Anxiety Disorder Due to Another Medical Condition

🧩 Overview Anxiety Disorder Due to Another Medical Condition

Anxiety Disorder Due to Another Medical Condition is a neurobiological form of anxiety that originates from physical or physiological disturbances within the body, rather than from external stressors, trauma, or psychological conflict. In this condition, anxiety is not “all in the mind” — it is the body itself generating alarm signals because an underlying medical problem is disrupting the brain’s regulation of fear and arousal.

The disorder commonly appears in individuals whose medical illness directly affects the central or autonomic nervous system, the endocrine (hormonal) axis, or the metabolic balance that stabilizes neurotransmission. When these biological systems are thrown off balance, the body remains locked in a state of physiological threat, even when no external danger exists.

Typical symptoms include racing heartbeat, palpitations, sweating, tremors, shortness of breath, dizziness, chest tightness, and a sense of impending doom or heart attack. These reactions mimic panic disorder but are driven by internal pathology rather than cognitive misinterpretation. The brain interprets the body’s abnormal signals as evidence of danger, amplifying the anxiety cycle.

For example, hyperthyroidism elevates metabolic rate and sympathetic activity, leading to tremors and tachycardia that feel identical to panic. Hypoglycemia can produce confusion, jitteriness, and restlessness due to rapid glucose depletion in the brain. Cardiac arrhythmia or mitral valve prolapse can cause palpitations and dizziness that the brain perceives as life-threatening. Even neurological lesions or tumors in limbic regions can distort emotional regulation and trigger anxiety-like episodes.

According to DSM-5-TR (APA, 2022), this diagnosis falls under Anxiety Disorders and requires clear medical evidence that the anxiety symptoms are a direct physiological consequence of a verified medical condition, not simply a psychological reaction to being ill. For instance, a patient with coronary artery disease may feel anxious, but the diagnosis of this disorder applies only when the heart’s dysfunction itself produces anxiety signals via autonomic overstimulation, not when the person merely “worries” about their illness.

It must also be carefully distinguished from Substance/Medication-Induced Anxiety Disorder, where the cause is external—such as caffeine, corticosteroids, or withdrawal states. In contrast, Anxiety Disorder Due to Another Medical Condition arises internally from organic imbalances such as endocrine dysregulation, immune-neuroinflammatory responses, or structural brain abnormalities.

In essence, the disorder reflects how biological malfunction and emotional experience intersect: the body’s internal chaos becomes translated by the brain into the language of fear. Recognizing this link is crucial, because effective treatment often depends not on psychotherapy alone but on correcting the underlying medical cause, thereby restoring the nervous system’s sense of safety.

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⚙️ Mechanisms

In Anxiety Disorder Due to Another Medical Condition, the body is the starting point of anxiety—not the mind. Some illnesses trigger false alarms in the brain, like a burglar alarm that goes off without an intruder.

The main mechanisms can be grouped into three levels:

1) Neurochemical Changes

When the body is out of balance—for example:

• Hyperthyroidism → excessive adrenaline output
  
  
• Hypoglycemia → brain reads energy deficit as a threat
  
  
• Hypoxia or certain infections/inflammation → disrupt brain function and cortisol

Neurochemicals such as norepinephrine, epinephrine, serotonin, and cortisol become dysregulated → the fight-or-flight system stays over-engaged → tachycardia, sweating, tremor, and free-floating fear.

In short: the brain misreads internal signals as danger because biology has shifted.

2) Autonomic Arousal

The autonomic nervous system (ANS) regulates heartbeat, breathing, and blood pressure. When a medical illness perturbs it, the brain interpbets the signals as “impending catastrophe.”

Examples:

• Arrhythmia → palpitations mimicking a panic attack
• Asthma/COPD → air hunger; brain equates “lack of air = danger”
• Adrenal disorders → excess adrenaline release

Result: intense panic-like anxiety even though the root cause is bodily.

Key idea: the brain reacts to bodily dysregulation rather than initiating fear.

