Psychological correlates of patients with postural orthostatic tachycardia syndrome (POTS)
Abstract
Psychological symptoms are frequently reported in patients with Postural Orthostatic Tachycardia Syndrome (POTS); however, the nature of these symptoms is not well understood. The current study described baseline psychological symptoms in patients with POTS, and examined associations between psychological and self-report autonomic symptoms. Participants reported mild anxiety symptoms, moderate depressive symptoms, severe somatization, and elevated anxiety sensitivity. Depressive symptoms and pain catastrophizing were significantly associated with autonomic symptoms. The current study adds to the literature by documenting elevated levels of anxiety sensitivity, and relationships between psychological and autonomic symptoms.
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The correlation between higher anxiety and greater symptom burden was reported significant in one larger study (n = 94) but not the smaller one (n = 58).
“The correlation was reported significant in one larger study (n = 94) (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Two studies found medium correlations between higher symptom burden scores and higher depression scores, and one large study also found this association.
“Two found medium correlations (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Anxiety sensitivity was not significantly correlated with autonomic symptoms in two studies, despite elevated levels of anxiety sensitivity in POTS patients in one study.
“was not significantly correlated with autonomic symptoms in two studies (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
A small association was found in two studies between higher anxiety and greater autonomic/orthostatic symptom burden.
“A small association was found in two studies between higher anxiety and greater autonomic/orthostatic symptom burden (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Severe somatization was reported in POTS participants in one study compared to the general population.
“Severe somatization was reported in POTS participants in one study (Fisher et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
No significant relationship between somatization and symptom burden was observed.
“but no significant relationship with symptom burden was observed.”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Mental functioning components had small to medium correlations with symptom burden.
“Mental functioning components (PROMIS mental health T-score and SF-36 mental component) had small”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Two studies found small-medium correlations between higher catastrophizing scores and higher symptom burden.
“Two medium-high quality studies explored catastrophizing (viewing or presenting a situation or future situation as considerably worse than it is) in relation to symptom burden and found small-medium correlations (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
The pain catastrophizing scale had a medium significant association with greater autonomic symptoms.
“One medium quality study reported that the pain catastrophizing scale (helplessness, active rumination and excessive magnification of the experience of pain) had a medium significant association with greater autonomic symptoms (Fisher et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Functioning and health-related quality of life demonstrated significant medium-large correlations with self-reported symptom burden in four medium-high quality studies, with more severe symptoms associated with increased impairment.
“All of these demonstrated significant medium-large correlations with self-reported symptom burden, where more severe symptoms were associated with increased impairment”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
Catastrophizing had a small but significant relationship with symptom burden in POTS.
“Catastrophizing was shown to have a small but significant relationship with symptom burden in POTS”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Fisher et al., 2020
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BackgroundInfluentialPostural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review
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“Physiological symptoms, particularly anxiety and depression, are frequently reported in patients with POTS, though the mechanisms linking autonomic dysfunction and these mental health conditions remain the subject of ongoing research [12].”
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“Recent publications from our institution have reported an average age of 27-36 years, with 81.25-92% female and 87.9-93.75% White individuals [8,12,19,34].”
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“Beyond these physical manifestations, patients with POTS frequently experience significant mental health challenges, including anxiety, depression, and reduced quality of life [4].”
Self-citationA Survey-Based Study Examining Exercise in Postural Orthostatic Tachycardia Syndrome (POTS) Patients
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“Given that people with POTS have been found to have a higher rate of somatic focus and fear of symptoms [11], they may be more likely to interpret increased symptoms during exercise (e.g., palpitations and shortness of breath) as harmful, which could lead to avoidance behaviors.”
Self-citationSaunders, N. R., Kawamura, A., Macleod, O., Nieuwesteeg, A., & Souza, C. D. (2025) · Paediatrics & child health · doi:10.1093/pch/pxae114
Shevets, V., Sherstiuk, L., Bumeister, V., Lychko, V., Korenkov, O., Ivakhnyuk, T., Sotnikov, D., & Brizhata, I. A. (2023) · Acta Balneologica · doi:10.36740/abal202301107
- Authors
- Fisher, C. J., Katzan, I., Heinberg, L. J., Schuster, A. T., Thompson, N. R., & Wilson, R.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Fisher, Carolyn J.
- ORCID
- Venue
- Autonomic Neuroscience
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 227
- Pages
- 102690
- ISSN
- 1566-0702 (ISSN-L)
- OpenAlex
- W3033154269
- Cited by
- 22
- References
- 0
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 2 · 2023: 3 · 2022: 5
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autonomic Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic Foundation
- 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
- postural orthostatic tachycardia syndrome, psychological symptoms, anxiety symptoms, depressive symptoms, somatization, anxiety sensitivity, pain catastrophizing, autonomic symptoms, autonomic dysfunction
- MeSH terms
- Adult, Anxiety, Depression, Female, Humans, Male, Middle Aged, Quality of Life, Stress, Psychological, Postural Orthostatic Tachycardia Syndrome, Catastrophization
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