The genesis and presentation of anxiety in disorders of autonomic overexcitation
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Introduction We investigated the genesis and presentation of previously-reported anxiety in disorders of autonomic overexcitation in relation to interoception, body vigilance and trauma to test our hypothesis that patients with the postural tachycardia syndrome (PoTS), vasovagal syncope (VVS) and essential hyperhidrosis (EH) represent atypical anxiety phenotypes in whom affective symptoms are more related to apprehension and vigilance of physiological (interoceptive) feedback than neurotic or trauma-related factors. Methods The Anxiety Sensitivity Index, Body Vigilance Scale, Self-consciousness Scale, Childhood Traumatic Events Scale and heartbeat tracking tasks were completed by 23 healthy controls, 21 PoTS, 20 EH and 20 VVS patients. Interoceptive accuracy (IA) was assessed during supine rest (9min), isometric exercise (3min), cold pressor (90s) and head up tilt (HUT) (9min). Results In comparison to controls, PoTS, VVS and EH patients reported increased symptoms of somatic anxiety but not of social anxiety/self-consciousness or trauma. Autonomic patients' IA was diminished and consistently underestimated even during autonomic arousal compared to controls. Controls and EH IA negatively correlated with somatic anxiety/hypervigilance, whereas PoTS and VVS IA and somatic anxiety/vigilance positively correlated. Conclusions Affective symptoms in PoTS, VVS and EH appear to be driven by anxiety and vigilance of physical sensations/symptoms, rather than trauma or neurosis. Increased somatic vigilance/anxiety in PoTS and VVS may be due to interoception being anxiogenic in these cohorts. Diminished interoception may be due to a common central dysregulation, as both sudomotor and cardiovascular forms of autonomic dysfunction had comparable IA deficits. These findings provide a possible therapeutic pathway for psychological symptoms in PoTS, VVS and EH.
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Perceptual amplification and hypervigilance have more recently been expanded to explain some symptoms and comorbid conditions associated with POTS.
“This has more recently been expanded to explain some of the symptoms and comorbid conditions associated with POTS(79).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [79]
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Self-citation
- Authors
- Owens, A. P., Low, D. A., Iodice, V., Critchley, H. D., & Mathias, C. J.
- Affiliations
- National Hospital for Neurology and Neurosurgery (GB)
- Liverpool John Moores University (GB)
- Brighton and Sussex Medical School (GB)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Owens, Andrew P
- Venue
- Autonomic Neuroscience
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 203
- Pages
- 81-87
- ISSN
- 1566-0702 (ISSN-L)
- OpenAlex
- W2555113146
- Cited by
- 41
- References
- 77
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 8 · 2020: 1 · 2019: 3 · 2018: 8 · 2017: 2
- FWCI
- 4.81
- Type
- journal article
- Language
- en
- Open access
- Locations
- Autonomic Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Liverpool John Moores University (submittedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- anxiety, postural orthostatic tachycardia syndrome, vasovagal syncope, essential hyperhidrosis, interoception, interoceptive accuracy, body vigilance, somatic anxiety, hypervigilance, childhood trauma, self-consciousness, sudomotor dysfunction, cardiac autonomic dysfunction, heart rate monitoring
- MeSH terms
- Adult, Affective Symptoms, Anxiety Disorders, Autonomic Nervous System, Female, Humans, Hyperhidrosis, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Syncope, Vasovagal, Postural Orthostatic Tachycardia Syndrome, Self Report
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