Chronic illness

Anxiety disorders

Having an anxiety disorder as well as an illness is actually very common. Anxiety and depression affect nearly half (46%) of women who have a chronic illness. It is a double whammy. It is sometimes difficult to know if it is the illness which is causing the anxiety, or anxiety makes the illness worse.

Some illnesses directly increase the likelihood of developing anxiety, such as arthritis, cardiovascular disease and polycystic ovary syndrome (PCOS). Pain, the aggressiveness of an illness and even the treatments, such as chemotherapy, can increase anxiety. If you previously had experiences with anxiety and depression, past trauma or have a lack of support these can all make your anxiety levels higher.

Do some of these things ring true for you?

LEARN Have a look at the different stories and pictures below, listen to a podcast or watch a video.

THINK Then, to understand more about what causes anxiety you can explore the different social, psychological and physical things that can increase anxiety. In this section you will find questions to ask yourself about each cause to see if it affects you.

DO Once you have explored the causes of anxiety then it is time to do something. Go to the ‘Toolkit’ to find a range of different tools to help yourself try and reduce anxiety.

View the causes of Anxiety Disorders for Chronic illness

Do you relate to these?

One of the many problems of being chronically ill – people tend to think you’re strong or you can handle it because you’ve dealt with it for so long. However in reality you are just pretending to be ok.

When did I last take my pain meds?! Can I take them again? I want to take them again! Has it been at least 4 hours…? I can’t remember!

Somewhere on this long journey, I lost myself. I don’t know when or how, but I am no longer who I used to be. I can’t even remember who that was.

Calm down, calm down, calm down.

“The enemy is fear, we think it is hate, but it is fear.”
Ghandi

I wonder what it feels like not to be anxious all the time.

Sometimes I worry I am only imagining all these symptoms and that I am actually crazy.

I want to stay in my bed and never get out. Everything makes me anxious. I can’t leave my room without getting overwhelmed by anxiety. And when i leave my house within minutes I’m having an anxiety attack. Just never leave the bed.

Causes of anxiety disorders for Chronic illness

What happens

Some personalities are more prone to anxiety - you might like having control over your world and when you are diagnosed with an illness that sense of control can be taken away from you. Sometimes you can get over-focused on every ache and pain to the point of obsession.

Questions to ask yourself

Is it in my make-up to be anxious about things?

How much do I like to feel in control?

Do I get anxious that I might be losing control?

How fixated am I on every ache and pain?

What happens

If you have had a diagnosis of anxiety or depression before in your life you are more at risk of having a further episode.

Questions to ask yourself

Have I had anxiety or depression before?

What happens

Distressing and faulty thinking such as:

  • catastrophising - thinking the worst possible thing will happen
  • jumping to conclusions - thinking you can predict the future (and it is bad) 

create a negative cycle.

Distressing thoughts cause physical symptoms such as a racing heart, feeling sick causing you to want to run away. Your self-talk remains negative - “I am hopeless” and the whole cycle starts again. If you find it hard to challenge your thoughts or if you avoid situations that cause anxiety you don’t get the benefit of facing your fear and working through the anxiety – this can lead to anxiety disorders.

Questions to ask yourself

Think of a recent time when you felt anxiety and ask yourself – in what ways were my thoughts unhelpful or faulty?

For example, do I:

  • jump to the wrong conclusions about what people are thinking about me?
  • think something really bad is about to happen?
  • what is the evidence to support my thoughts?
  • what is the worst thing that could happen? How likely is this?
What happens

The effect of an illness on your body varies. The symptoms you have can be a reminder your body has changed and may be behaving in ways you don’t like. When you focus on your appearance, these effects can cause you significant levels of anxiety. In particular, studies have found that if you struggle with self confidence and you develop breast cancer, you are at risk of having a high level of anxiety.

Questions to ask yourself

How anxious am I about how my body looks?

How anxious am I about the effects my illness is having on my body?

What happens

Physical, emotional, mental and sexual abuse can significantly affect your mental and emotional health. Ever having felt neglected, threatened or that you may be harmed in some way increases the risk of you experiencing an anxiety disorder. With maltreatment you learn you can’t trust that people will do the right thing by you – even sometimes those you thought loved and cared about you. With abuse you may lose the idea that everything in your world will be okay in the future and you may no longer feel safe.

Questions to ask yourself

Have I felt:

  • neglected?
  • threatened?
  • that I might be harmed at any time during my life?

