Can anxiety kill you? (Yes or No?)

A panic attack represents a person’s fear of losing control in certain situations or of dying of anxiety. They present strong physiological reactions that can give the feeling that we are going to die. But can it really happen?

Can anxiety kill you?

People who suffer from anxiety often use phrases like “I think I’m going to have a heart attack,” “I can’t take it anymore,” “These symptoms are horrible,” “I’m going to die.“

This disorder leads people who suffer from it to panic, constant attacks of fear that could last for minutes, in some cases these symptoms could last longer. This fear is known psychologically as a panic attack.

“Pathological anxiety” is disproportionate or excessive with reference to the stimulus it causes. It usually occurs recurrently, limiting the lifestyle of the person who suffers from it. In a way, this anxiety attack protects us from imaginary dangers.

These panic attacks can strike at any time without warning. Many individuals are concerned about having new attacks. A person suffering from these attacks will feel ashamed for not having the ability to carry out some daily activities, being discouraged, for example, would not have the facility to carry out activities such as driving a car or going to a shopping store.

What is Anxiety?

Anxiety is a fundamental emotion that we encounter in people of all cultures. The term may sound a little foreign to us, but this emotion is known to all of us – we have lived it in many life situations, from an early age. We understand by anxiety an accentuated state of anxiety, in which we wait for something bad to happen or we feel that we are no longer safe. Here are some typical examples:

• We don’t know what it will be like at an exam or an interview for a job. It will be hard? Will we manage? What questions will they ask us? What will others say if we fail? Maybe it will be good, but maybe not!

• Our child is late to come home and does not answer the phone. Did something happen to him? Why doesn’t he answer? Maybe it’s nothing serious, but we’re not sure!

• We are in the city and it is dark on the street we are walking. Are we safe? It’s like I heard some sounds in the dark. Is it a cat? Or is someone watching us?

• Our mother became seriously ill. We don’t know what his prognosis is. Will he do well? Will the treatment he received work?

• We lost our jobs due to staff reductions. How are we going to handle it? What will happen to us? How will our lives change? It can’t be easy!

This anxiety is not just a mental state, but we live it in our whole body: our heartbeats are faster, our breathing is difficult or very fast, our muscles feel tense, we sweat, our stomach tightens. Living these things, it is often difficult for us to stay in one place, to feel like doing something, to talk to someone, to go somewhere, to move from one corner of the room to another. 

What Are Anxiety Disorders?

Anxiety disorders are the most common mental health problem globally. Studies in both adolescents (e.g. Kathleen Merikangas’ study in JAACAP in 2010) and adults (e.g. Ronald Kessler’s study in JAMA in 2005) show that the prevalence of lifelong anxiety disorders is approx. 30%. 

The evolution of anxiety disorders is chronic, and in the absence of proper treatment, people suffer major long-term costs, such as the increased risk of somatic diseases and high comorbidity with other mental health problems (eg depression, alcohol abuse or other substances), high rate of disability, academic failure, unemployment or low performance at work.

It is important to understand that anxiety is not in itself a mental problem or a term that defines a bad, dysfunctional emotion that we should completely eliminate from our lives. The fact that anxiety is an emotion that we encounter in all cultures, from ancient times, and we find it in all mammals, proves that it is a natural emotion, which has been preserved in our evolution because it serves an important purpose for survival. 

Therefore, before we talk about anxiety as a mental problem, we need to understand the difference between normal anxiety and pathological anxiety. 

What is Panic Disorder?

Panic disorder is one of the forms of clinical anxiety, which occurs in about 2-5% of people and usually begins after the age of 20 years. We speak of panic when a person has recurrent episodes of fear (anxiety/agitation) very intense, which occur suddenly and unexpectedly.

These episodes, called panic attacks, can take minutes or tens of minutes, but usually reach their maximum intensity in the first 10 minutes. Panic attacks can occur from time to time or, conversely, very frequently and often cannot be predicted (i.e. the trigger is unknown to the person concerned).

For example, it can happen that the person climbs the stairs a few floors and suddenly feels overwhelmed by a feeling of sickness, dizziness and it seems that his heart will give way. Or the same sensations can occur behind the wheel of a car, without the person having previously made a physical effort.

The symptoms of panic attacks

The symptoms of a panic attack can be very diverse, but they are always very unpleasant, and the person is convinced that his health (physical or mental) is endangered by them:

• palpitations, strong and/or accelerated heartbeat
• sweating
• heat or cold waves
• numbness, tingling in the body
• tremors or chills
• A feeling of suffocation or a lump in the throat
• difficult breathing or shortness of breath
• pressure, discomfort or chest pain
• nausea, diarrhoea or other stomach problems
• feeling dizzy, sick, losing balance or fainting
• feelings of unreality, of being out of the body or the feeling that what is happening is strange, unusual
• fear of dying
• fear of losing control or going crazy.

Attention! All these symptoms may be based on a medical condition (for example hyperthyroidism, hypoglycemia, cardiovascular disorders such as mitral valve prolapse, asthma, pulmonary oedema). We speak of a panic attack when no somatic cause can be identified for recurrent panic symptoms. 

Usually, people with a panic attack have numerous medical check-ups before consulting the services of a psychology/psychiatry specialist. This is natural and it is highly recommended that prior to establishing a diagnosis of anxiety disorder and starting any treatment, a specialist medical consultation be made to rule out any medical condition that may have similar symptoms.

The diagnosis of panic disorder

A single panic attack is not a diagnosis in itself. In fact, many people go through a panic attack (or even several) throughout their lives and do not develop a clinical disorder. A diagnosis of panic disorder is made when a person repeatedly goes through panic attacks and is overwhelmed by worries or fears about them. 

