A warm welcome to Dr. Manuela Padurariu, MD, PhD, as a guest author.
Hello, I’m Dr. Manuela. I have chosen a topic that I think is important for patients suffering from anxiety, since I have been confronted lately with so many cases of anxiety with physical (somatic) symptoms.
Connection Between Anxiety And Physical Symptoms
Clinical experience and scientific evidence point to a strong connection between anxiety and somatic symptoms, suggesting that efforts should be made to understand the human body as a whole. Thus, psychiatric disorders such as anxiety disorders should not be separated from the rest of the medical sciences, since psychiatric and somatic disturbances may be influencing each other in so many ways.
In almost every case of anxiety disorder we can identify at least one physical symptom, but in certain cases the main anxiety symptom is a physical one. On the other hand, physical medical disorders may also present with anxiety symptoms, thus pointing out the complex relationship between the body and mind and the profound somatic impact of anxiety disorders.
It is long known that organs which have sympathetic/parasympathetic (autonomic) innervations are highly reactive to stressful conditions, such as the heart. In addition, stress is implicated in many somatic diseases, such as heart disease. In this way, organs and systems such as of cardiovascular, digestive, respiratory, endocrine, muscular, and urinary have great dependency on autonomic innervations. In anxiety disorders, these systems become very reactive and may respond in ways so intense that it can even mimic a somatic disease. For example, panic attacks mimicking a heart attack.
Physical Symptoms of Panic Attacks
The most spectacular physical symptoms we can see are in panic attacks associated with or without a form of phobia (ex. agoraphobia or social phobia). Somatic changes that occur may frighten the patient and he may perceive those symptoms as a signal of imminent stroke, heart attack, or even death. These thoughts further exacerbate the panic attack into a vicious cycle. Some typical symptoms of panic attack that may trigger the belief of catastrophic thinking include intense tachycardia (increased heart rate), dizziness with a sensation of fainting, tunnel vision, paresthesia (numbing, tingling sensation), trembling, or suffocation (can’t catch your breath). In a panic attack there is a tendency to leave the place where the panic attack started and to look for help, frequently in the form of seeking urgent medical attention. They usually end up in the emergency room and could be investigated for stroke, heart attack, or asthma attack.
Anxiety Disorders with Prominent Physical Symptoms
The anxiety disorders that have prominent physical symptoms include panic disorder, agoraphobia, other phobias (ex. social phobia), generalized anxiety disorder, and acute stress disorder. For anxiety presentations which have constant physical symptoms rather than catastrophic ones, and the patient does not require urgent medical consultation, they will ask for repeated medical consultation to different specialties including cardiology, neurology, gastroenterology, respirology, allergy/immunology, or endocrinology, because certain physical symptoms of anxiety can mimic specific disorders in these specialties.
Specific Physical Symptoms of Anxiety
Some specific symptoms, classified according to the system predominantly affected, may include:
- Neurologic symptoms of anxiety include tension headache and migraines, temporary difficulties in concentration, and dizziness or lightheadedness that may induce the belief of fainting. Also, symptoms of derealization, confusion, and tunnel vision can give the impression of going crazy or going out of control, but other complains such as blurry vision, paresthesia, or fatigue may appear.
- Cardiovascular symptoms of anxiety include elevation of blood pressure, tachycardia (increased heart rate), palpitation, chest pressure, and chest pain. In patients with hypertension, chronic anxiety may complicate the development of the disease and the treatment. Also, panic attacks may acutely elevate blood pressure to very high values.
- Respiratory symptoms of anxiety include shortness of breath, sensation of suffocation, hyperventilation (breathing too fast), and dyspnea (hurts to breathe). Hyperventilation in an anxiety episode decreases carbon dioxide retention and impairs normal utilization of oxygen despite an excess of it. In cases of asthma, we may see a vicious cycle where stress/anxiety may trigger a dyspneic episode, which may further exacerbate anxiety.
- Muscular system manifestations of anxiety are usually accompanied by tremor, twitching, spasms, and pain.
- Cutaneous/mucous system manifestations of anxiety include dry mouth, sweating, sensation of burning, feeling of coldness, and flushing.
- Digestive symptoms of anxiety include sensations of pain, nausea, vomiting, constipation, diarrhea, pyrosis (heartburn), hiccup, and flatulence (gas).
The Neurobiology of Physical Anxiety
The physical symptoms that accompany anxiety (physical anxiety) may be caused by an increase in adrenergic (sympathetic) and cortisol activity, hyperventilation with changes in carbon dioxide/oxygen ratio, and a change in the distribution of blood perfusion in the body. Also, it seems that the body of anxious individuals might not be so flexible in adapting their autonomic system to stressful or rest conditions, and could show an abnormal reaction to apparently threatening stimuli. For instance, the adrenergic response to a stressor may be more intense and prolonged in individuals who suffer from anxiety when compared to healthy ones.
Also, patients with anxiety may experience a heighten vigilance (being keyed up and on-edge for danger) and hypersensitivity to normal somatic phenomena such as tachycardia or hyperventilation in certain conditions such as physical effort, hypoxia (low oxygen) in small crowded spaces, or dizziness in the context of dehydration. This hypersensitivity and hypervigilance for even normal physical changes can trigger and maintain the vicious cycle of anxiety.
Treatment of Physical Anxiety
The treatment of physical anxiety is carried out along with the treatment of psychological anxiety (worry, maladaptive thinking) and uses methods of psychotherapy and pharmacotherapy. There are various methods to control physical complaints induced by anxiety, but the treatment of the anxiety itself has to be mandatory. Also, when anxiety complicates the response to the treatment of somatic disease, then the management of anxiety has positive effects on the overall treatment of it.
Thank you for reading my post. It was a pleasure to write it, and share this with you.