Has abuse put me more at risk of anxiety?

How much can I trust others?

How safe do I feel?

What happens

If you have cancer or an illness that puts your life at risk, fear can turn to high anxiety - fear can be of pain, of the future, of cancer spreading, of disability, and of death. You are going through a lot and this is to be expected; finding strategies to help can be important.

Questions to ask yourself

How much do I fear my illness will spread or get worse?

How much do I fear my life is at risk?

How much do I fear death?

What happens

When you have an illness many people want to help you and tell you about the latest cure or pill they have heard about. You can feel judged for not listening to their advice, or for even having the illness in the first place. You can become highly anxious people are watching everything you do, everything you eat, when you exercise – everything becomes public.

Questions to ask yourself

How anxious am I about what others think of me?

How much do I feel judged by people for even having an illness?

How much do I feel that people are watching everything I do and take?

What happens

Having roles that give you meaning and a sense of purpose are important to your mental and emotional health. You might be a best friend, a mother, aunty, artist, volunteer… there are many roles you may have. Sometimes you can take on the role of “sick person”. Sometimes these roles are given to you and at other times you choose the roles you have. If you feel good about your roles, feel a sense of purpose and that you have a place in this world you are more likely to have the confidence to deal with your anxiety.

Questions to ask yourself

What roles do I have?

How anxious am I about the roles I have?

Do any of my roles cause me to have anxiety that affects my day to day living?

Social causes →
What happens

Problems with your family can include lots of things. It might be your family doesn’t understand your illness or dismisses it as nothing much to get anxious about, or they may be over bearing in their need to watch and protect you particularly if you have a life threatening illness. Illness sometimes changes the roles of family members from partners, mothers, brothers to carers 24 hours a day - sometimes willingly, sometimes not. If you are in a relationship, your illness can impact on this, or if you are not in a relationship you can get highly anxious your illness will stop you from finding someone to be with or having a family.

Questions to ask yourself

Are there family problems which cause me to be anxious?

Have there been changes to my family which I am anxious about? If so, what are they?

What role does my family play in my illness?

How does my illness affect my partner?

Will my illness stop me from having a happy relationship?

Will my illness stop me from having a family? (if applicable)

What happens

You might be anxious about changes caused by your illness such as a loss of independence, or interruptions to your career or whether you will get the support you need.  

Other life events can create a layered effect of overwhelming anxiety if you have to also cope with a change in your job, separation or divorce or the death of someone you love.

Questions to ask yourself

Have I experienced any stressful or difficult events recently?

Has my illness caused changes which make me anxious?

How do I cope with change?

How anxious am I about losing some of my independence?

What happens

Sometimes the trauma from a past event comes up again when you are faced with another crisis such as your illness. You may find yourself reliving the trauma, possibly having distressing memories of a traumatic time where you experienced fear of or actual harm, helplessness and a sense of horror.  This is a condition called Post Traumatic Stress Disorder (PTSD).

Questions to ask yourself

Are my anxious feelings and thoughts associated with an event that happened in the past?

Could I have PTSD?

What happens

Being ill can affect your ability to work, your income and your lifestyle. Your financial situation and whether you have enough medical insurance will influence how anxious you are. There are often fears about bills piling up and about whether you will have enough money to get the treatments you want and to look after yourself and your family while you are ill. These things can make you highly anxious.

Questions to ask yourself

How anxious am I about money?

How anxious am I about being a financial burden to others?

What happens

When you have an illness, some friends will know how to cope and support you and others may not know what is helpful for you. You may become anxious about their attitudes and responses as well as about being a burden to your friends too.

Questions to ask yourself

Do I feel accepted by my friends?

Who accepts or does not accept me?

How anxious am I about the effects my illness might have on my friends?

What happens

Having people to talk to when you need support is one of the most important ways to feel good about yourself. This might be friends, family and other people you mix with. The people who support you may change or disappear depending on the stage of your illness. Feeling alone and grieving for things you may have lost because of your illness can negatively affect your mental and emotional health. You may start to get anxious about being left alone. With some illnesses in particular, such as some cancers and after a cardiac event, a lack of support can increase your risk of developing anxiety.

Questions to ask yourself

Do I have friends, family or people I trust who can be there for me?

Who can I turn to if I need support and someone to talk to?

Have people who I turn to for support moved on, or they are no longer there for me?

Does my illness increase my risk of anxiety if I don’t have support?

