The Impact of Chronic Anxiety on Physical Health

Contemporary life and society are fast-paced and demanding. It’s no surprise that chronic anxiety has become a prevalent concern affecting individuals from all over the world. The pervasive nature of anxiety not only affects a person’s mental health, but its impact on physical health can also be just as problematic. The statistics tell a sad story: 28% of people aged between 16 and 29 are likely to experience anxiety and the majority are female. Anxiety levels are increasing too. More people are being diagnosed with anxiety conditions and, according to figures by NHS England, GAD (generalised anxiety disorder) accounted for the largest numbers of all chronic mental disorders (CMD) in the North West and North East of England at 7.3%. It’s likely that these figures are similar across the rest of the UK. 

The most commonly presented anxiety conditions:

• Generalised anxiety disorder
• Mixed depression and anxiety
• Health anxiety
• Social anxiety
• Panic disorder

Understanding chronic anxiety

Unlike the occasional bout of stress or anxiety that occurs in response to specific situations, chronic anxiety is persistent. It is an excessive sense of worrying that goes beyond the triggering event. While stress and anxiety are normal responses to challenging situations, chronic anxiety becomes a continuous state of apprehension and fear that can disrupt daily life and have a profound impact on the body. 

The causes of chronic anxiety

Chronic anxiety can stem from a range of factors including genetic, environmental and psychological elements. Having a family history of anxiety disorders, traumatic experiences or prolonged exposure to high-stress environments can contribute to its development. Additionally, chemical imbalances in the brain, particularly those involving neurotransmitters like dopamine and serotonin can play a part in worsening chronic anxiety.

Symptoms

Diagnosing chronic anxiety comes from recognising a range of emotional, cognitive and physical symptoms. Those suffering often experience persistent worry and restlessness. They will likely feel constantly on edge and unable to relax. Cognitive symptoms occur as racing thoughts, excessive self-doubt and an anticipation of negative outcomes. In terms of the physical side of things (which is often overlooked), people can suffer from headaches, muscle tension, fatigue and sleep disturbances. These symptoms impact on overall quality of life quite significantly. 

It’s essential for GPs to recognise chronic anxiety and distinguish it from occasional stress, which is generally linked to specific stressors and is time limited. Chronic anxiety persists over an extended period of time and symptoms can be present for six months or more.

The mind-body connection

The relationship between the body and the mind is complex and the two impact upon each other in terms of health. Chronic anxiety is an example of how mental and emotional states can impact physical health. This mind-body connection involves a bidirectional communication system. Thoughts, emotions and mental health can all influence our bodily functions and vice versa. 

When someone experiences chronic anxiety, the mind sends signals to the body to prepare for a perceived threat. This begins the ‘flight or fight’ response. This triggers the release of stress hormones like cortisol. Though these are needed for short-term stress management, chronic exposure to elevated levels of cortisol can have a negative effect on a range of bodily systems. 

When cortisol is released due to chronic anxiety, it can lead to heightened inflammation. This causes a range of possible health issues, including a weakened immune system, digestive disorders and cardiovascular problems. Muscle tension from anxiety can also cause musculoskeletal pain, migraines and headaches. 

The impact on the cardiovascular system like increased heart rate and blood pressure are common responses. Over time, these physiological changes can contribute to cardiovascular problems developing, which is why it’s important to address mental health problems early. 

Understanding the mind-body connection allows for the creation of comprehensive strategies to manage anxiety. Interventions that target both mental and physical well-being are often more effective. 

Impact on cardiovascular health 

Since chronic anxiety causes a persistent activation of the body’s stress response, it can exert a severe impact on cardiovascular health. Studies have established a link between chronic anxiety and an increased risk of cardiovascular conditions, including heart disease and hypertension. In many cases, the anxiety disorders have also been linked to adverse outcomes, including mortality.

The continuous release of stress hormones, particularly cortisol, and the activation of the sympathetic nervous system cause physiological changes that can negatively affect the cardiovascular system. One effect is the elevation of heart rate and blood pressure. When this occurs over a prolonged period, it can strain the heart and blood vessels.

Research findings have consistently shown that individuals with chronic anxiety are at a higher risk of developing coronary heart disease, stroke, fatal ventricular arrhythmias, congestive heart failure and sudden cardiac death. The relationship between anxiety and heart health extends beyond mere correlation. 

Prolonged stress and anxiety can lead to sustained high blood pressure, which puts additional strain on the heart. This increases the risk of heart attacks, strokes and other cardiovascular complications.

Moreover, chronic anxiety may also influence health behaviours, which further impacts cardiovascular well-being. When someone experiences chronic anxiety, they are prone to using unhealthy coping mechanisms. These include excessive alcohol consumption, poor dietary habits and smoking. All of these also contribute to cardiovascular risk factors.

When we recognise the connection between chronic anxiety and cardiovascular health, we recognise the need to have a comprehensive approach to managing the condition. Interventions that target stress reduction and mental well-being are good and they can have a positive impact on cardiovascular outcomes. 

Immune system suppression

Chronic anxiety has been linked to immune system suppression. This can make people more susceptible to illnesses and infections. This is due to the effects of stress hormones like cortisol and their effects.

Cortisol and immune function

Chronic exposure to elevated cortisol levels can lead to a reduction in lymphocytes. These are white blood cells that play a crucial role in immune response. Studies have shown that stressors compromise the immune system’s ability to defend against pathogens.

Inflammation and immune response 

Chronic anxiety contributes to chronic inflammation. In turn, this has been associated with immune system dysregulation. The Journal of Behavioral Medicine published a study that highlights the relationship between chronic stress, inflammation and immune function. This study showed that prolonged stress can lead to systemic inflammation that negatively affects the body’s immune responses.

