A Word about Panic Attacks and Anxiety Disorders

A subject that I have not yet (to my very own surprise) discussed in this blog: anxiety disorders. Something that frequently surprises me personally is the fact that this psychological disorder is during a patient’s first visit to his/her physician frequently not at all or incorrectly diagnosed. Instead, patients are very often handed antidepressants – or if it happens to be a homeopathically inclined physician – treatment with St. Johns Wort or something similar is then recommended. At first I thought this was a random phenomena in my practice but according to what I have been reading that is apparently not the case. In the course of a study a professor for psychosomatics at Witten University determined that it usually takes seven (!!) years for this disorder to be properly treated – and – even more bewildering to me – that “even psychiatrists prefer diagnosing a depression as anxiety disorder.” It is a fact that anxiety disorders are the most prevalent psychological disorders of women and that at one point or the other in their lives 15% of all Germans are diagnosed with an anxiety disorder and I have decided that it is high time for me to post a few blog contributions on the subject!
Today I would like to begin with something that I have always found to be very helpful during therapy, namely a few simple explanations dealing with the subject of anxiety, anxiety reactions and –symptoms. Very often it becomes clear to me that the afflicted immediately appear to be relieved when the reasons for their physical symptoms are explained to them. That is because I myself have lived through a panic attack and am intimately familiar with “the feeling inside” – as if death or at least a fainting spell is imminent! After experiencing something awful like that it is easy to understand why most of those who have gone through this will make every effort to never, never suffer a repetition. Although the symptoms can vary, some of the following are generally a part of it:

  • Vertigo
  • Intense sweating
  • Nausea, sometimes also diarrhea
  • Numbness or tingling in the extremities
  • Dry mouth
  • Rapid heartbeat
  • Trembling
  • Rapid breathing
At its climax a fully-fledged panic attack feels like an impending heart attack, as if one is about to lose control of all voluntary and involuntary bodily functions and is already standing with one foot in hereafter. No wonder that those affected immediately rush to see their doctor because they are convinced that the end is near! By the way, I don’t have the slightest problem with that: First of all it is a good idea to exclude all physical causes for the symptoms (a thyroid dysfunction e. g. can potentially cause very similar symptoms), secondly they need the reassurance of a medical authority that physically everything is just fine before they can even begin accepting psychological causes as the source for this experience – and even then it is very difficult for many! To begin with, here in Germany it is still somehow disreputable to have a psychological disorder and secondly there is probably no other psychological disturbance that is experienced that massively and threatening on a physical level. After all the physical symptoms are very real, they are not just imagined. It will take a lot to convince the patient that something so clearly physical can be triggered by the psyche!

And that is exactly my mission of the day: I would like to present a brief explanation of the physical mechanisms forming the basis of a panic attack. I always see it with my clients that the entire experience immediately loses some of its threat once one understands how the system ticks.

If you are one of those affected you must first and foremost consider this: Over thousands of years of evolution your body has developed and has been designed for a very specific purpose namely that of keeping it safe and therefore your very survival! Therefore, nothing happening in your body is directed against you. All symptoms (however unpleasant) are actually designed to protect you and in dangerous situations get you out of harm’s way. Anxiety reactions are triggered automatically; they are an emergency program of the vegetative (therefore instinctive) nervous system. That also makes lots of sense because the vegetative nervous system does not rely on the (comparatively slow) deliberations of your more recently evolved brain areas. It is controlled by ancient brain structures and triggered with lightening speed. When your ancestors in prehistoric times ran afoul of my favorite intern, the saber tooth tiger, split seconds counted. Longwinded ventilations such as: “ In which direction should I run?” would have been the end of your ancestor. Instead the danger stimulus was transmitted with lightening speed in an abbreviated format kicking in the entire “Fight-Flight-Program” at once.

The accelerating heartbeat: Perfect because that immediately pumps as much oxygen rich blood as possible into all parts of your body! All those body parts necessary for fighting and fleeing are now optimally provided with it – now you turn into a world-class sprinter!

Breathing grows deeper and faster: This serves to supply the body with a maximum amount of oxygen. Frequent side effects are often the feeling of suffocating (because the respiratory rate is extreme high) or dizziness (as a side effect of too much oxygen in the brain – the reason why hyperventilating people are often made to breath into a paper bag in order to inhale more carbon dioxide than oxygen and thus neutralize its effect).

