Mind meets body: When anxiety masks a medical problem

Psychiatric Times published a “partial listing” of 47 medical illnesses, ranging from cardiac arrhythmias to pancreatic cancer, that may first present as anxiety.

It’s perfectly normal for someone to feel anxious or depressed after receiving a diagnosis of a serious illness. But what if the reverse occurs and symptoms of anxiety or depression masquerade as an as-yet undiagnosed physical disorder?

Or what if someone’s physical symptoms stem from a psychological problem? How long might it take before the true cause of the symptoms is uncovered and proper treatment begun?

Psychiatric Times, a medical publication seen by some 50,000 psychiatrists each month, recently published a “partial listing” of 47 medical illnesses, ranging from cardiac arrhythmias to pancreatic cancer, that may first present as anxiety. Added to that was another “partial listing” of 30 categories of medications that may cause anxiety, including popular antidepressants like selective serotonin reuptake inhibitors, or SSRIs.

These lists were included in an article called “Managing Anxiety in the Medically Ill,” meant to alert mental health practitioners to the possibility that some patients seeking treatment for anxiety or depression may have an underlying medical condition that must be addressed before any emotional symptoms are likely to resolve.

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Doctors who treat ailments like cardiac, endocrine or intestinal disorders would do well to read this article as well lest they do patients a serious disservice by not recognizing an emotional cause of physical symptoms or addressing the emotional components of a physical disease.

For example, Dr. Yu Dong, a psychiatrist at Inova Fairfax Hospital in Virginia, and colleagues pointed out last month that patients with respiratory conditions like asthma, sleep apnea or pulmonary embolism could present with symptoms of anxiety, or those with cardiac symptoms like chest pain or rapid heartbeat could have an anxiety disorder.

The problem of missing the proper diagnosis grows out of a long-ago separation of powers within the medical profession that often limits the ability of practitioners to see the forest for the trees, as it were. Medical doctors like cardiologists or gastroenterologists are often ill equipped to recognize and treat emotional symptoms related to a physical ailment, and psychiatrists may not consider the possibility…

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