Anxiety disorders may worsen physical conditions .

Patients with physical illnesses are at increased risk of also having an anxiety disorder, according to researchers of a new multinational study. As well, the severity of the physical illness and any loss of function as a result are worsened among those who also have an anxiety disorder.

While the findings aren't necessarily unique, according to Dr. Jitender Sareen (the study's lead author) and colleagues, the results of other similar studies have been limited by size, relying on subjects to self-report, and failure to use professionals to diagnose mental disorders.

The investigators attempted to address these limitations by evaluating data from the German Health Survey, in which over 4,000 men and women were interviewed between 1997 and 1999. Sareen said, “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.”

This is the largest study of its kind and the only one to evaluate subjects for psychiatric illness and validated methods, he noted, including the DSM-IV and the Medical Outcomes Study 36-item Short-Form Health Survey.

The researchers' analyses showed that the presence of an anxiety disorder – panic disorder, phobia, generalized anxiety disorder (GAD), agoraphobia, social phobia, or obsessive-compulsive disorder (OCD) – was independently associated with diseases of the respiratory and the gastrointestinal tracts, allergies, migraine, thyroid disease, arthritis, and any physical condition experienced in the previous month's time.

The scientists also discovered that the anxiety disorder was more likely to have come about before the physical condition, and that the quality of life of the patient and their physical functioning were worse if they also had an anxiety disorder.

Sareen said anxiety disorders and physical ailments can become a vicious circle and that “painful conditions like migraine and arthritis could increase a patient's anxiety about the pain. Or panic attacks may be mistaken for asthma attacks.”

Anxiety causes people to avoid situations they feel may exacerbate symptoms, which leads them to avoid social activities or limit their pursuits. As a result, the individual may develop substance abuse or obesity, and this further raises the risk of other painful conditions and physical diseases.

Sareen advises that clinicians watch for anxiety disorder in their patients, especially those with the specific physical conditions identified in the study.

He noted, “Physicians are becoming more aware of the importance of recognizing and treating depression. Our study shows that anxiety is also very common and that similar efforts are warranted.”

The study findings are published in the Archives of Internal Medicine .

SOURCES: Dr. Jitender Sareen, BSc, MD, FRCPC, University of Manitoba, Winnipeg, Canada.