Susceptibility to illness

With a weaker immune system, those with chronic anxiety are also more susceptible to illnesses and infections, like upper respiratory infections. The body is also much more likely to heal slower and won’t be as good at producing antibodies.

Gastrointestinal issues

There is well-documented evidence that chronic anxiety is linked to gastrointestinal problems like irritable bowel syndrome (IBS) and other digestive disorders. Chronic anxiety impacts the digestive system significantly and it can exacerbate existing conditions while also contributing to the development of new ones.

Irritable bowel syndrome (IBS)

For people with an existing diagnosis of IBS, chronic anxiety can exacerbate symptoms. The manifestation of gastrointestinal symptoms can come from the gut-brain axis, which is a bidirectional communication system between the gut and the brain. The axis can be disrupted by chronic stress, which leads to reactivity and increased sensitivity in the gut.

Digestive disorders

Chronic stress and anxiety can affect various aspects of digestive processes. This includes motility, secretion of digestive enzymes and nutrient absorption. The disruption can contribute to the development or exacerbation of digestive disorders, including inflammatory bowel disease (IBD).

While the exact relationship is complex, chronic anxiety has been associated with an increased risk of inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. Studies show that there is no coincidence here. Adverse life events, including chronic stress and depression, do increase relapses for patients with quiescent IBD.

Stress response and gastrointestinal symptoms

Chronic exposure to stress hormones is believed to lead to alterations in gut permeability and immune function. Chronic anxiety can also impact the balance of the gut microbiota. This influences the composition of beneficial and harmful bacteria within the gut. An imbalance may contribute to gastrointestinal symptoms.

Sleep disruption

Chronic anxiety frequently disrupts sleep patterns, creating a cyclical relationship where anxiety contributes to sleep problems, and insufficient sleep exacerbates anxiety. Understanding this interplay is essential as both mental and physical health heavily depend on the restorative benefits of quality sleep.

The impact of anxiety on sleep:

• Racing thoughts and hyperarousal: Chronic anxiety often leads to racing thoughts, persistent worry and hyperarousal. This makes falling asleep difficult as it is hard to relax.
• Increased cortisol levels: Elevated levels of cortisol interfere with your natural circadian rhythm. This disrupts the sleep-wake cycle and means poorer sleep quality.

The importance of quality sleep for physical health

Adequate sleep is crucial for a well-functioning immune system, which we already know is affected by anxiety itself. Chronic sleep deprivation associated with anxiety also compromises the immune response, thus making individuals more susceptible to illnesses.

We’ve discussed cardiovascular health and the impact of chronic anxiety but another problem associated with anxiety—poor sleep—also increases the risk of hypertension and other cardiovascular conditions, an anxiety double-whammy as it were. 

Sleep is also essential for cognitive functions like memory consolidation, learning and problem-solving. Sleep disruptions impair these cognitive processes.

The vicious cycle between anxiety and sleep problems

Anxiety and sleep disturbances often form a vicious cycle. Anxiety can lead to difficulty falling asleep, maintaining sleep or experiencing restorative sleep. In turn, insufficient or poor-quality sleep can heighten anxiety levels. Sleep deprivation also contributes to mood swings, irritability, and heightened emotional reactivity, all of which can exacerbate anxiety symptoms.

Addressing sleep disruptions in anxiety 

There is a specific type of cognitive behavioural therapy for insomnia called CBT-I. This is an approach that addresses the specific thoughts and behaviours contributing to sleep problems. Establishing a consistent sleep routine, creating a conducive sleep environment and practising good sleep hygiene also contribute to better sleep quality to try and break the vicious cycle.

A bedtime routine that incorporates mindfulness meditation, deep breathing exercises or progressive muscle relaxation can also help alleviate anxiety and promote sleep.

Coping mechanisms

With so many physical impacts of chronic anxiety, it becomes imperative to manage the condition effectively. This involves a range of approaches that address the mental and physical sides of things. Here are some strategies:

Mindfulness and relaxation techniques

As well as being great for promoting sleep, these techniques are also useful in the general battle against chronic anxiety. They help to calm the nervous system. Mindful breathing means focusing on your breath with slow, deliberate inhalations and deep exhalations. 

Progressive muscle relaxation (PMR) is another technique that helps to reduce tension and anxiety. This focuses on gradually tensing and relaxing different muscle groups deliberately.

Mindfulness is a popular ‘in vogue’ trend but also a coping mechanism that does work for anxiety. Essentially, it promotes being aware of the present moment so you can break the anxious thought cycle.

Lifestyle changes

Having a healthy lifestyle works in anxiety reduction. Physical activity has been shown to reduce stress and anxiety because it releases the body’s natural stress relievers – endorphins. With 30 minutes of moderate exercise on the majority of your days, you’ll be naturally combatting anxiety. 

A healthy diet is also essential since certain foods can influence our moods and energy levels. Avoiding stimulants like caffeine and sugar can promote less anxiety. What’s more, foods that are rich in omega-3 fatty acids, antioxidants and vitamins help boost the immune system that’s been weakened by anxiety.

Stress management techniques

If stress is adding to anxiety either at work or in everyday life, it can be useful to take on board techniques to minimise it. This might involve time management activities where you prioritise tasks, set realistic goals and reduce jobs into manageable chunks that prevent you from feeling too overwhelmed. Excess worriers can also benefit from choosing a specific time like a 30-minute slot when they allow themselves to worry and then try not to worry about it the rest of the time. 

Journaling is often recommended as a technique to gain perspective and clarity. It can also help you identify triggers for the anxiety. 

Seeking support

Asking for help with anxiety isn’t easy but it can be beneficial. Some people require support from their GP whilst others can manage their anxiety by sharing their feelings and experiences with trusted friends and family members. Support groups, whether online or in person, are also helpful as you can meet people who have similar experiences.