Studies consistently report that all anxiety disorders can be very debilitating and impinge seriously upon a person's quality of life.
Association with Depression
Depression and nearly every anxiety disorder often go hand in hand, in both the young and old. In fact, the lifetime risk for depression in people with anxiety disorders may be higher than 70%. Furthermore, the combination of depression and anxiety is a major risk factor for both substance abuse and suicide. The following are examples of depression in specific anxiety disorders:
Increased Risk for Suicide
- Between 50% and 65% of people with panic disorder also have major depression. In fact, some studies have suggested that treating panic disorder early enough may help prevent major depression later one.
- More than two-thirds of OCD patients suffer from depression.
- Most patients with GAD will experience at least one episode of significant depression and many develop recurrent episodes to the point that GAD becomes the intermittent state. In patients with both disorders, GAD usually precedes the onset of depression.
- Social anxiety during adolescence or young adulthood has been associated with a higher risk for depression, and the presence of both increases the danger for severe depression.
- People with PTSD are four to seven times as likely to be depressed as are people without PTSD.
- According to one interesting 2000 study of teen-agers, anxiety disorders were associated with later bipolar disorders (manic-depression) in adulthood, while, conversely, manic behavior in adolescence appeared to increase the risk for adult anxiety disorders.
Studies suggest that 18% of people with panic disorder attempt suicide and up to 30% harbor suicidal thoughts. one study reported suicide attempts in about 12% of people with social phobias or OCD. It is not altogether clear whether people with both depression and anxiety have a higher risk for suicide than those with one disorder. According to some studies, the development of anxiety in people with depression increases their risk of suicide by a factor of two to six. Some, however, have found no higher risk.
Alcoholism and Other Forms of Substance Abuse
Severely depressed or anxious people are at high risk for alcoholism, smoking , and other forms of addiction. Anxiety disorders are highly prevalent among people with alcoholism. It should be noted, moreover, that long-term alcohol use can itself cause biologic changes that may actually produce anxiety and depression.
Risk for Substance Abuse in Specific Anxiety Disorders. The following are some observations on specific anxiety disorders and substance abuse.
- Some people with GAD and panic disorders may use alcohol or drugs to self-medicate.
- Social phobia appears to pose a particular risk for alcohol abuse. People with this disorder are likely to drink in order to boost confidence. Alcohol itself has no direct beneficial effect on anxiety, but studies suggest that the belief in its effect appears to relieve anxious feelings. (Alcohol or substance abuse is not associated with specific phobias-such as fear of flying or of spiders.)
- Heavy smoking and substance abuse are common in people with PTSD. In adolescents, the disorder not only increases the risk for drug and alcohol use but also for eating disorders.
Effects on Work, School, and Relationships
Studies consistently report negative effects of anxiety disorders on work and relationships. Some examples from studies are the following:
- In one 2001 study, more than 10% of patients with GAD missed at least six days of work within the previous month.
- In a survey of OCD sufferers, 40% reported that they had to stop working because of the disorder; only 40% worked full-time, and only half were married.
- In another study, people with social phobia, even if they were not depressed, were more likely than others to drop out of school or to report lower functioning.
Effects on Physical Health
People with panic disorder perceive their own physical and emotional well-being as poor. They use alternative therapies and seek medical help more often than do those in the general population. Any causal connection between anxiety and medical disorders is unclear.
Effects on the Heart.
Anxiety has been associated with a number of heart problems. A 2001 study reported an association between thicker blood-vessels in both women and men with anxiety and with hardening of the arteries in men (but not in women.) Another study indicated that people who experience anxiety are more likely to develop high blood pressure than are those who are not anxious. Both anxiety and depression have been associated with a poor response to treatment in heart patients.
Some researchers speculate that intense anxiety might trigger abnormal and dangerous heart rhythms in people with existing heart problems. In other studies, panic disorders, post-traumatic stress disorder, and phobias have been associated with a higher rate of sudden death from cardiac events, including heart attack.
Effects on the Gastrointestinal Tract.
Anxiety frequently accompanies gastrointestinal medical conditions. Of note, half the cases of irritable bowel syndrome are related to anxiety.
Effects on Headache.
One study reported that 32% of people with chronic tension headaches met criteria for anxiety. It isn't clear whether the psychological disorder preceded or followed the onset of headaches. Similarly, another study reported that young girls with anxiety disorders were three times more likely to have chronic headaches than those without the disorder. (Headaches in both studies were also strongly associated with depression.)
Effects on Sleep Disorders in Children.
One study of children linked anxiety with a higher risk for sleep disorders, such as frequent nightmares, restless legs, and bruxism (grinding and gnashing of the teeth during sleep).
Physical Effects of Post-Traumatic Stress Disorder.
Some studies on people, including military veterans, who have endured major traumatic events have found a higher risk for health problems. one study of Vietnam veterans reported that PTSD was associated with greater physical limitations, poorer physical health, and a lower quality of life than in those in the normal population, regardless of other accompanying emotional or medical disorders. In another study of these veterans, PTSD sufferers had double the risk for abnormal heart rhythms and four times the risk of a heart attack compared to men without PTSD.
Injuries from Obsessive-Compulsive Disorder.
People with obsessive-compulsive disorders can experience skin problems from excessive washing, injuries from repetitive physical acts, and hair loss from repeated hair pulling (behavior known as trichotillomania).
Effect of PTSD on the Brain
Studies are reporting that PTSD is associated with shrinkage in the hippocampus, the part of the brain important for memory and learning. Studies of animals indicate that such damage may result from long-term exposure to cortisol, the major stress hormone. Groups who had suffered severe trauma also scored 40% lower in tests of verbal memory than the general population. There was no difference in IQ or in scores of other types of memory. one study suggests that exposure to chronic stress, common in PTSD patients, may compromise the function of the brain's receptors for benzodiazepines (a class of medications used to treat anxiety).