The Connection Between Anxiety and Other Mental Health Issues

Approximately 1 in 4 people in the UK will experience a mental health problem each year. According to Mental Health UK mixed anxiety and depression is Britain’s most common mental disorder, with 7.8% of people meeting the criteria for a diagnosis. Younger people are more likely to have some form of anxiety, and more women report experiencing high levels of anxiety than men.

Anxiety as a common comorbidity

Anxiety is a feeling of unease, a feeling of worry or fear that can range from being mild to severe. Anxiety is usually experienced as a combination of physical sensations, thoughts and feelings. Anxiety can feel like you are constantly worrying about things, have a sense of dread and you may have difficulty concentrating. Feeling anxious occasionally is different to having an anxiety disorder. Feeling occasionally anxious is a normal part of everyday life as many people worry about things such as their health, money worries, or family problems. But anxiety disorders involve more than just a temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away when the problem resolves and it can get worse over time. 

Signs and symptoms of anxiety disorder may include:

• Excessive, intense and persistent worry that is not proportionate to the actual threat or situation.
• It may feel difficult to control.
• It will often interfere with your daily activities, work and relationships, and affect your overall quality of life.
• It may lead to avoidance of certain situations or activities.
• It will usually be persistent and chronic, lasting for six months or more.
• The feeling of worry may be present even when there is no immediate cause for concern.
• Feelings of dread, panic or ‘impending doom’.
• Uncontrollable overthinking.
• Changes in appetite over a prolonged period of time.
• Dissociation, which is feeling like you aren’t connected to your own body, watching things happen around you without really feeling it.
• It may not have an obvious trigger, or the trigger may be disproportionate to the situation and the level of anxiety experienced.
• You may experience intense physical symptoms such as muscle tension, headaches, nausea, sweating, trembling, and difficulty concentrating.
• It may affect your ability to sleep.
• It will often require professional intervention, such as therapy or medication, to manage the symptoms effectively.

There are several types of anxiety disorders, including:

• Generalised anxiety disorder (GAD) – this is chronic anxiety that can last for months or years. There may be no particular cause for the anxiety.
• Panic disorder – people with this type of anxiety have frequent panic attacks that can come on unexpectedly.
• Social anxiety disorder – this involves intense fear of social situations in which a person may be watched or judged.
• Phobia-related disorders – phobias relate to fear and aversion to specific objects and situations.

Anxiety as a common comorbidity refers to the coexistence of anxiety disorders alongside other medical or psychiatric conditions. Very often if someone has a mental health diagnosis, they will be experiencing anxiety alongside it. Similarly, people with chronic medical conditions such as diabetes, cardiovascular diseases, or chronic pain may also experience anxiety as a secondary condition.

Understanding and addressing anxiety as a comorbidity is important in healthcare, as it can make the management and treatment of the primary condition more complex. Effective care often involves a comprehensive approach that takes into account the primary condition and the anxiety disorder, as they can influence each other and can impact the overall well-being of the person experiencing it.

Some useful contacts if you are struggling with anxiety are:

• Anxiety UK
• Social Anxiety UK
• No Panic UK

Anxiety and Depression

When thinking about mental health, one of the more common comorbidities is depression and anxiety. Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety.

Depression is a mental health disorder which is characterised by persistent feelings of sadness and hopelessness, and a lack of interest or pleasure in activities. It can affect your thoughts, emotions and physical well-being. It is a prolonged and intense condition that can significantly impact a person’s daily life.

Symptoms of depression can include:

• Persistent sadness or low mood – regularly feeling sad, empty or hopeless.
• Loss of interest or pleasure in things you once enjoyed – these can include things like hobbies, socialising or work.
• Changes in sleep patterns – including experiencing insomnia or sleeping too much.
• Changes in appetite or weight loss/weight gain – this can include significant weight loss or gain due to changes in eating habits.
• Fatigue or lack of energy – this can include feeling tired and lacking energy, even after sleeping.
• Difficulty concentrating or making decisions – this can include problems with memory, focus and decision-making.
• Feelings of worthlessness or guilt – experiencing intense self-critical thoughts and feelings of guilt.
• Irritability or restlessness – feeling easily agitated or on edge without a clear reason for feeling like this.
• Experiencing physical symptoms – some people may experience physical symptoms such as headaches or stomach aches.

