Anxiety Attack Disorder Causes – Myths & Reality

Although it is uncommon, a number of medical problems can produce anxiety. Because anxiety affects many organ systems (cardiovascular, respiratory, neurological, gastrointestinal, urinary, etc.), patients and doctors may focus on the problems in one organ system and miss seeing the overall pattern. It is possible for medical doctors to sometimes overlook Anxiety Disorders and over-investigate possible medical causes for symptoms that are actually caused by anxiety. In the same way, psychiatrists and psychologists who are attuned to listening to complaints related to anxiety may miss an underlying medical problem that is causing them.

In the cardiovascular system, pain from an insufficient blood supply to the heart muscle can occur either in the form of angina pectoris (in which the heart’s need for oxygen carried by the blood exceeds the supply available through narrowed coronary arteries that supply blood to the heart muscle itself) or an acute myocardial infarction, or heart attack (in which the blood supply is so badly cut off by narrowing or complete blockage of a coronary artery that some heart muscle dies); in either case great anxiety may occur. Arrhythmias, in which the heart beats either irregularly or too rapidly or slowly may cause anxiety by producing alarming palpitations and/or reducing the blood supply to the heart muscle itself or to the rest of the body. Congestive heart failure, in which the heart is unable to supply the body’s needs for blood and the oxygen it carries, may also provoke anxiety. Very low blood pressure or shock (in which insufficient effective blood volume is present to supply the body’s tissues with oxygen and other essential substances) can raise anxiety. In these instances of cardiovascular disorder, anxiety can alert a person to the primary cardiovascular problem; relief of the primary problem by medical treatment helps relieve the anxiety it has been causing. In such cases treatment should be directed primarily at the cardiovascular problem.

Respiratory problems—including recurrent attacks of asthma, chronic lung diseases such as emphysema, and acute problems such as pulmonary embolism (in which a blood clot blocks part of the blood flow through a lung and decreases the amount of oxygen that can be absorbed into the circulating blood from that part of the lung)—can all heighten anxiety. Again, relief of the primary respiratory disorder usually reduces the resulting anxiety, whereas treatments for Anxiety Disorders alone would be ineffective and could leave the potentially serious primary problem untreated.

Neurologic problems, including encephalopathy (brain dysfunction from a variety of causes) and seizure disorder (epilepsy), may cause anxiety. Sometimes a benign neurological disorder such as familial tremor (a nonprogressive inherited anxiety disorder) may be mistaken for anxiety disorder. Sensations that the world or the person are spinning (vertigo) are very distressing and frequently produce anxiety.

Disorders of the hematologic (blood) and immune systems may produce anxiety, as in anemia, when too little oxygen is carried by the blood, or when the immune system overreacts in acute anaphylactic shock, or with certain chronic immune diseases which may affect the brain’s blood vessels.

Several endocrine or hormonal disorders can give rise to anxiety. Among them diabetes (too little insulin), hypothyroidism and hyperthyroidism (too little or too much thyroid hormone, respectively), parathyroid disease (which causes changes in calcium and phosphorus levels), Cushing’s disease (too much hormone from the outer part of the adrenal gland) and pheochromocytoma (too much anxiety hormone from the center of the adrenal gland) even the natural may all cause pronounced anxiety.

Medications prescribed by physicians or purchased “over the counter” may also cause anxiety symptoms. Stimulants, digitalis, thyroid supplements, cold medicines, diet pills, antispasmodic medications, and—paradoxically—antidepressants given to reduce panic may all cause anxiety. Discontinuation of a variety of drugs, including antianxiety drugs (minor tranquilizers), sleeping pills, and certain blood pressure medicines may cause withdrawal symptoms which include prominent anxiety.

Certain dietary excesses or deficiencies may lead to anxiety. The most common offenders are caffeine and caffeine like substances which are found in coffees, teas, and many soft drinks (see the October 1981 issue of Consumer Reports for details on the caffeine content of various beverages). Individual sensitivity varies widely, and some people become anxious with a few cups of coffee or tea or cans of caffeinated soft drink while others may tolerate large amounts without symptoms. Caffeine-containing soft drinks may be an unrecognized cause of anxiety, restlessness, and sleep difficulty in adolescents and especially in younger children. The jitteriness precipitated by caffeine may amount to panic in some individuals, and those with Panic Disorder seem more sensitive to caffeine as well as to a variety of other alerting substances such as some over-the-counter cold preparations. Extreme vitamin deficiencies (which are exceedingly rare) may also lead to anxiety. Sometimes people get mistakenly diagnosed with hypoglycemia and not anxiety, but this is mostly incorrect.

Alcohol in its many forms (beer, wine, hard liquor) is a well-recognized yet consistently underdiagnosed cause of anxiety. Patients may minimize or completely exclude their alcohol use from their medical history, and doctors some¬times neglect to ask. Both the excessive consumption of alcohol and withdrawal from alcohol (hangover, shakes,” and D.T.’s) can be associated with anxiety. This can be especially troublesome, since some people misuse alcohol in an ill-advised attempt to treat an anxiety problem.

Each of these “medical” causes of anxiety has different symptoms, signs, and sometimes laboratory tests which can point to the correct diagnosis. Careful history taking, physical examination, and laboratory tests as indicated are the keys to finding and resolving medical causes of anxiety.

Although these medical problems are seldom the cause of severe anxiety, they should be identified, since some are life-threatening and may be treated with benefit if discovered early. Even PMS can cause anxiety. The anxiety associated with taking or discontinuing certain drugs and other substances can be easily relieved, but only if the cause is recognized. Providing your doctor with a complete history is essential.