One of the most frightening anxiety disorders is panic disorder. Susan is a case in point. When she first came to see me she was afraid of walking along the sidewalks in New York. She was afraid that she would get dizzy and fall to the ground, so she stayed close to the buildings along the sidewalk, occasionally touching the building for "safety". She was also afraid of walking through a mall. Susan had a sense that she would be trapped in a crowd and wouldn't be able to find her way out in case she had a panic attack. So she always had to be accompanied by someone-to help her find her way out.
My new book on anxiety is out this week and I go through each of the anxiety disorders to help you understand what they are, why we have them, how evolutionary theory fits in, how you think and behave when you are anxious-and how you can change. One frequent and often debilitating problem is panic disorder with agoraphobia. (Some people have panic disorder without agoraphobia.) But it's important to know that we can now treat this problem-often without resorting to medication.
Let's take a closer look at how we diagnose this problem.
What are Panic Attacks?
Panic attacks and panic disorder are common problems for millions of people. A panic attack consists of the following symptoms:
- palpitations, pounding heart, or accelerated heart rate
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- derealization (feelings of unreality) or depersonalization (being detached from oneself)
- fear of losing control or going crazy
- fear of dying
- paresthesias (numbness or tingling sensations)
- chills or hot flushes
Panic disorder includes the following:
- recurrent unexpected Panic Attacks
- at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
- persistent concern about having additional attacks
- worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
- a significant change in behavior related to the attacks
For example, Susan's panic attacks were marked by her heart pounding, sweating, feeling dizzy, weakness in her legs, and her fear that she would lose control and feint. Although it had been months since her last panic attack, she anticipated having other panic attacks and worried that she would fall down or look foolish. She was especially worried because she was going to get married in a few months and she was concerned that she would have a panic attack at her wedding. Another man had a fear of taking the train because he felt trapped and worried that he would get nauseated and vomit. He also feared eating before going to work because he thought this made him more prone to nausea. (Ironically, his food deprivation may him more prone to feeling dizzy which he misinterpreted as a sign that he was "really sick".)
Many people who have panic disorder also have agoraphobia--- they avoid situations that are (in their mind) associated with panic. For example, typical "triggers" (and situations to avoid) include closed spaces, open spaces, exercise, bridges, tunnels---not because they believe that the bridge or tunnel will collapse, but because they fear they will have a panic attack. Many panic patients describe a sense of shortness of breath as they hyperventilate and try to catch their breath. One man feared flying -not because he feared the plane would crash-but because he feared he would have a panic attack and there would be no exit. "No way out" is a common fear.
We use a schematic with our patients to describe the process of panic and agoraphobia. Take a look at the schematic below and see if you see yourself here. If you do, follow this blog.
Please Click Here to See a Bigger Image of The How You Develop Panic and Agoraphobia Chart
I will be discussing panic disorder-and how you can help yourself- in future blogs. The great news is that this is a highly treatable problem. Summertime is coming-and many panickers fear sweating, hyperventilation and being out in the open. So now is a good time to start getting help.