Unpacking Anguish in Psychiatric Populations: Symptom Dimensions, Affective Correlates, and Evidence for Stronger Alignment with Depression

Abstract Background Anguish is a subjectively intense affective state frequently observed in psychiatric practice, yet its diagnostic status remains uncertain. Objective This study investigated whether anguish is more closely associated with depressive or anxiety pathology by examining symptom patterns and psychiatric comorbidities in a clinical cohort. Methods One hundred outpatients (aged 17–77 years; M = 44.5) from general, anxiety, and affective disorder clinics at the University of São Paulo were classified into three groups: no anguish (n = 50), reported anguish (n = 35), and reported anguish with limited articulation (n = 15). Standardized instruments included the Brief Symptom Inventory, Defensive Style Questionnaire, Hospital Anxiety and Depression Scale, Hamilton Anxiety Rating Scale, State–Trait Anxiety Inventory, and the MINI International Neuropsychiatric Interview. Results Patients reporting anguish showed significantly higher somatisation, fears, depressed mood, gastrointestinal complaints, and neurovegetative symptoms. Anguish was markedly associated with depressive disorders, which were 3.6 times more likely to co-occur with anguish than anxiety disorders. Conclusions Anguish emerges as a distinct affective phenomenon more strongly aligned with depression than with anxiety. Its systematic assessment may improve diagnostic precision and inform more tailored interventions in psychiatric care.