Anxiety disorders can worsen physical illness

By Karla Gale

NEW YORK (Reuters Health) - Patients with physical maladies are at increased risk of having an anxiety disorder as well, a multinational research group reports in the Archives of Internal Medicine. Furthermore, the severity of the physical illness and any loss of function that may result are exacerbated among patients who also have an anxiety disorder.

While these findings may not be unique, lead author Dr. Jitender Sareen and colleagues point out, the results of other studies have been limited by small study size, reliance on self-reports of physical illness and failure to use professionals to diagnose mental disorders.

To address these limitations, the investigators evaluated data from the German Health Survey, in which 4,100 adults were interviewed between 1997 and 1999. "The GHS is the only study in the world where psychologists and psychiatrists diagnosed mental disorder, and in a second interview, study physicians diagnosed physical illnesses," Sareen, from the University of Manitoba in Winnipeg, Canada, said in an interview with Reuters Health.

It is also the largest study of its kind and the only one to evaluate subjects for psychiatric illness with validated methods, he added, including the Diagnostic and Statistical Manual of Mental Disorders and the Medical Outcomes Study 36-item Short-Form Health Survey.

Their analyses showed that the presence of an anxiety disorder -- panic disorder, phobia, generalized anxiety disorder, agoraphobia, social phobia, or obsessive-compulsive disorder -- was independently associated with diseases of the respiratory and the gastrointestinal tracts, arthritis, allergies, thyroid disease, migraine, and any physical ailment experienced in the last month.

Sareen's group also found that the anxiety disorder was more likely to have developed before the physical illness, and that the patients' quality of life and physical functioning were worse if they also had an anxiety disorder.

Anxiety disorders and physical illness can turn into a vicious circle, Sareen said. "Painful conditions like migraine and arthritis could increase a patient's anxiety about the pain," he explained. "Or panic attacks may be mistaken for asthma attacks."

Anxiety causes individuals to avoid situations that could precipitate symptoms, leading them to restrict physical pursuits or avoid social activities. Obesity or substance abuse may develop as a result, thereby raising the risk of other painful conditions and physical diseases, Sareen noted.

"Physicians are becoming more aware of the importance of recognizing and treating depression," he said. "Our study shows that anxiety is also very common and that similar efforts are warranted."

He advises that physicians watch for anxiety disorders in their patients, particularly those with the specific physical conditions that their study identified.

If a sign of an anxiety disorder is detected, patients should seek treatment. This may not only reduce the emotional problem, it might also improve the symptoms of physical illness.

SOURCE: Archives of Internal Medicine, October 23, 2006.