For example, the person is overly concerned about the implications that panic attacks will have on his life. “What if I really die one day? What if I go crazy? What if I can’t work anymore? What if I can’t enjoy life anymore? ”

Due to the intense concern not to go through new panic attacks, the person changes their behaviour considerably, avoiding many situations that could trigger such attacks. For example, a person who has had panic attacks while driving refuses to drive. 

Or a person who has had panic attacks when left alone at home or on the street always tries to be accompanied by a trusted person. Another common example, a person who has had panic attacks after a physical effort, avoids a large number of activities that involve such an effort – avoid sports, walking, climbing stairs, sex.

In short, a clinical diagnosis is taken into account when the person has great difficulty in carrying out their daily activities, when social life or professional activity is severely impaired or when the quality of life as a whole decreases considerably.

Can anxiety kill you? – A higher risk of suicide than depression

In October 2013, four studies published in the journal Depression and Anxiety looked at the risk of suicide for people with mental health problems. Specifically, the researchers investigated whether anxiety is associated with the risk of suicide, as measured by suicidal thoughts, suicide attempts, or suicide. 

Moreover, the effect of anxiety on the risk of suicide was compared with that of depression. Of course, anxiety and depression are most often found in comorbidity in patients (in some studies comorbidity, i.e. the simultaneous presence of both types of symptoms, is approximately 60-80%). 

However, there are statistical procedures that can estimate the association between anxiety symptoms and suicide risk, independent of depressive symptoms, and vice versa. Such procedures are widely used in medical, genetic and psychological research.

All four studies concluded that anxiety symptoms are strongly associated with the risk of suicide and in some even stronger than depression. The first study was conducted by an Australian research group led by Dr Philip Batterham on a sample of approx. 7,500 people, chosen from all age groups. 

The results showed that the current incidence of suicidal thoughts and the diagnosis of major depression depends more on the symptoms of anxiety (23% and 45%) recorded 4 years onwards than on the symptoms of depression (16% and 35%).

The second study, conducted by American researchers led by Dr Holly Wilcox of Johns Hopkins University School of Medicine, looked at the risk of suicide among 1,433 people with recurrent major depression (DMR). 

The researchers hypothesized that the additional diagnosis of PTSD (“post-traumatic stress disorder,” an anxiety disorder associated with exposure to a traumatic event) offers an increased risk of suicide in these individuals. Indeed, 14.3% of people diagnosed with DMR and PTSD had an increased incidence of suicide attempts, and statistical analyzes confirmed that PTSD is an independent risk factor for suicide.

The study, published by Dr Zimri Yaseen and other U.S. researchers, looked at the risk of suicide among 2,864 people with depression, looking specifically at the role of panic symptoms, that is, recurrent panic attacks, and the persistent fear that these attacks will produce death. 

The results show that the panic symptoms assessed three years earlier are associated with the current risk of suicide of these people. In-depth statistical analyzes have shown that fear of dying is the key factor associated with the increased risk of suicidal ideation and suicide attempts.

The fourth study is a meta-analysis conducted by an American research group led by Dr Zhen W. of the Mayo Medical Clinic. The researchers analyzed 42 studies published in the literature, comprising a total of approx. 310,000 participants from several countries. 

The studies were selected for analysis if the research was methodologically correct and if it focused on the relationship between anxiety and suicide risk. Based on this meta-analysis, the authors were able to conclude that anxiety patients have an increased risk of suicide, both in terms of suicidal thoughts (2.89 times higher risk) and in terms of suicide attempts. (2.47 times higher risk) and committing suicide (3.34 times higher risk). 

The risk of suicide has been associated with every type of anxiety disorder, except for obsessive-compulsive disorder. It should be noted that the degree of confidence in these results is moderate, however, given that the 42 studies analyzed are very different methodologically and all have some limitations.

Of course, the general conclusion supported by these studies is not that we should give less importance to depression than anxiety when we talk about the risk of suicide. 

Combating depression is a well-established method in the scientific community as being effective in reducing this risk. Studies point to the priority need for suicide prevention programs to seriously consider evaluating and treating symptoms of anxiety, not just depression.

It is also an alarm signal for professionals: assessing the risk of suicide among people with anxiety problems (not just depression) is particularly important.

FAQ on Can anxiety kill you?

References

Batterham, P.J., Christensen, H. and Calear, A.L. (2013), ANXIETY SYMPTOMS AS PRECURSORS OF MAJOR DEPRESSION AND SUICIDAL IDEATION. Depress Anxiety, 30: 908-916.

Kanwar, A., Malik, S., Prokop, L.J., Sim, L.A., Feldstein, D., W. Z. and Murad, M.H. (2013), THE ASSOCIATION BETWEEN ANXIETY DISORDERS AND SUICIDAL BEHAVIORS: A SYSTEMATIC REVIEW AND META‐ANALYSIS. Depress Anxiety, 30: 917-929

Stevens, D., Wilcox, H.C., MacKinnon, D.F., Mondimore, F.M., Schweizer, B., Jancic, D., Coryell, W.H., Weissman, M.M., Levinson, D.F. and Potash, J.B. (2013), POSTTRAUMATIC STRESS DISORDER INCREASES RISK FOR SUICIDE ATTEMPT IN ADULTS WITH RECURRENT MAJOR DEPRESSION. Depress Anxiety, 30: 940-946. 

Yaseen, Z.S., Chartrand, H., Mojtabai, R., Bolton, J. and Galynker, I.I. (2013), FEAR OF DYING IN PANIC ATTACKS PREDICTS SUICIDE ATTEMPT IN COMORBID DEPRESSIVE ILLNESS: PROSPECTIVE EVIDENCE FROM THE NATIONAL EPIDEMIOLOGICAL SURVEY ON ALCOHOL AND RELATED CONDITIONS. Depress Anxiety, 30: 930-939.

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