Managing Anxiety and Autonomic Nervous System Disorders: A Patient's Journey

Anxiety and autonomic nervous system dysregulation?

Hello, Doctor.
This is my first time asking a question here.
I was diagnosed with generalized anxiety disorder at the age of 22, but after several years of treatment, I am no longer on medication.
Last year, due to some noise and panic issues, my sleep was severely affected.
However, after a year of follow-up counseling, I have seen improvements, although I still tend to be more sensitive to noise in certain situations (such as when I am fatigued or just waking up).
Recently, since last month, I returned to see the psychiatrist who previously treated me.
I specifically consulted about whether my irregular sleep schedule, caused by fear and noise-related insomnia, could negatively impact my health.
Before this visit, my sleep had improved, and I was able to sleep through the night.
However, I have recently experienced episodes where I wake up feeling as if something is stuck in my chest, making it hard to breathe.

Additionally, since last month, I have noticed that the veins in my hands have become very prominent (around the area below the thumb towards the back of the hand), and there is a specific spot that feels painful.
I have seen two family medicine doctors who suggested it might be neuropathic pain or phlebitis.
Although there has been significant improvement over the past month, I often worry about whether I might have cardiovascular disease due to some recent episodes of extreme fatigue, chills, and persistent tiredness regardless of how much I sleep, along with occasional left chest pain or palpitations.
This has led me to worry about the possibility of having cardiovascular issues.
My previous doctors and therapists have noted that I have a strong awareness of my health, which allows me to differentiate between my anxiety and normal thought processes.
I have previously addressed some compulsive behaviors through behavioral therapy with my therapist, achieving about an 80% improvement.
However, I currently find myself particularly concerned about my physical health, possibly due to my awareness of my long-term sleep deprivation.
I feel that my initial decision to stay up late was not entirely my fault, as my sleep environment was excessively noisy, and I tend to be more sensitive to such disturbances.
Last month, I also visited a cardiologist for a check-up, which included a 24-hour Holter monitor and blood tests (to rule out hereditary hyperthyroidism).
The results showed only mild arrhythmia, and my psychiatrist later reviewed the ECG and reassured me that I am still young and that the arrhythmia is very mild, so there is no need for concern.
I even asked if I needed to resume medication, and the psychiatrist advised against it, encouraging me to have more confidence in my health, emphasizing that I am young and unlikely to have serious issues.
However, when I look at the veins in my hands, I can't help but associate them with potential cardiovascular problems, which makes me anxious.
The painful spot on my hand constantly reminds me to pay attention to it, even though I genuinely want to focus on my own activities and not dwell on it.

I am unsure how to better adjust to this situation.
I already have a frequent exercise routine and practice mindfulness.
The psychiatrist also inquired about any significant family medical history.
I only mentioned that my grandfather had a stroke, to which the psychiatrist asked how old he was at the time, and I replied around 80.
The doctor reassured me to not worry.
However, the recent issues with chest pain and discomfort often lead me to connect them with the prominent veins in my hands.
There were even a couple of mornings when I woke up with bruises and blood spots on my legs (though this has improved later), which has made me genuinely concerned about whether there might be an issue with my heart.
Thank you, Doctor.

Ks, 20~29 year old female. Ask Date: 2023/05/19

Dr. Lin Mianzhang reply Psychiatry

Hi there! Your situation may be indicative of hypochondriasis, a condition where symptoms fluctuate with psychological stress.
I suggest you reflect on any recent stressors and consider ways to cope with them.
If necessary, you can ask your psychiatrist for a referral for psychotherapy and an evaluation to determine if medication might be helpful.
Wishing you peace and good health.

Reply Date: 2023/05/19

More Info

Managing anxiety and autonomic nervous system disorders can be a complex journey, especially when intertwined with physical symptoms that can lead to heightened worry about one's health. Your experience reflects a common challenge faced by many individuals dealing with anxiety disorders, particularly generalized anxiety disorder (GAD), which you were diagnosed with at 22. It’s commendable that you have made significant strides in managing your anxiety over the years, including a period without medication.

The symptoms you describe, such as sensitivity to noise, sleep disturbances, and physical sensations like chest tightness or pain, can indeed be manifestations of anxiety. Anxiety can lead to a heightened state of arousal in the autonomic nervous system, which is responsible for regulating bodily functions such as heart rate, blood pressure, and respiratory rate. This heightened state can result in physical symptoms that mimic more serious health issues, leading to a cycle of worry and anxiety.

Your concerns about the visibility of your veins and the associated pain, as well as the episodes of fatigue and chest discomfort, are understandable. It's important to recognize that anxiety can cause physical symptoms, including muscle tension, which may contribute to sensations of pain or discomfort in various parts of the body. The fact that you have undergone thorough evaluations, including a 24-hour Holter monitor and blood tests, and that these tests have returned normal results, is reassuring. Your healthcare providers have indicated that your heart health is stable, which is a positive sign.

The connection between anxiety and physical symptoms is well-documented. Anxiety can lead to hypervigilance, where individuals become overly aware of bodily sensations, interpreting them as signs of illness. This is often referred to as health anxiety or hypochondriasis. It’s crucial to differentiate between genuine medical concerns and those that are exacerbated by anxiety. Your ability to recognize when your anxiety is influencing your thoughts is a valuable skill that can help you manage your symptoms.

To address your current concerns, consider the following strategies:
1. Cognitive Behavioral Therapy (CBT): This therapeutic approach is effective for anxiety and can help you challenge and reframe negative thoughts about your health. Working with a therapist can provide you with tools to manage your anxiety more effectively.

2. Mindfulness and Relaxation Techniques: Since you already practice mindfulness, consider incorporating more relaxation techniques such as deep breathing exercises, progressive muscle relaxation, or guided imagery. These can help reduce anxiety and improve your overall sense of well-being.

3. Physical Activity: Regular exercise is beneficial for both physical and mental health. It can help reduce anxiety symptoms and improve sleep quality. Continue to engage in activities that you enjoy and that keep you active.

4. Sleep Hygiene: Given your history of sleep disturbances, maintaining good sleep hygiene is essential. This includes creating a calming bedtime routine, limiting screen time before bed, and ensuring your sleep environment is conducive to rest.

5. Limit Information Overload: In today’s digital age, it’s easy to become overwhelmed by health information online. Consider limiting your exposure to health-related content that may trigger anxiety.

6. Regular Check-ins with Healthcare Providers: Continue to communicate openly with your healthcare providers about your symptoms and concerns. Regular follow-ups can help you feel more secure about your health status.

7. Support Networks: Engaging with support groups or talking to friends and family about your experiences can provide emotional support and reduce feelings of isolation.

In summary, while your concerns about your health are valid, it’s essential to focus on the positive feedback from your healthcare providers and the progress you’ve made in managing your anxiety. By employing coping strategies and maintaining open communication with your healthcare team, you can navigate this journey more effectively. Remember, it’s okay to seek help and support as you work towards a healthier, more balanced life.

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