Anxiety and depression so often go hand in hand and it is not always clear why this is the case. One theory is that the two conditions have similar biological mechanisms in the brain. This means that they are therefore more likely to exist together. Another theory is that they have many overlapping symptoms, so people frequently meet the criteria for both diagnoses.

Bipolar Disorder and Anxiety

According to Bipolar UK, 1.3 million people in the UK have bipolar disorder. Bipolar disorder, previously called manic depression, is where a person has extreme mood swings. These include emotional highs, known as mania or hypomania, and lows, otherwise known as depression. When your mood shifts to mania, or hypomania which is less extreme than mania, you may feel euphoric, full of energy or unusually irritable or restless. When you feel depressed, you may feel sad or hopeless and you may lose interest or pleasure in activities you would usually enjoy.

Symptoms of bipolar during a manic phase may include:

• Feeling incredibly high or euphoric.
• High levels of creativity, energy and activity.
• Feeling highly energetic or impulsive.
• Getting little or no sleep.
• Grandiosity, having an inflated sense of self-esteem or self-importance. A feeling of possessing special powers, talents or abilities.
• People may engage in numerous activities simultaneously and have a heightened sense of productivity. However, these activities may lack practicality or purpose.
• Difficulty engaging in one activity, becoming easily distracted.
• Experiencing racing thoughts, racing speech, or talking over people.
• Having a poor appetite and weight loss.

People experiencing this may not recognise this themselves and it may be those around them who observe this and raise concerns. 

Symptoms of bipolar during the depressive stage may include:

• Feelings of sadness, tearfulness or hopelessness.
• Angry outbursts, feeling easily irritable or frustrated.
• Loss of interest or pleasure in most or all normal activities.
• Sleep disturbances, which may include insomnia or sleeping too much.
• Feeling tired or lacking energy.
• Reduced appetite and weight loss.
• Increased cravings for food and weight gain.
• Anxiety, agitation or feeling restless.
• Slower reactions, thoughts, speech or body movements.
• Feelings of being worthless or of guilt, fixating on past failures or self-blame.
• Having trouble thinking, concentrating, making decisions.
• Problems with memory.
• Unexplained physical problems, which can include things like aches and pains.
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts.

There are different types of bipolar disorder. Bipolar I disorder involves manic episodes that last at least seven days or are severe enough to require hospitalisation. Depressive episodes may also occur. Bipolar II disorder is characterised by a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown mania. Cyclothymic disorder involves chronic fluctuations in mood with periods of hypomania and mild depression that lasts for at least two years.

It is not uncommon for people with bipolar disorder to also experience anxiety disorders. Studies have shown a high rate of comorbidity between bipolar disorder and various anxiety disorders, including generalised anxiety disorder, panic disorder, and social anxiety disorder. Anxiety may contribute to the onset of mood episodes in those already predisposed to bipolar disorder.

Both anxiety and bipolar disorder can involve similar symptoms such as restlessness, irritability and difficulty concentrating. These overlapping symptoms can make it challenging to differentiate between the two conditions, which can lead to potential misdiagnosis or a delayed diagnosis.

There may be some treatment challenges as some medications that are effective for bipolar symptoms may not adequately address anxiety, and vice versa. Finding the right combination of medications and therapeutic approaches is crucial. Some researchers have suggested that certain subtypes of bipolar disorder may be associated with higher levels of anxiety. For example, bipolar II disorder may be more commonly associated with anxiety than bipolar I disorder.

