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Stress is common in the context of physical illness and chronic illness can increase your risk of developing an anxiety disorder. There are a number of signs of anxiety in physical illness to watch out for to enable you to seek help as early as possible

Stress as a result of illness

It is not surprising perhaps that when you have a chronic illness, you may be more inclined to experience stress. For example, when your physical movement is restricted, this can cause distress; and you may worry about your future and health in the long-term. If you experience episodic pain with a condition that “flares up” at times, you may become anxious worrying about when the next “attack” will be. This can lead to a sense of helplessness and feelings of unpredictability and uncertainty, such as can be seen in anxiety. You may also find normal daily activities difficult and experience frustration at the restrictions the illness imposes.

How each individual responds to stress when ill varies. The propensity to become stressed can be determined by genetic vulnerabilities, coping style, personality type and extent of social support; so when we have a problem, we assess it and try to work out if we possess the resources necessary to cope with it. IIf we conclude that it is serious and we lack the resources necessary to cope with the problem, we will perceive ourselves as being under pressure or stress.

Not all stress resulting from physical illness is negative, however. Stress can be positive when it makes us adapt to changing circumstances and become more adaptable; this enhances our coping mechanisms and equips us better for future changes. It can also serve as a warning that we are not coping well and that we need to make changes in order to maximise our health and wellbeing.

Having some stress or anxiety when you have a chronic illness can therefore be adaptive in that it may encourage you to be compliant with treatment, be aware of symptoms and become expert at knowing when and when not to seek help. However it can also become dysfunctional and mean you become a frequent visitor to medical services or withdraw from normal daily living and especially avoid activities that may lead you to feel unwell. Whilst anxiety is normal, clinical anxiety results in intense and prolonged feelings of dread that interfere with normal functioning and can, in turn, affect the individual's coping strategies for their physical illness. Having a life-threatening condition is understandably going to change your world view and increase your sense of vulnerability. It might lead to a sense of impending danger or doom and a feeling of being out of control; such feelings might cause an anxiety disorder to develop.

There are a number of physical health conditions associated with increased incidence of anxiety and for some people, anxiety may be caused by an underlying health issue. In some cases, signs and symptoms normally associated with anxiety may be the first indicators of a medical illness. The use of or withdrawal from certain substances can also cause anxiety therefore substance use can cause of worsen anxiety. In addition, there are a number of prescribed medications or therapies given for illness that unfortunately include anxiety in their lists of side effects. So anxiety resulting from physical illness is something to be very much aware of.

Chronic illness increases a person's risk for developing anxiety or an anxiety disorder:

  • Nearly half of those diagnosed with cancer report experiencing psychological distress that manifests itself as excessive worry or panic attacks.

  • People with chronic pain are as many as three times more likely to display symptoms of anxiety

  • People with MS experience higher rates of anxiety than the general population - currently, anxiety disorders are estimated to affect 43 percent of those with MS in the USA.

  • Those with heart disease are at increased risk of developing anxiety: these figures vary by form of disease but range from 20-40 percent of the population in incidence.

  • A recent study asserted that chronic obstructive pulmonary disease patients are 85 percent more likely to go on to have an anxiety disorder in comparison compared with healthy individuals; furthermore, the rate of clinical anxiety in COPD outpatients has been as much as 46%.

  • Studies show that people with type 2 diabetes are as much as four times more likely to be diagnosed with anxiety and depression. Studies indicate levels of 20 to 40 percent of people with type 2 diabetes have anxiety specifically and this is also more common in women.

  • Incidence of anxiety in chronic pain sufferers are widespread: arthritis, fibromyalgia; irritable-bowel-syndrome, migraine; musculoskeletal disorders/neck and back pain are all associated with significantly increased levels of anxiety and diagnosis of anxiety disorders.

Signs of anxiety in physical illness

  • Excessive preoccupation with physical health

  • Insomnia as a result of the worry

  • Experiencing bad dreams about physical health issues

  • Reporting panic attacks about long-term prognosis

  • Reluctance to discuss the illness or associated problems

  • Avoiding treatments or situations that might trigger anxiety

  • Avoiding socializing

  • Having intrusive thoughts (unwanted thoughts or images) about dying

  • Irritability about physical health

Anxiety is an important mediator in cognitive constructs that can exacerbate the experience of illness. These include:

  • Catastrophizing. This is where someone focuses on the worst case scenario in any given situation, a common feature in anxiety disorders. A tendency to catastrophize is linked to greater impairment and reduced treatment adherence with a health condition.

  • Hypervigilance. This is obviously common in anxiety but when it applies to illness it leads to greater focus upon possible symptoms of the illness and a general immersion in the illness itself. This leads to a reduced “locus of control” and to the person seeing themselves defined by their illness.

  • Fear avoidance is where someone restricts movements or activities for fear of recreating a scenario that they associate with the initial health event or diagnoses. For example, they may become increasingly avoidant of any activity or situation they associate with their heart attack or initial asthma attack. When an individual needs to engage in rehabilitation programs, this can prove especially problematic.

So whilst the illness may lead to the anxiety, the anxiety can also exacerbate the experience of the illness.

Those who suffer with comorbid anxiety and physical illness are said to have poorer quality of life, so it is crucial that both your anxiety and physical health issues are addressed. Symptoms of anxiety can often be mis-attributed to the physical illness or otherwise overlooked in the context of medical concerns; therefore awareness of possible signs and symptoms and use by professionals of appropriate psychometric measures is key. Lack of awareness about the condition also often increases anxieties felt by the newly diagnosed. As a result, often, when faced with a life-limiting illness, people often concentrate on their physical health and so can neglect their emotional wellbeing. This lack of attention can unfortunately result in transient mental health states becoming pathological and moving into the territory of a disorder.

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