is more recent, according to background information in the article.
Studies have found that individuals with phobic anxiety may be more likely to
experience sudden cardiac death; others have found that rates of anxiety disorders
are higher than expected in patients with thyroid disease, cancer, hypertension
and several other conditions.
Jitender Sareen, B.Sc., M.D., F.R.C.P.C., University
of Manitoba, Winnipeg, Canada, and colleagues further explored the association
between anxiety disorders and physical conditions in 4,181 adults who were part
of the German Health Survey (GHS) conducted between 1997 and 1999.
The survey assessed whether participants had any physical
illnesses through a questionnaire asking about 44 particular conditions, a medical
interview conducted by a primary care physician, blood pressure measurements,
and blood and urine samples.
Psychiatric interviews were conducted by a psychologist
or physician, who used criteria from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV) to detect anxiety disorders. A quality
of life survey?which measured factors such as physical functioning, pain and general
health?was also administered, and to determine disability levels participants
reported how many days of the past 30 they were unable to perform their usual
daily activities.
Among the 1,913 men and 2,268 women in the study, 429
(8.4 percent) had an anxiety disorder within the past month and 2,610 (60.8 percent)
had a physical condition within the past month. Having an anxiety disorder was
associated with having any type of physical condition, and specifically with respiratory
diseases, gastrointestinal diseases, arthritis, allergies, thyroid disease, and
migraine headaches.
Most individuals with both an anxiety disorder and physical
illness developed the anxiety disorder first, and they tended to have a poorer
quality of life than those with anxiety disorders or physical conditions alone.
Those who had both types of disorders also were more likely to have one or more
days of disability than those with physical illnesses alone.
“The mechanisms of association between anxiety disorders
and physical conditions remain unknown, although several possibilities should
be considered,” the authors wrote. For example, the presence of an illness may
cause worry and anxiety that eventually becomes serious enough to qualify as an
anxiety disorder, the presence of an anxiety disorders could trigger biological
processes that contribute to illness or a third condition, such as a substance
abuse disorder, could be linked to both.”
“These findings extend previous work in clinical and
community samples that noted an association between anxiety disorders and physical
illnesses but also demonstrate the unique association of this comorbidity with
poor quality of life and disability,” the authors concluded. “Although there have
been increased efforts to recognize and treat depression in the medically ill,
our findings underscore the need to create similar programs to recognize and treat
anxiety disorders in the medically ill.”
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