3) Neurological Impact

When the medical condition directly affects the brain:

• Brain tumor
• Multiple sclerosis
• Traumatic brain injury
• Parkinson’s disease
• Temporal lobe epilepsy

Involved regions:

• Amygdala (fear processing)
• Prefrontal cortex (cognitive control/threat appraisal)
• Hippocampus (memory for aversive events)

Dysfunction in these circuits causes hyperactivation of fear systems, creating a persistent sense of threat in the absence of real danger.

In plain terms: systems that should warn only during real danger become phantom alarms that won’t switch off.

Quick Mechanism Summary

Mechanism	Medical Cause	Effect in Body/Brain	Experienced Symptoms
Neurochemical	Hormonal/metabolic abnormalities	Neurotransmitter balance shifts	Unprovoked fear/anxiety
Autonomic	Cardiac/pulmonary/adrenal disorders	Overactive fight-or-flight	Palpitations, dyspnea, tremor
Neurological	Brain disease/injury	Faulty fear processing	Ongoing anxiety without clear cues

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🧱 Essence of the Disorder

• Directly bodily in origin: anxiety stems from physiological effects of a medical condition (endocrine/metabolic, cardiac/pulmonary, neurological, etc.), not primarily from psychological causes.
  
  
• Source can be identified: clinical/lab evidence links symptoms to the medical illness (e.g., high thyroid hormones, low glucose, arrhythmia, hypoxia, neuroinflammation).
  
  
• Misdirected threat mode: bodily dysregulation overdrives neurotransmitters/hormones and the ANS → false alarms.
  
  
• Prominent physical signature: palpitations, air hunger, sweating, tremor, flushing—often fluctuating with the course of the medical illness (e.g., during glucose dips or thyroid surges).
  
  
• Diagnosis requires ruling out primary psychiatric disorders and delirium; if these do not better explain the picture and a medical cause is evident → diagnose here.
  
  
• Treatment principle: treat the medical cause first; medications and psychotherapy are adjuncts to reduce distress and prevent fear-of-symptoms cycles.
  
  
• Different from substance-induced anxiety: not caused by drugs/substances, but by internal pathophysiology.

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🧭 Phenomenology of Symptoms

Overall: similar to other anxiety disorders but with a distinct bodily signature and physiological fluctuation tied to the underlying illness.

1) Autonomic/Somatic (often most prominent)

• Palpitations, forceful/irregular beats
• Air hunger, chest tightness, exertional breathlessness
• Tremor, muscle tension/spasms, lip quiver
• Sweating, hot/cold flashes, chills, cold extremities
• Dizziness, light-headedness, presyncope
• Nausea, GI churning/diarrhea (ANS overdrive)
• Insomnia or fragmented sleep (hyperarousal)
• Clue: flares track physiological shifts (glucose dips, high pulse, thyroid surges).

2) Affective/Cognitive

• Heightened worry without an external trigger
  
  
• Fear of internal sensations (interoceptive fear)—e.g., “palpitations = heart attack”
  
  
• Poor concentration, disorganized thinking, short-term memory lapses (when hormones/glucose/O₂ fluctuate)
  
  
• Heightened interoceptive sensitivity

3) Panic-like Episodes

• Rapid onset within minutes: palpitations, chest tightness, dyspnea, paresthesias, fear of death/losing control
• Frequently provoked by bodily states: sudden exertion, high caffeine, fasting, hypoglycemia, hyperthyroid phases, arrhythmia
• Tip: if panic coincides with vital-sign changes (HR/BP/SpO₂) or recurs in the same physiological context, suspect a medical cause.

