Q: How can you distinguish between a neurological symptom of SB and anxiety? I am trying to sort out my distinct conditions, but sometimes it is hard for me to separate what is coming from my brain and what is coming from my body.

A:

This is a great and complex question. Anxiety can come from internal and external sources. External causes include stressful situations like public speaking, job interviews, meeting new people, school tests, etc. Internal causes of anxiety include medical conditions such as excessive thyroid hormone (hyperthyroidism), shortness of breath from asthma or smoker’s lung (COPD), or chronic pain conditions. There are many other medical conditions that cause anxiety symptoms.

There are several internal psychiatric conditions of anxiety, including generalized anxiety disorder, adjustment disorders with anxiety, and panic attacks. Obsessive-compulsive disorder is also a type of anxiety condition. These technical classifications are ways to describe anxiety conditions which cause difficulties for people during everyday life. These conditions are neurologically-based, likely involving problems with communication between the nerves in the brain. Situations which promote these conditions include emotional trauma such as after an accident, following abuse, or during family strife like divorce or unexpected death.

It is very possible for someone living with Spina Bifida to experience anxiety for many of the reasons mentioned above. The structural changes in the brain associated with Spina Bifida could result in the nerve communication difficulties and brain chemistry problems leading to anxiety. Dealing with the multiple medical issues of Spina Bifida such as mobility challenges, bowel and bladder difficulties, chronic pain, and seizures can cause anxiety.

Another neurologically-based problem in Spina Bifida (usually when there is also Chiari malformation and hydrocephalus) is the social challenges that occur from non-verbal learning problems and visual-motor challenges. These brain-based impairments, which hinder social interactions with others, can lead to anxiety.

Finally, one must always consider the ventricular shunt in any neurologic symptom. While isolated feelings of anxiety without other symptoms is not a usual presentation of a shunt malfunction, if you are suddenly having anxiety symptoms without an identifiable trigger, the shunt should be evaluated. Anxiety-like symptoms including racing heart, sweating/flushing, nausea/vomiting, and dizziness are shunt symptoms that need attention.

So the bottom line is your anxiety is likely coming from many different causes both internally and externally. There isn’t a good way to separate SB symptoms from primary anxiety symptoms. Your neurology team should first make sure the shunt is functioning properly. Afterwards, a mental health specialist can help you identify the sources of your anxiety and what you can do to reduce your discomfort from it. Both counseling and medication can be beneficial. There is more information on anxiety in the “Living With Spina Bifida” section of our Web site.

* This information does not constitute medical advice for any individual.As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.