Complications

Alcoholism and Other Forms of Substance Abuse

Severely depressed or anxious people are at high risk for alcoholism, smoking, and other forms of addiction. Anxiety disorders are highly prevalent among people with alcoholism. Moreover, long-term alcohol use can itself cause biologic changes that may actually produce anxiety and depression.

Risk for Substance Abuse in Specific Anxiety Disorders. The following are some observations on specific anxiety disorders and substance abuse:

• Some people with GAD and panic disorders may use alcohol or drugs to self-medicate.
• Social phobia appears to pose a particular risk for alcohol abuse. People with this disorder are likely to drink in order to boost confidence. Alcohol itself has no direct beneficial effect on anxiety, but studies suggest that the belief in its effect appears to relieve anxious feelings. (Alcohol or substance abuse is not associated with specific phobias -- such as a fear of flying or spiders.)
• Heavy smoking and substance abuse are common in people with PTSD. In adolescents, the disorder not only increases the risk for drug and alcohol use but also for eating disorders.

Effects on Work, School, and Relationships

Studies consistently report that anxiety disorders have negative effects on work and relationships. Some examples:

• In one 2001 study, more than 10% of patients with GAD missed at least 6 days of work within the previous month.
• In a survey of OCD sufferers, 40% reported that they had to stop working because of the disorder. Only 40% worked full-time, while only half were married.
• A 2006 study indicated that children with OCD are more likely to be bullied than other children.
• Studies report that people with social phobias are less likely to get married, to leave home, and to finish school than those without this disorder. Their outlook worsens if they have other emotional disorders.

Effects of Major Anxiety Disorders on Physical Health in Adults

Anxiety disorders are associated with many different physical illnesses. Research suggests that people who have both an anxiety disorder and a physical illness have a worse quality of life and greater risk for disability than those who have only a physical illness. According to a 2006 study in the Archives of Internal Medicine, anxiety disorders tend to occur before the development of physical disorders.

Heart Disease. Anxiety has been associated with several heart problems, although the mechanisms are unclear. Some studies have observed a tendency for unhealthy cholesterol levels in people with panic disorder. A 2001 study reported an association between thicker blood vessels in both women and men with anxiety and with hardening of the arteries in men (but not in women). Another study indicated that people who experience anxiety are more likely to develop high blood pressure than those who are not anxious. Both anxiety and depression have been associated with a poor response to treatment in heart patients, including a worse outcome after heart surgery.