Anxiety and Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, and unwanted, thoughts, ideas or obsessions. To get rid of the thoughts, they feel driven to do something repetitively. The repetitive behaviours may be things such as handwashing, cleaning, checking on things repeatedly, and mental acts like counting. For people with OCD, thoughts are very intense, persistent and intrusive, and behaviours are rigid.

Obsessions are intrusive and distressing thoughts, images or urges that repeatedly enter a person’s mind. These thoughts are often irrational and unwanted, and can cause significant anxiety. Compulsions are repetitive behaviours or mental acts that people feel driven to perform in response to the obsessive thoughts. The compulsive actions may reduce the anxiety associated with the obsessions temporarily. OCD can occur in children as well as adults.  

People with OCD may experience intense anxiety due to the obsessions, and the compulsive behaviours are often performed as a way to alleviate the anxiety or prevent a feared event or situation. Experiencing anxiety and obsessive-compulsive disorder (OCD) together is not uncommon, as these two conditions can often coexist. Stress and anxiety can cause OCD symptoms to worsen.

OCD UK provides advice, information and support services for those affected by OCD, and campaigns to end the trivialisation and stigma of OCD.

Anxiety and Eating Disorders

An eating disorder is a mental health condition which is characterised by abnormal eating habits that negatively impact a person’s physical and mental well-being. These disorders often involve extreme emotions, and behaviours surrounding food and body image.

There are several types of eating disorders, which include:

• Anorexia nervosa – people with anorexia nervosa have an intense fear of putting on weight and they have a distorted body image. It is a serious, potentially life-threatening eating disorder. They may engage in extreme dieting and excessive exercise in order to achieve and maintain an unhealthy, low body weight.
• Bulimia nervosa – people with bulimia nervosa regularly engage in overeating, otherwise known as binge eating, followed by compensatory behaviours such as vomiting, misusing laxatives, weight-loss supplements, excessive exercise, or fasting to prevent weight gain. It is a serious, potentially life-threatening eating disorder.
• Avoidant/restrictive food intake disorder (ARFID) – ARFID involves having limited food preferences, avoidance of certain textures or smells, and a lack of interest in eating or trying new foods. It is not necessarily driven by concerns about weight or body shape.
• Binge eating disorder (BED) – people with BED consume large amounts of food, often rapidly and to the point of discomfort. It differs from bulimia nervosa, as individuals with BED do not regularly engage in compensatory behaviours.
• Other specified feeding or eating disorders (OSFED) – OSFED consists of a range of disordered eating patterns that do not fit the criteria of other specific eating disorders but still cause significant distress and impairment.

Eating disorders and anxiety often coexist alongside each other and can be interconnected. They share common risk factors and can influence each other. People with anxiety may use disordered eating behaviours as a way to cope with their anxiety. However, the strict rules associated with eating disorders can contribute to further anxiety. People may use food and body weight as a means of having a sense of control over their lives when they feel overwhelmed by anxiety. Societal pressure around body image and beauty standards can contribute to the development of both anxiety and eating disorders.

Please see our knowledge base for information about supporting children with eating disorders.

If you need support with an eating disorder, you can contact Beat Eating Disorders who offer advice and support for anyone affected by an eating disorder. 

Substance Abuse and Anxiety

Substance abuse refers to the harmful use of psychoactive substances, which includes alcohol and illicit drugs. It involves the repeated use of substances in ways that can lead to physical, mental or social harm to the person engaging in the behaviour.

Substances commonly abused include:

• Alcohol
• Tobacco
• Prescription medications
• Cocaine
• Heroin
• Methamphetamine
• Cannabis

The impact of substance abuse can vary widely and can involve a variety of health problems, impaired judgement, difficulties in relationships, legal issues and difficulties in everyday functioning. Substance abuse and anxiety are very often interconnected. People may use substances as a way to cope with their anxiety, while substance abuse in itself can contribute to the development or exacerbation of anxiety disorders. People with anxiety disorders may use substances as a way of self-medicating. While this may provide some temporary relief and escapism, it can lead to dependence and make anxiety worse. 

