Evidence of overlapping genetic diathesis of panic attacks and gastrointestinal disorders in a sample of male twin pairs

Preliminary Evidence That Shared Genetic Influences Underlie Comorbidity Between Self-Reported Eating and Internalizing Disorders and Gastrointestinal Disease in Adult Women and Men

INTRODUCTION

Accumulating research suggests both eating disorders (EDs) and internalizing disorders (e.g., anxiety, depression) are associated with gastrointestinal disease (e.g., irritable bowel syndrome, inflammatory bowel disease). However, the mechanisms underlying comorbidity with gastrointestinal disease-and whether they may differ for eating and internalizing disorders-remain poorly understood. Addressing these gaps is a critical first step to refining etiologic models of comorbidity and identifying potential targets for intervention.

METHOD

Participants included female and male twins ages 18-65 from the population-based MSU Twin Registry (N = 5883). Lifetime history of EDs, internalizing disorders, and gastrointestinal disease was assessed via questionnaire. We first examined whether EDs and internalizing disorders were independently associated with gastrointestinal disease phenotypically. We then used trivariate Cholesky decomposition twin models to investigate whether EDs and internalizing disorders were related to gastrointestinal disease through overlapping or distinct genetic/environmental pathways.

RESULTS

Eating (OR = 2.54, p = 0.009) and internalizing (OR = 2.14, p < 0.001) disorders were independently associated with gastrointestinal disease. Conclusions were unchanged after adjusting for important covariates (e.g., body mass index, age) and did not significantly differ across sex. Twin models suggested genetic influences shared by all three conditions explained their co-occurrence, with 31% of the variance in EDs and 12% of the variance in gastrointestinal disease attributable to genetic influences shared with internalizing disorders.

CONCLUSION

Shared genetic mechanisms may contribute to comorbidity between EDs, internalizing disorders, and gastrointestinal disease. Identifying overlapping molecular pathways could potentially lead to novel interventions that simultaneously address all three conditions.

Biobehavioral approach to distinguishing panic symptoms from medical illness

Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.