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Anxiety hurts.

January 3, 2012

We’ve all seen the Cymbalta media blitz.  “Depression Hurts.”  It will probably echo for years like, “I’ve fallen and I can’t get up.”  I’m glad to see acknowledgement of what I have known most of my adult life from my own experience, the mind and the body are not separate entities.  What affects the psyche affects the physical body and vise versa.  There is a much broader recognition of the physical effects of depression these days.  There are also more helpful medical treatments for depression.  I think this makes it easier for doctors to acknowledge it as a real problem and not a character flaw, having specific treatment to recommend.

It is unfortunate, but there is a lag in the recognition of anxiety as a serious, treatable problem with widespread physical effects.  In my opinion this stems from the lack of reliable, effective treatments that take no more effort than writing on a scrip pad.  Anxiety is a much tougher nut to crack than depression and it places a significant economic burden on society in terms of lost productivity and comorbid conditions.  See this abstract on PubMed for some specific numbers.  Here’s another citation from Science Daily about the hidden effects of anxiety on academic performance.  I found an excellent discussion of generalized anxiety disorder on the Mayo Clinic website if you’d like more information.  Generalized anxiety disorder tends to be a chronic remitting-relapsing problem which rarely completely resolves.  Medications and psychotherapy can help tremendously, but treatment may go on for many years or lifelong and at great expense.

In the mean time, anxiety takes its toll on the body.  Anxiety has been associated with higher morbidity and mortality from conditions such as heart disease, more dental problems, GI problems, headaches.  According to this study published in the journal Medical Health, anxiety “contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work.”

One phenomenon I find puzzling is the practice some doctors have of labeling symptoms of unknown origin, “anxiety,” often with a bit of derision.  It’s as if the symptoms become unimportant if they are anxiety related and don’t warrant treatment, no matter how distressing they are to the patient.  There are two disturbing problems here.  One is the willingness of medical providers to dismiss physical symptoms because of their inability to determine cause.  The other is the implication that the symptom is unimportant if it is caused by anxiety.  This leaves the patient in the untenable position of suffering a distressing symptom and being told that they will not be treated.  I am not saying all medical providers subscribe to this philosophy, however I have heard many stories from people who have experienced this treatment.  Sometimes with dire health consequences, usually with dire emotional consequences.

So what can be done for this dreadful, chronic anxiety?  There are several medications that have been found to be helpful.  Not magic cures, just helpful.  Psychotherapy is also helpful.  The combination of the two even more so.  The Mayo Clinic article covers these in brief.  As far as psychotherapy goes, cognitive behavior therapy is the most often mentioned but is far from the only type of psychotherapy available.  The disproportionate attention to CBT is most likely due to it being a limited time therapy that is easily standardized and has strong research backing for effectiveness in the treatment of various disorders.  This doesn’t detract from the helpfulness of longer term supportive therapy in many cases.

What I hope people can take away from this discussion is a recognition of the role anxiety plays in both exacerbation of existing physical symptoms and causing physical symptoms.  I hope in the future people won’t have to hide their anxiety problems from health care providers for fear of getting labeled and left untreated.

3 Comments leave one →
  1. Melissa permalink
    January 4, 2012 8:48 am

    Anxiety and stress go hand in hand with chronic illness. I experience the two as the pivotal parts of a traumatic “loop de loop” that is difficult, at best, to break.
    Coming home from the hospital, after yet another psychological traumatizing series of days and nights of being held, ready for whatever treatment whims a doctor might think up, listening for footsteps of nurses and doctors (“are they coming to MY room? FInally??) breaks me every time.
    I return home, shattered, fragile, confused as to what was really done, what the results were, and what I’m to do next. Mostly, the bad stuff is what I remember, because, in general, these are bad experiences. I remember a few good souls along the way, but unfortunately, they are not the powerful ones– they are the housekeepers, the transporters, the nurses aides that stop to talk for a minute, ask how I’m doing, want to talk about who I am when I’m not in the hospital, who want to share a bit of who they are too. Doctors and nurses generally don’t seem to feel that who I am, or what I think are worth stopping for two minutes to find out. I sense a certain fear of slowing down, of being trapped with or by me, the patient. Doctors flee when the conversation goes beyond pills and blood work. Nurses start checking their watches when I ask them anything about my stress and how to conquer it. The guy who wakes me up at 4:30 a.m. to check my weight doesn’t speak at all, and treats me as though I’m about to run off if he doesn’t keep a close eye and grip on me.
    That’s scary in the dark hours of morning. I can never get back to sleep.
    So, what I’ve described above is just a smattering of the anxiety and trauma-supporting stuff that swirls around me. The real actual trauma usually occurs at the hands of the doctor in the procedure room or operating room or emergency room. My traumas have had to do with life and death situations, and the feeling that there’s no one in control. Too many of these situations have cropped up in my hospitalizations that I feel I can ever trust a doctor or a procedure or a hospital again.
    I go out of my way to avoid hospitalizations, making that late night or weekend call to 911 an act of LAST RESORT. I know that death is the final arbiter, and that I ought not fool around with waiting til the last minute, but, on the other hand, I must ask– DO the docs and nurses know that they ought not fool around with my sense of security? Probably not.
    So that’s all I can say, at 4:30 in the dark morning, as I think about anxiety as it relates to my chronic illness of late.

  2. Ruth K permalink
    January 5, 2012 10:22 am

    Melissa: thank you so much for your post. Nice (perhaps NOT the right word) to find out that I am not alone in this particular boat. Yes, I do have friends and family dealing with the same issues: always that feeling of waiting for the other shoe to drop.
    At the beginning of my cancer journey, and cronic illness IS a journey, I had an enlightening conversation with my Ortho Physician’s Assistant regarding this very issue: he was on his own journey and openly discussed it with me after his heart by-pass. And before I left, we hugged. One of the few I have received…….. so a virtual cyber hug from me to you, I understand where you are, have had so many of those middle of the night episodes and who the hell can you call at 3 a.m. to talk you down? I am constantly asking myself if I have the right to scare the hell out of a family member or close friend by sharing my fears…. my anxiety… my fatalism…. and the answer is usually a big fat NO. Just saying to someone close that I am tired of living with the fear, the pain, the uncertainty about the future can make them over-react when usually in the light of day I decide that I can go on and maybe, just maybe I will get a little better. And life as I know it will go on….. my late husbands words “this too shall pass” echo in my brain, and I sincerely hope he was right.
    If it helps: Hugs as well as prayers go out from me to not just you but to all of us riding in this particular row-boat.

  3. Melissa permalink
    January 6, 2012 12:02 pm

    Thank you SO much, Ruth. It is always good to know that there’s someone else out there at 3 a.m. wondering if they’ll make it until the sun comes up. It seems like our culture, of late, has been leaning into fear, mistrust, and hatred. It is easy to slide into that whirlpool, too, when that’s the overwhelming story on the news, and when we and those around us are losing jobs, fighting for disability benefits, and longing for loving human contact and connection. My hugs and prayers to you, too, dear.
    Sometimes I wonder if we, the chronically ill, are the norm, and the “productive” members of society are the weirdos? Another idea to toss around?
    keep on showing up, reaching out, and leaning into love.

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