You're Not Alone

- 25% of people with asthma have panic disorder.

- 37% of people with COPD have panic disorder.

Learning to live with chronic illness is stressful. Stress causes changes in chemicals in the body that can lead
to feelings of anxiety and depression, which commonly accompany chronic medical illnesses. Patients and
family members usually experience feelings of loss and sadness and feelings of anxiety when physical
activity becomes more limited. There is a close relationship between mental well-being and physical
symptoms. Anxiety and depression often go together.

If symptoms of stress, depression and anxiety are acknowledged and treated quickly, then patients feel
better and their physical symptoms also improve.

Symptoms
Symptoms of anxiety include physical symptoms, such as difficulty breathing, chest tightness, shakiness,
headache and dizziness as well as psychological symptoms, such as fear of what will happen, excessive
worrying about who will care for you, and excessive worrying about illness progression.

Treatment
Treatments of anxiety include medications and psychotherapy, either individual or family psychotherapy.
Medications for anxiety include antidepressants, anxiolytics and other medications. Individual psychotherapy
and family therapy can provide support and encouragement as well as teach you and your family how to set
new goals and develop new coping strategies. You and your physician can choose which treatments suit you
best.

Understanding the role of anxiety in chronic medical illness is an important step in self-care.

This information has been approved by Alison Heru, MD (November 2008).

http://www.nationaljewish.org/healthinfo/conditions/psychsoc/anxiety.aspx

Expression of emotion is closely linked with dyspnoea and some patients may avoid emotion as
an adaptive coping mechanism. This may result in patients living in an ‘emotional straightjacket’
(Dudley et al, 1980), which may then predispose to or compound existing anxiety and
depression.
Impaired physical and social dimensions of daily living often result in a sedentary lifestyle with
progressive dyspnoea and fatigue. This in turn leads to social isolation and an inability to
participate in many activities of daily living.
http://www.nursingtimes.net/nursing-practice-clinical-research/psychological-effects-
of-chronic-lung-disease/1940860.article

Kelly, C., Lynes, D. (2008) Psychological effects of chronic lung disease. Nursing
Times; 104: 47, 82–85
Anxiety Linked With A Higher Risk For Certain Chronic Conditions
As an everyday emotion, anxiety can be a good thing, prompting us to take extra precautions. But when
anxiety persists, it can undermine our physical health. Evidence suggests that people with anxiety
disorders are at greater risk for some chronic medical conditions.

The July 2008 issue of Harvard Women's Health Watch describes several conditions affected by anxiety:

Gastrointestinal disorders: About 10% to 20% of Americans suffer from irritable bowel syndrome (IBS)
or functional dyspepsia. In these disorders, the nerves regulating digestion appear to be hypersensitive to
stimulation. There are no firm data on the prevalence of anxiety disorders in people with such digestive
disorders, but a recent New Zealand study found an association between high anxiety levels and the
development of IBS.

Chronic respiratory disorders: Although results vary, most studies have found a high rate of anxiety
symptoms and panic attacks in patients who have chronic respiratory disorders such as asthma or
chronic obstructive pulmonary disease (COPD), with women at greater risk than men. In several studies
involving COPD patients, anxiety has been associated with more frequent hospitalization and with more
severe distress at every level of lung function. So even if anxiety doesn't affect the progress of the
disease, it takes a substantial toll on quality of life.

Heart disease: Anxiety disorders have also been linked to the development of heart disease and to heart
attacks in people who already have heart disease. Two recent studies concluded that among people with
heart disease, those suffering from an anxiety disorder were twice as likely to have a heart attack as
those with no history of anxiety disorders.

Harvard Women's Health Watch reports good news as well: understanding and treating anxiety can often
improve the outcome for people with chronic diseases.

Harvard Health Publications

Harvard Medical School 10 Shattuck St., Ste. 612
Cambridge, MA 02115
United States
http://www.health.harvard.edu
http://www.medicalnewstoday.com/articles/112446.php

Chronic diseases and mental
illnesses are linked to one
another. Chronic diseases can have a
profound physical, psychological,
emotional, and interpersonal impact on
an individual as well as the caregivers.
Having a chronic disease and coping
with the health consequences and
limitations that can accompany chronic
disease can lead to chronic stress,
depression, and anxiety