The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey

Abstract

Although depression has clearly been shown to be associated with physical disorders, few studies have examined whether anxiety disorders are independently associated with medical conditions after adjusting for comorbid mental disorders. We examined the relationship between anxiety disorders and a wide range of physical disorders in a nationally representative sample. Data came from the National Comorbidity Survey (N=5,877, range=age 15-54 years, response rate=82.4%). The Composite International Diagnostic Interview [Kessler et al., 1998] was used to make DSM-III-R [American Psychiatric Association, 1987] mental disorder diagnoses. Physical disorders were assessed based on a list of several conditions shown to respondents. All analyses utilized multiple logistic regression to examine the relationship between past-year anxiety disorder diagnosis and past-year chronic physical disorder. Anxiety disorders were positively associated with physical disorders even after adjusting for mood disorders, substance-use disorders, and sociodemographics. Among respondents with one or more physical disorders, a comorbid anxiety disorder diagnosis was associated with an increased likelihood of disability even after adjusting for severity of pain, comorbid mood, and substance use disorders. Among specific anxiety disorders, posttraumatic stress disorder, panic attacks, and agoraphobia were more likely to be associated with specific physical disorders than generalized anxiety disorder, social phobia, or simple phobia. There is a strong and unique association between anxiety disorders and physical disorders. Clinically, the presence of an anxiety disorder among patients with physical disorders may confer a greater level of disability.

Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy

“…As previously reported in the literature, we also found an association between having an anxiety disorder and a physical disorder; the multiparous women with blood-and injection phobia had more chronic medical diseases than the controls (Kose and Mandiracioglu, 2007;Sareen et al, 2005). The distribution of actual chronic medical diseases that affect outcomes did not differ between the groups and was therefore not considered as an independent variable in the multiple regression analyses.…”

Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R)

“…It is possible that the relationship between PTSD and chronic medical conditions could be confounded by injuries stemming from the traumatic event (e.g. traumatic brain injury) (Sareen et al, 2005) and/or the qualifying trauma being diagnosis with a lifethreatening illness. A major strength of the present study was that we excluded respondents whose qualifying trauma for the PTSD assessment was diagnosis with a life-threatening illness (e.g.…”

“…depression, other anxiety disorders, substance abuse) tend to co-occur with PTSD symptomatology following trauma exposure (Brady, Killeen, Brewerton, & Lucerini, 2000;Breslau, Davis, Peterson, & Schultz, 2000;Brown, Fulton, Wilkeson, & Petty, 2000;Creamer, McFarlane, & Burgess, 2005;O'Donnell, Creamer, & Pattison, 2004). Similar to PTSD, depression (Evans, Charney, Lewis, Golden, Gorman, Krishnan et al, 2005), other anxiety disorders (Sareen et al, 2005;Scott, Bruffaerts, Tsang, Ormel, Alonso, Angermeyer et al, 2007), and substance-related disorders (Dickey, Normand, Weiss, Drake, & Azeni, 2002) have been independently associated with chronic medical conditions. Trauma exposure may play a role in previously found relationships between other psychiatric diagnoses (i.e.…”

“…To date, research examining the relationship between PTSD and chronic medical conditions has generally failed to take the total number of lifetime traumas into account (Seng, Graham-Bermann, Clark, McCarthy, & Ronis, 2005). While epidemiological findings based on the original National Comorbidity Survey (NCS) showed that individuals with PTSD were at higher risk for a range of chronic medical conditions compared to individuals without PTSD (Lauterbach et al, 2005) and those with other anxiety disorders (Sareen, Cox, Clara, & Asmundson, 2005), trauma exposure was not taken into account. One study did examine the relationship between number of lifetime traumas, PTSD, and physical health among women with a history of childhood abuse (Cloitre et al, 2001).…”

The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis

“…For instance, weight-related discrimination and stigma can be deeply distressing for obese individuals; 9,10 in addition, the negative effect of obesity on health and quality of life might be particularly stressful. 6,11,12 Both pathways may subsequently result in anxiety disorders.…”