4) Triggers

• Internal: low glucose, caffeine/nicotine, hormonal swings, dehydration, sleep loss, acute pain
• External: heat/poor ventilation, high altitude (low O₂), medications that stimulate heart/thyroid

5) Presentations by Common Causes (examples)

• Hyperthyroidism: palpitations, tremor, sweating, insomnia, weight loss, day-long jittery anxiety
  
  
• Hypoglycemia: tremor, cold sweat, palpitations, confusion—rapid relief after glucose
  
  
• Arrhythmia: episodic palpitations, presyncope, chest discomfort → panic-like anxiety tied to rhythm change
  
  
• Asthma/COPD: shallow/rapid breathing → brain reads “air shortage,” strong fear response
  
  
• Neurological (TLE/MS/brain tumor): steady or atypical anxiety with focal neuro signs (numbness, weakness, seizures, unusual perceptions)

6) Behavior/Avoidance

• Avoids exertion, stairs, or crowded/poorly ventilated spaces
• Repeated vital-sign checking and reassurance seeking
• Reliance on “safety aids” (sweet drinks, glucose tabs, pulse oximeter)

7) Temporal Pattern

• Follows bodily rhythms (morning/evening swings, post-fasting, after caffeine/alcohol, menstrual phases)
  
  
• Improves when the medical condition is controlled (meds/treatment/lifestyle)

8) Red Flags (seek urgent medical care)

• Crushing chest pain radiating to arm/jaw, acute dyspnea, pallor/diaphoresis, impending faint
  
  
• Marked rhythm disturbance/syncope, first-ever seizure, acute focal neuro deficits (slurred speech, facial droop, one-sided weakness)

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🩺 Medical Conditions Often Implicated

Category	Examples	Typical Associated Features
🧠 Neurological	Brain tumor, epilepsy (esp. temporal lobe), multiple sclerosis	Panic-like anxiety, irritability
❤️ Cardio-vascular	Arrhythmia, heart failure	Palpitations, chest tightness
🫁 Respiratory	COPD, asthma	Dyspnea, agitation
🧬 Endocrine/Metabolic	Hyperthyroidism, hypoglycemia, pheochromocytoma	Sweating, tremor, fear of dying
💉 Inflammatory/Infectious	Lupus, encephalitis	Confusion, severe anxiety

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🧠 DSM-5-TR Diagnostic Criteria (Essentials)

• Prominent anxiety (e.g., excessive worry, panic attacks, tension, insomnia)
• Clinical/lab evidence that the medical condition is the direct cause
• Not better explained by another primary mental disorder (e.g., GAD, Panic Disorder)
• Does not occur exclusively during delirium
• Causes clinically significant distress or impairment

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💊 Treatment

Target the medical cause first, then add symptom-relief strategies as needed.

• Treat the underlying condition: e.g., antithyroid therapy for hyperthyroidism; glucose control for diabetes
  
  

• Pharmacotherapy for anxiety:

• SSRIs (e.g., sertraline, escitalopram) when anxiety persists despite medical control
• Benzodiazepines short-term in selected cases (monitor dependency risk)
  
  

• Psychotherapy:

• CBT to reframe bodily sensations as non-dangerous
• Skills: breathing training, mindfulness and relaxation

🧭 Clinical Example

A 35-year-old woman presents with palpitations, sweating, and fear of a heart attack. Labs reveal hyperthyroidism. After thyroid treatment, anxiety diminishes markedly → Anxiety Disorder Due to Another Medical Condition.

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📌 Quick Summary

Item	Details
Name	Anxiety Disorder Due to Another Medical Condition
Primary Cause	Bodily disorder affecting brain/ANS physiology
Core Symptoms	Marked anxiety, palpitations, fear of dying, tension, panic
Course	Persists while the medical illness is uncontrolled
Treatment	Fix medical cause + anxiolytics as needed + CBT
Vs. GAD	Has a provable medical etiology, not purely psychological

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📚 References

• American Psychiatric Association. (2022). DSM-5-TR.
• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s Synopsis of Psychiatry (12th ed.).
• Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology (5th ed.).
• Garakani, A., & Mathew, S. J. (2021). Neurobiology of medical-condition-induced anxiety. Current Psychiatry Reports, 23(8), 45–59.
• Nemeroff, C. B., & Owens, M. J. (2019). Neuroendocrine systems in anxiety disorders. Dialogues in Clinical Neuroscience, 21(4), 381–390.
• NIMH (2024). Anxiety Disorders Overview.
• Mayo Clinic (2025). Anxiety disorders: Causes and risk factors.

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