Blood is diverted from where it is not used in order to supply the limbs and muscles with an extra portion enabling them to generate a maximum performance. The perceived side effects of a panic attack is that one pales or that several body- or skin areas feel numb; it includes the frequently described symptoms in the stomach-intestinal area that also immediately and logically switches to minimum sustenance: In the presence of our tiger it is really more important to keep from being digested by sprinting than to do the digesting ... and that triggers the urgent need to visit the toilet because intestines and bladder get ready to evacuate (by the way, although not necessarily socially acceptable that also makes lots of sense: the less ballast when running, the better!).

The release of the activating hormone Adrenalin is another important element of the Fight-and-Flight reaction: Now you are loaded with maximal energy, your body is keyed-up and thus in the prime condition for survival. If you were to start running like lightening, your energy would naturally dissipate, would simple be used up. However if the fight- or flight reaction fails to materialize (because there is nothing to battle or evade), the pent-up tension in your muscles causes them to tremble. All that absorbed oxygen may also cause them to feel like rubber – culminating in the famous “weak knees” that so often go along with a panic reaction. To keep your body from overheating, your glands increasingly begin excreting sweat, as they would if you were to jog in the park just for fun. You break out in a sweat ... by the way also very effective when fighting: a slippery enemy is difficult to grab! The adrenalin also causes your pupils to open wide to increase your peripheral vision enabling you to notice and register any threats in your vicinity – especially from as far as between nine and thirty feet away, probably exactly from where the tiger is trying to sneak up on you. This tends to cause the image exactly in front of you to appear blurry, a fact that frequently causes the sense of vision disorders and/or vertigo.

There are a few other panic symptoms but all of them can be diagnosed based on the previously described rationale: everything happening in your body is intended to be for your own good! You should always try and remember that when you believe that these symptoms are bound to kill you! That simply won’t happen even if it sometimes feels that way during the culmination of the panic. After all, Mother Nature isn’t that feeble-minded, she would never arm us with a survival mechanism that kills us with its very own diligence in the hour of need! The symptoms are frightening, unpleasant, disturbing, stressful ... call it what you want. The next blogs are naturally going to deal with the important question how to handle the panic attacks. One thing is for sure, the symptoms are never life threatening or even deadly.
I also want to address a second concern frequently troubling panic patients: It doesn’t last forever! Most of the people suffering from panic attacks believe that the unpleasant symptoms - if they don’t do something about it like for instance taking a sedative or immediately exiting that horrible elevator – would continue increasing until something terrible happens (the feared heart attack or fainting spell, for instance). Not so! Here Mother Nature has also wisely taken precautions. She has provided us with this vegetative nervous system, a sophisticated, according to the closed loop principle functioning component. The sympathicus activating all your body’s reactions also has an antagonist, the parasympathicus. It represents the brake while the sympathicus can be compared to the gas pedal. The best part of this brake is its propensity to kick in automatically and self-regulate and if you take the time, it returns your body’s function to normal. The symptoms subside on their own anywhere between five and thirty minutes. The precondition is that you simply let the panic attack run its course (without frantically fighting it or escaping from the situation you happen to be in at the time).

Easily said, understood. Convincing a client to expose him/herself for just ten minutes to a situation that will in all probability trigger something as unpleasant and frightening as the physical symptoms of a panic attack in him/her, often means heavy lifting. Today it is not the intention that you turn into a hero and don’t see your panic attacks as something awful. Still, I feel it is very important to make two points abundantly clear:

1. Panic Attacks don’t kill!

The human body can handle even very intense panic attacks over an extended period surprisingly well and suffers absolutely no damage. The only exceptions are those people with serious pre-existing conditions (such as diabetes, valvular heart defects or something like that). For them panic attacks can be just as harmful as any other intense physical activity– like excessive jogging, for instance and in those cases a somewhat more careful therapy is indicated. All others need to be aware that to this day no one has ever died of a panic attack!

2. Panic Attacks are time limited and if permitted, subside on their own.

They don’t last forever and the symptoms don’t ramp up ad infinitum. There is no documented case where somebody actually fainted as a result of a panic attack! Even if it sometimes feels as if – during the attack the body is much too activated and intense for that to happen. (What do you think would have happened to one of your ancestors if he or she had fainted at the appearance of good ol’ sabre tooth tiger? See!)

Well, that is all for today – future installments are obviously going to offer alternatives to better deal with panic attacks. In the meantime I hope that you – in case you are afflicted – while reading this reacted like my clients in response to these explanations: that you hopefully sighed with relief and that all of this doesn’t appear to be so threatening and mysterious, any longer. That would have already accomplished a lot!