By: Shanda Curiel, PsyD
OCD & Anxiety Psychologist / Primary Therapist
Resilience Treatment Center
“I first knew my anxiety had become a problem when I was standing in line to pay for baby food at a local store. I had been perfectly fine getting into line for the cashier. After a few minutes of waiting for my turn, I suddenly felt the overwhelming urge to leave the store. I had no justification as to why I needed to leave, but my panic attack was taking over so I excused myself out of the crowded line. I sat my basket down in the closest spot I could find and walked out of the store, hurrying to my car. Once I was in my car alone I felt normal again. Safe.” According to Kessler, Chiu, Demler, and Walters, in 2005 the lifetime prevalence of adults with anxiety disorders was approximately 28.8% of the U.S. population (as cited in National Institute of Mental Health, n.d.). One such condition is Panic Disorder, in which individuals often have repeated panic attacks that lead to a strong, pervasive fear of having another panic attack and/or a modification in behavior to avoid having symptoms of panic (American Psychiatric Association, 2013). Panic Disorder is less common in childhood, but likelihood of onset increases into adolescence and adulthood, with females being more likely to develop this condition (2013).
The general public sometimes references the phrase “panic attack” loosely after a prolonged or strong bout of anxiety; however, panic attacks are bursts of multiple, extremely intense, involuntary, physiological symptoms that occur at suddenly such as, trembling, light-headedness, nausea, chest pains, heart palpitations, perspiration, etc. (2013). During a panic attack episode, individuals can also experience the cognitive and emotive effects of fearing they may lose control or die from a heart attack, for example (2013). “My very first panic attack, I truly felt as if I were dying. My chest hurt, my heartbeat was racing rapidly, and my breathing was shallow, almost feeling nonexistent. Not being able to catch my breath then led to me hyperventilating, trying to compensate. I was sweating as if I had just run a marathon. My hearing became amplified just as my wooden deck and plants began spinning around me. My mouth lacked any saliva; I could barely swallow until I began feeling as if I needed to vomit. My younger brother had been with me that August night. I became so frightened at what was happening to me, he chose to call for an ambulance. I can remember being adamant about not wanting to wake my toddler son, whom was sleeping just inside the living room, so I refused treatment inside my home. After the embarrassing, public administration of oxygen and a vitals check from paramedics, the realization that I was not dying left me more confused than ever. During a panic attack, I feared people around me would notice and/or I would vomit in front of everyone around. Some of my attacks were out of the blue and some were triggered from an abusive relationship I was in at that current time. The personality traits of my abuser would later continue to be a trigger for me as years went on, whether the individual was male or female.”
Some individuals modify their lives to such a degree that another psychiatric condition can arise, Agoraphobia. This condition entails persistent fear and/or avoidance of situations such as, transportation, crowds, open spaces, enclosed spaces, and/or being outside of the home independently (American Psychiatric Association, 2013). The avoidance is in response to disproportionate anxiety, fearing no way to flee the situation or seek help if desired (2013). “My ultimate fear then became having another panic attack. If I stayed home, I ‘knew’ I was safe. At first I began avoiding large crowds of people, which now evoked the feeling of being smothered or unable to breathe, compounding the unpredictability of a large amount of people. By beginning to avoid crowds, I began to feel as if I had control of the situation, which led to me avoiding any place where I had previously had a panic attack or any place similar. My agoraphobia avoidance included restaurants, family functions, sporting events, grocery stores, friend’s houses, and riding in cars with other people. Due to my fear of riding in cars with others, I even refused to allow my family member to drive me to the ER when I sprained my ankle. Thinking I was controlling my panic attacks was completely backwards; I ended up isolating myself from everything I once enjoyed.”
Coping with Panic Disorder without treatment often leads to individuals doing what feels best in the moment, avoiding anxiety-provoking situations. “When I first started experiencing panic attacks and the constant edginess from anxiety, I gave into the flight or fight feeling each time, choosing to leave the situation in order to make myself feel better.” Sometimes individuals repeatedly seek emergency medical care, either believing they are experiencing a medical emergency and/or to immediately obtain medications to ease some of the symptoms.
Medications prescribed by an outpatient psychiatrist can be helpful to ease the intensity of anxiety and panic attacks symptoms, but it is also beneficial to learn other ways of managing. According to Barlow, Gorman, Shear, & Woods (2000), evidence-based psychotherapy treatment for Panic Disorder involves Cognitive-Behavioral Therapy, often paired with Interoceptive Exposure (as cited in Barlow, 2008), where uncomfortable physiological sensations are evoked repeatedly until habituation occurs and misappraisals can be disproven. Individuals learn that the anxiety will reduce if given the chance by remaining in the frightening situation. “Initially, I made the decision to seek treatment through medication. Finding the right medication took many months and numerous different brands of medication before my doctor found what works best for me. I tried sessions with several psychologists. As time passed I began to understand the process better and how to recognize the symptoms sooner. I would silently talk myself out of leaving the situation. I would focus on my breathing and reassure myself this will pass. Although these do not always help as fast as I would wish, I received a sense of comfort by doing these. I started researching ways to cope, looking for answers to questions I had, diets that might help, anything that would help me make sense as to, why me? Knowledge became my power. Walking the neighborhood high school track became my escape to clear my head or prioritize my thoughts. I began distancing myself from people I felt were toxic to my recovery, eventually gaining the personal confidence in myself that I had once lost. I started taking back my life, not fighting the attacks. Instead, allowing myself to go with the flow of the attack knowing that I will be ok, knowing each attack does not last as long as I mentally picture, and knowing that I have been through the motions before and that I can do this.”
When anxiety symptoms are left untreated, they can develop into debilitating conditions that impact family, school/work, and social functioning. Families often try to accommodate the loved one’s requests in an effort to soothe them, but this helps reinforce that the avoidance behaviors should be repeated each time anxiety is experienced in order to prevent or neutralize it. “I sacrificed so much because of having Panic Disorder. I missed many years’ worth of my son participating in school functions, as well as sports. I sacrificed time with my family, their joys and accomplishments, that I cannot get back to witness. I allowed friendships to slip away because I constantly made excuses as to why I could not join their outings. I robbed myself of fulfilling my goals or dreams because I did not have the confidence within myself to feel as if I could. Until now.”
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed..). Arlington, VA.: American Psychiatric Association.
Barlow, D. H. (2008). Panic Disorder and Agoraphobia. In M. G. Craske Editor & D. H. Barlow Editor (Eds.), The Clinical Handbook of Psychological Disorders (pp. 1-64). Retrieved
from https://www.researchgate.net/profile/William_Trost/publication/6124095_Dialectical_Behavior_Therapy_for_Borderline_Personality_Disorder/links/00b4951adec520a7fb000000/Dialectical-Behavior- Therapy-for-Borderline-Personality-Disorder.pdf
National Institute Mental Health. (n.d.) Any Anxiety Disorder Among Adults. Retrieved May 2, 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml
National Institute Mental Health. (n.d.) Panic Disorder Among Adults. Retrieved May 2, 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/panic-disorder-among-adults.shtml
*Some information based on clinical experience and knowledge of patient symptomatology.
**Quotations from an anonymous individual with Panic Disorder and Agoraphobia.