Is There a Link between Hyperhidrosis and Anxiety
The majority of diseases and symptoms do not appear by themselves. They have a link with our mental processes and our behaviors, which is true especially for certain conditions, as in rheumatoid arthritis and Crohn’s disease. Even pain is strongly modulated by emotion, and there’s a biopsychosocial model of pain that explains how this symptom, which was thought to be merely biological, has many psychological influences.
If that is true for chronic pain, what can we say about a common physiologic event such as sweating? Moreover, is there a link between hyperhidrosis and anxiety?
Sweating and the sympathetic nervous system
Hyperhidrosis is basically excessive sweating, and sweating is a normal function regulated by the autonomic nervous system. It is therefore not surprising that hyperhidrosis as an excessive function of the sweat glands is associated with imbalances in the nervous system, as in the case of anxiety.
In normal circumstances, anxiety and nervousness trigger sweating through the sympathetic nervous system. This part of the autonomic nervous system prepares the body for emergency situations, and it is triggered by emotional responses such as stress, fear and anxiety. These emotions stimulate the sympathetic branch of the autonomic nervous system through a chemical messenger called acetylcholine, and it ultimately activates our sweat glands.
However, hyperhidrosis is different from the normal process of sweating. Is it only a biological dysfunction? Or does it share the same connection with the sympathetic nervous system and our emotions?
Anxiety is not only in the mind
One of the most common misconceptions about anxiety is how most people believe it is only a psychological symptom. But anxiety is not only in the mind; it widely affects our biology, modulates our immune response, upregulates and downregulates metabolic functions, and may even trigger certain diseases that were initially thought to be caused by a biological component alone.
In many cases, anxiety is a trigger for a cascade of events that initiate and perpetuate chronic disease in an ongoing vicious circle of events. For example, anxiety has been identified as a trigger of asthma attacks, which compromise breathing in these individuals. But then, not being able to breathe properly makes the patient feel even more agitated, and the vicious cycle is maintained until either the symptom is addressed through drug therapy or anxiety is relieved through mindfulness meditation, psychotherapy, and other techniques.
The relationship between anxiety and hyperhidrosis shares a similar association, and there are scientific, psychological, and biological bases we will discuss next.
The biological component of hyperhidrosis
We just covered how sweating is a normal function triggered by the sympathetic nervous system. Consequently, hyperhidrosis has a strong biological component that is based on an excessive reactivity of this part of the autonomic nervous system.
This is why the definite treatment for hyperhidrosis is called sympathectomy, and it is basically taking out ganglia of the sympathetic nervous system that trigger sweating in the problem area.
Anxiety has a physiopathology based on a parasympathetic dysfunction, too. It creates an alteration in the noradrenergic system and imbalances in the brain concentration of serotonin and GABA. This ultimately triggers an exaggerated response in the fight or flight reactions throughout the body, and that includes hyperhidrosis.
Social and psychological alterations in hyperhidrosis
There’s an inextricable link between sweating and both social and mental functions. If we briefly review the anatomy of the brain, we will understand the reason why.
The thermoregulatory centers of the brain, which monitor our body temperature and may trigger sweating as a response, are found in a region called hypothalamus. This structure receives many different connections from the outside world through our senses and is interconnected with other parts of the brain. The hypothalamus is a part of the limbic system and modulates vital functions such as breathing, blood pressure, and the function of the sweat glands in response to emotional triggers.
We shouldn’t forget that the limbic system is also one of the most important regions of the brain that regulates our learning process. Thus, it associates our emotional response with certain behaviors and external stimuli. That is why people with hyperhidrosis who are afraid of rodents would trigger an episode of excessive sweating after seeing a rat passing by.
In a general sense, our central nervous system is an expert in creating connections between internal emotions and the outside world, and sometimes these connections are unhealthy, as in the case of hyperhidrosis. Moreover, it is possible that individual social influences by our family and our immediate environment are the main cause of the alteration and either initiate or prolong our brain program to trigger hyperhidrosis as a reflex to anxiety and various other stimuli.
Hyperhidrosis as a trigger of anxiety
Throughout this article, we have seen how anxiety triggers hyperhidrosis. But is it possible that the reverse is true as well? The answer is yes; hyperhidrosis can be a trigger of anxiety and start a vicious cycle.
Patients with excessive sweating during social occasions may start feeling embarrassed or nervous to think that others will see their underarm region drenched in sweat. This link between anxiety and hyperhidrosis affects our personal, social, and working relationships, and becomes a source of stress. Moreover, it can further trigger other body responses to growing levels of anxiety, such as headaches, gastrointestinal issues, palpitations, and psychosocial problems, such as social withdrawal.
Thus, hyperhidrosis and anxiety share a common link similar to that described for asthma attacks. It is commonly anxiety that triggers hyperhidrosis in the first place, but then excessive sweating perpetuates the problem and adds up to anxious thoughts. This has a profound impact on self-esteem and significantly reduces the quality of life until either of the components are addressed using psychotherapy and relaxing techniques to improve anxiety or a biological solution such as sympathectomy, laser or iontophoresis therapy to improve hyperhidrosis.