Anxiety is a common symptom that can be a normal response to a fearful situation, an anxiety disorder like Panic Disorder, or a symptom of a medical illness. It is important to determine which it is. In medical settings patients are often anxious about possible serious medical illnesses such as a heart attack or cancer. This is normal unless it is excessive or severely debilitating..
Anxiety can also be due to a psychiatric illness. Common examples include panic disorder, generalized anxiety disorder, PTSD, phobias, and social anxiety disorder.
Anxiety has both psychological and physical symptoms. Psychological symptoms include fear, panic, worry, irritability, startling easily, poor concentration, and/or insomnia.
Physical symptoms are numerous and may include palpitations, chest discomfort, "butterflies" in the stomach, fatigue, frequent urination, dry mouth, faintness, headache, lightheaded, muscle tension, nausea, trouble swallowing, shortness of breath, tingling in arms and legs, and/or pallor. Patients with one or more of these physical symptoms may see their personal physician to find out what is wrong.
It is easy to understand how a patient may be convinced that they have a medical illness when they experience physical symptoms. The reality is that sometimes medical illnesses are the cause of the anxiety symptoms. It is important not to misdiagnose these as being an anxiety disorder.
There are a large number of medical illnesses that have anxiety as a symptom. Neurological and endocrine diseases account for about half of such illnesses. The remainder are due to cardiac, infectious, rheumatologic, drug-induced, or other causes. Withdrawal from alcohol or sedatives usually includes anxiety. Conversely, stimulants like caffeine, nicotine or "speed" are examples of chemicals that can cause anxiety-like symptoms.
Excessive thyroid hormone (hyperthyroidism) may manifest as anxiety. These patients also often have physical symptoms such as excessive sweating, heat intolerance, weight loss, excessive frequency of bowel movements, weakness, menstrual irregularity, rapid pulse, elevated blood pressure, tremor, warm and moist skin, and/or an enlarged thyroid gland (goiter).
Patients with respiratory illnesses like asthma may experience anxiety due to a sense of air hunger. They may also hyperventilate (breathe too rapidly and/or too deeply) so they blow off excessive carbon dioxide, which is an acid in the blood. This leads to the blood becoming too basic or alkaloid. As a consequence, this causes a drop in ionized blood calcium that may cause tingling in the hands and around the mouth. Anxiety also often occurs.
Low blood sugar (hypoglycemia) may cause anxiety symptoms. Excessive amounts of medication for diabetes may be the cause, but there are a number of others.
A low magnesium level may trigger anxiety. This can be the result of certain medications such as diuretics, digitalis, and some antibiotics. Kidney disease and gastrointestinal malabsorption are among common reasons for low magnesium.
A common medical condition associated with anxiety is a cardiac rhythm disorder, especially atrial fibrillation. This rhythm disturbance is commonly seen with enlargement of the upper chambers of the heart, disease of a heart valve, an overactive thyroid, coronary heart disease or other cardiac disorders. It is characterized by a very rapid and extremely irregular heartbeat. Blood clots can form in an upper chamber of the heart and result in a stroke.
An unusual medical cause of anxiety is a tumor that produces excessive amounts of adrenalin. This results in sustained or intermittent high blood pressure, headaches, palpitations, sweating, and anxiety.
I have provided several examples of medical causes of anxiety. There are numerous others so this is not an exhaustive list. There are also several psychiatric causes of anxiety.
Of course, normal anxiety is quite common but easily explained by the circumstances surrounding the onset of the anxiety. In that case you would expect the anxiety to be proportional to the situation.
Peter M. Hartmann, MD
Family Medicine and Psychiatry
