Hyperhidrosis is a complex yet widespread condition, characterized by excessive sweating regardless of body temperature. Although it’s actually more common than peanut allergies or psoriasis, myths and misconceptions about excessive sweating are everywhere.
One contested issue is the connection between anxiety and hyperhidrosis — and this is a subject that demands nuance and the ability to accept a bit of a grey area.
To learn more about the connection between anxiety and hyperhidrosis, we spoke to Lisa Pieretti, the Executive Director and Co-founder of the global non-profit International Hyperhidrosis Society (IHhS).
As a passionate advocate for hyperhidrosis sufferers and patients, Lisa has been fighting to increase awareness, bust myths, and educate healthcare and industry since 2003.
In this article, we speak to Lisa about topics such as:
- What is the link between hyperhidrosis and anxiety?
- What role does stigma play in hyperhidrosis anxiety?
- What can patients do about hyperhidrosis anxiety?
What is the Connection Between Hyperhidrosis and Anxiety?
First, it’s important to lay out the two “types” of hyperhidrosis. Understanding the differences between them encourages better medical advice, more effective treatment, and stronger grasp on the psychological causes and consequences.
- Primary Focal Hyperhidrosis: As the IHhS site says, primary hyperhidrosis is when excessive sweating isn’t caused by another health condition (physical or psychological) — it is the condition. It’s characterized by sweating in specific areas (e.g. hands, feet, underarms, forehead, and back). It usually starts in childhood or teenage years. Typically, sufferers do not experience excessive sweating during the night while they sleep.
- Secondary Generalized Hyperhidrosis: Secondary hyperhidrosis is caused by a separate medical condition or by medication side effects. This usually occurs more broadly on the body, rather than in specific areas. Most notably, sufferers often do experience heavy sweating while sleeping (night sweats). This is a key differentiator between the two.
According to Lisa, the lack of widespread knowledge about hyperhidrosis within the medical community can sometimes lead to a vicious cycle between these two types of hyperhidrosis, and can also confuse sufferers about what the underlying cause of their condition is.
“If you go to the doctor and say that you’re sweating profusely on the palms of your hands, they may automatically attribute this experience to anxiety,” she says. “And unfortunately, one of the most common causes of secondary generalized hyperhidrosis is anxiety medication. So while the medication may help with anxiety, and perhaps somewhat with palm sweating (reducing the number of sweating episodes for example), it may cause profuse sweating at night and/or on large areas of the body.”
So, rather than offering the patient a range of potential hyperhidrosis treatments, the healthcare professional inadvertently gives them something that will make the problem worse, or create an additional issue.
“It’s entirely possible that primary focal hyperhidrosis will coexist with other conditions, both physical and psychological,” Lisa says. “But the inexorable link between sweating and subjective anxiousness or nervousness has caused many patients to be given treatment that doesn’t actually help them with their focal, primary excessive sweating.”
What Does the Data Say About Hyperhidrosis and Anxiety?
One 2002 study researched the prevalence of hyperhidrosis among people with social anxiety disorder (SAD), and found that more than a quarter of them experienced hyperhidrosis. And as Lisa cites in her research into patient experience, one key 2016 report compares the prevalence of anxiety and depression in patients with hyperhidrosis versus patients without hyperhidrosis:
“This study found that anxiety was present in 21.3% of patients with the condition, and depression was present in 27.2%,” Lisa explains. “And for patients without hyperhidrosis, anxiety and depression fell to just 7.5% and 9.7% respectively.”
Other research, published in 2014, found that in patients with severe cases of hyperhidrosis, the rate of social anxiety disorder was 47.1% — compared to just 13.8% in patients without hyperhidrosis.
To summarize, researchers agree that there is a clear correlation between anxiety and hyperhidrosis. One study concludes, “research shows that social anxiety does not explain hyperhidrosis, but that excessive sweating reduces the threshold for social anxiety.” And another report shows “a significant association between hyperhidrosis and the prevalence of anxiety, depression and ADD regardless of gender or age.”
This means both conditions can be treated as part of what Lisa calls “combination therapy” — to look at different treatment types that can be used together to improve quality of life for sufferers.