Substance abuse can alter the brain’s chemistry and contribute to and increase the risk of anxiety disorders. Withdrawal from certain substances can also induce anxiety-like symptoms. Substance abuse can complicate the treatment of anxiety disorders and prevent recovery. It may interfere with the effectiveness of medications and therapy. 

Environmental factors, such as having a history of trauma, can contribute to both substance abuse and anxiety. Addressing these underlying issues is important for treatment to be effective. Treatment options that address both substance abuse and anxiety are often recommended.

Treatment options may include:

• Behavioural therapies
• Counselling
• Support groups
• Medication
• Lifestyle changes

You can find drug and alcohol services near you by visiting TALK TO FRANK.

PTSD and Anxiety

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder caused by very stressful, frightening or distressing events.

People with PTSD may experience:

• Intrusive thoughts – people may relive the traumatic event through distressing memories, flashbacks or nightmares.
• Avoidance – those with PTSD may try to avoid any reminders of the traumatic event, including places, people or activities that trigger memories.
• Negative changes in thinking and mood – this can include persistent negative emotions, difficulties in relationships with others, a reduced interest in activities, or difficulty experiencing positive emotions.

PTSD and anxiety often coexist and they share some common symptoms. PTSD often involves significant anxiety symptoms. The experience of trauma can lead to persistent feelings of fear, hypervigilance, and an increased startle response. 

Effective treatment for PTSD often addresses the anxiety symptoms as well, as they are usually a part of the overall impact of the trauma.

PTSD UK helps people to access stigma-free support and resources, and work towards successful, sustained treatment and recovery. They also campaign to raise awareness of PTSD, and to help shape UK healthcare policies.  

Treatment Approaches

Treatment for people dealing with anxiety and comorbid mental health issues will be dependent on the specific combination of mental health conditions and the presence of symptoms. An assessment by a mental health professional will be necessary as it is important to receive the correct diagnosis. Treatment options will depend upon the diagnosis and symptoms.

Some common treatment options include:

• Talking therapies such as cognitive behavioural therapy (CBT) – CBT is a type of talking therapy that helps you to understand the link between your thoughts, feelings and behaviour. CBT is evidence-based and has been found to be effective for many mental health conditions, including anxiety disorders, depression and post-traumatic stress disorder (PTSD).
• Exposure therapy – this type of therapy is particularly useful for someone who has specific phobias and certain types of anxiety disorders. Exposure therapy involves gradually facing and confronting the phobia, allowing people to become less sensitive to whatever is causing anxiety.
• Mindfulness-based therapies – mindfulness-based approaches, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), teach people to be present in the moment and develop a non-judgemental awareness. When we become more aware of the present moment, this can help us to enjoy the world around us more and understand ourselves and other people better. When we become more aware of the present moment, we can sometimes appreciate things that we were taking for granted and find beauty in everyday experiences.

Some common medications which are used to treat a variety of mental health conditions include:

• Antidepressants – these medications work by affecting the balance of certain chemicals in the brain called neurotransmitters, which play a crucial role in mood regulation.
• Antipsychotics – these medications are primarily used to manage psychotic symptoms such as hallucinations and delusions. They are commonly prescribed for conditions like schizophrenia, bipolar disorder and certain mood disorders.
• Mood stabilisers – these medications are primarily used to treat mood disorders, such as bipolar disorder. These medications aim to stabilise and regulate mood swings, preventing episodes of both mania and depression.

Importance of Comprehensive Assessment

A comprehensive assessment in mental health is essential for:

• Fostering a holistic understanding of the person’s mental health.
• Making an accurate diagnosis.
• Identification of co-occurring disorders.
• Prevention and early intervention.
• Personalised treatment planning.
• Risk assessment.
• Progress monitoring.

MIND offers useful information about where you can access support for various mental health conditions.