Community causes →
What happens

Feeling supported by the services in your community will help you if you are feeling anxious. Not feeling supported when you have an illness, or when you are struggling to get help can be distressing.

Questions to ask yourself

How do I feel about the community where I live?

How connected do I feel and do I feel that I belong in my community?

What services are available in my community to support me?

What happens

When you are ill you can feel more vulnerable to physical and emotional hurt. This might be because you have a wound, pain or physical limitation that means you might fall or be hurt more easily. Your level of energy to deal with emotions may be much lower. This may cause you to fear moving around in your community such as dealing with crowds or transport or shopping.

Questions to ask yourself

How safe do I feel in my community?

How anxious am I about being physically attacked?

How anxious am I about falling over?

How anxious am I that I could be hurt emotionally?

What happens

When you have an illness, you may become very anxious about:

  • how safe and secure your job is.
  • whether people will feel you are not pulling your weight.
  • whether you will be overlooked.
  • how demanding it is of your time and energy to do your job.
Questions to ask yourself

How anxious am I about my work?

How secure do I feel in my job?

Do I feel exhausted by my job?

How supportive is my boss and work place?

Physical causes →
What happens

There is some debate about whether anxiety is inherited. If a family member has, or has had an anxiety disorder this doesn’t mean you will automatically get anxiety. It may be that some genes along with things that happen in your life may mix together to increase your vulnerability to anxiety.

Questions to ask yourself

Do I have someone in my family who has had an anxiety disorder?

In addition to other causes of anxiety, does a family history add to my risk of anxiety?

What happens

There are many physical aspects of your illness which can cause high levels of anxiety, including:

  • the type of illness you have: Polycystic Ovary Syndrome increases the risk of an anxiety disorder as do arthritis and chronic pelvic pain, premature and early menopause
  • the symptoms of your illness and how persistent they are
  • how much pain you are in
  • if your diagnosis was recent
  • if you are young  
  • if your illness is aggressive
  • the risk to your life from your illness
Questions to ask yourself

How anxious am I about my illness?

How anxious am I about the future of my illness?

How fearful am I of losing my life because of this illness?

Am I in a lot of pain?

How anxious am I that my dreams and plans for my life could be cut short by my illness?

What happens

The type of treatment you need may include lifestyle changes, medication and/or surgery. If the treatments for your illness are aggressive or if they are likely to impact on the things you are able to do, you can be highly anxious about this. Some medications and chemotherapy put you at greater risk of anxiety.

Questions to ask yourself

How long do I need to receive treatment for my illness?

Is this a short term thing or will I need to receive treatment for the rest of my life?

How much does my treatment cause me anxiety?

Will my medication cause me anxiety?

What happens

Excessive drinking (defined as more than two standard drinks on any day and with no alcohol free days in a week) can:

  • make you focus more on your anxieties.
  • be a sign you are trying to cover up or numb your feelings of anxiety.
Questions to ask yourself

How much am I drinking?

How anxious am I about my drinking?

Am I drinking to make the anxiety go away?

What happens

Lack of quality sleep can make you tired and this can cause anxiety which impacts on your daily life. Quality sleep can be difficult to achieve when you have an illness - either through pain, or the effect your symptoms have on you - or the anxiety you have about your illness may keep you awake.

Questions to ask yourself

How much sleep do I get per night?

Is it hard to go to sleep or do I wake in the night and find it hard to get back to sleep?

Does my anxiety keep me awake?

What happens

An unhealthy diet made up of high fat and sugary foods affects your mood and can make you more prone to worry. Erratic eating such as forgetting to eat or eating only one large meal a day doesn’t help your mood either. If you need a special diet because of your illness this can create added anxieties and obsessions such as about what you can eat when you go out to cafes, restaurants or other people’s homes. In addition, lack of exercise can make you more prone to anxiety. 

Questions to ask yourself

Do I generally eat a range of healthy foods?

How anxious am I about the foods I can eat because of my illness?

Am I able to exercise enough to feel better?

Created on 18/08/2013 | Updated on 10/12/2015
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About Jean Hailes

Jean Hailes is Australia’s leading and most trusted women’s health organisation. We believe in physical and emotional health and wellbeing in all its dimensions for all women in Australia throughout their lives.

We offer a range of free resources and easy to understand information on women’s health and wellbeing. Appointments at our specialist women’s health clinics can be made in person (East Melbourne and Clayton, VIC) or across Australia via our Telehealth consultation service. www.jeanhailes.org.au

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