Note: Duradry is an FDA-approved treatment that can reduce excessive sweating, using a simple 3-step process to eliminate sweat in the underarms. You can try Duradry as part of your treatment , and we’ll commit to giving you a full refund if you’re not satisfied with the results.
Patient Experience: Hyperhidrosis Anxiety & Psychological Impacts
As any hyperhidrosis sufferer will know (and I’m one of them), extreme uncontrollable sweating can have a massive effect on your confidence and sense of self-worth.
According to Lisa, “one of the biggest myths is that hyperhidrosis is no big deal.” And even though hyperhidrosis isn’t all-or-nothing in terms of its severity — i.e. there’s a spectrum of varying sweating levels — “the impact is often dismissed and not fully understood.”
“A few years ago,” Lisa says, “we did a survey and found that the experience of sweating excessively is felt to be worse than many other conditions, for example halitosis (bad breath).” Despite this, many sufferers feel their condition is trivialized, or there’s a social stigma around excessive sweating that makes it difficult for non-sufferers to understand and empathize with.
Lisa thinks we still have a long way to go to overcome this stigma.
“Sweating is associated with all kinds of negative connotations,” she says. “For example, that a person can’t be trusted, or they’re overweight, smelly, or unclean. And if someone sweats a lot, they’re seen as too nervous to handle pressure, or somehow unhinged.” And according to Lisa, this confuses people about the reality that hyperhidrosis is uncontrollable.
All this contributes to sufferers feeling misunderstood and unsupported, especially when their healthcare professional doesn’t offer effective solutions. “This can cause people to turn inwards, thereby increasing the chances of social anxiety and depression — because they feel ashamed of themselves and their body, judged, and they don’t know where to turn,” Lisa says.
How to Reduce Hyperhidrosis Stigma
As a hyperhidrosis sufferer who first started experiencing excessive sweating during my teenage years, I remember a huge sense of relief when I realized I wasn’t alone with the condition.
In fact, hyperhidrosis is relatively common — more than 15 million Americans suffer from it, which is 4.8% of the population. And this is widely considered to be a conservative estimate, because many cases go unreported. Already, this makes hyperhidrosis more common than psoriasis, peanut allergies, and many other widely-understood conditions.
According to Lisa, “we have so many subtle and profound ways to reduce stigma.” And she says shouting from the rooftops about the millions of people suffering from hyperhidrosis is one way to minimize shame. So too is committing to educating and informing more family doctors.
“At IHhS, we send out physician kits containing information, including first-hand accounts of what it was like to suffer from excessive sweating while growing up.” These accounts are written by “admirable people from all kinds of backgrounds — for example, professors and athletes.”
And Lisa wants to drive the point home to everyone she encounters that excessive sweating caused by hyperhidrosis is truly uncontrollable without the support of treatment.
“Every word matters,” she says. “So we need to educate the wider world that sufferers don’t have control over their sweating. It’s not their fault.” According to Lisa, this is one critical step towards building better global understanding and empathy, thereby contributing to a greater sense of wellbeing and improving the patient’s experience.
What Can Patients Do About Hyperhidrosis Anxiety?
Lisa advises sufferers she meets to figure out the combination of treatments that work for them. “For some, this is prescription topical wipes like Qbrexza® or over-the-counter antiperspirants, and for others it might be Botox® or miraDry®. Combining therapies to fit your individual needs and sweating experience is key,” she says. “In any case, managing the sweat is one battle, and this can be combined with psychological assistance to help you deal with the anxiety.”
And knowing you’re not alone can also be game-changing. “Go to the IHhS website (SweatHelp.org) and you’ll find a gazillion people who are experiencing similar struggles,” she says. “And if you sign up to our newsletter, you’ll get a monthly dose of intelligent info — as well as invitations to clinical trials, advice on choosing a healthcare provider, and more.”
A huge thank you to Lisa Pieretti and her incredible team at the International Hyperhidrosis Society. Duradry is proud to be sponsoring 2020 Hyperhidrosis Awareness Month.
If you want to ease the symptoms of hyperhidrosis, Duradry’s 3-step system can be your ally.