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Panic disorder usually
results from a combination of factors. One
thing that everyone with panic disorder has in common is
an initial
panic attack that to occur for no
apparent reason. Take, for
example, Brian, who experienced his first panic attack
while he was One day he was going
through his normal routine when, suddenly,
his heat
started to pound and he found it difficult to breathe.
The sensations lasted only ten minutes but left him
shaky and fright like
most people, Brian attributed the
physical symptoms to some physical illness and left work
to seek a
diagnosis from a physician At the doctor's, Brian
was told that he was
fine and that the symptoms were just "nerves."
Before going on with Brian's story, let's look at five
factors that
can cause this initial panic attack; for any particular
person only one
may be present, or several may combine to produce
the initial panic
attacks
·
Inherited reactive body: People with panic disorder often have
highly reactive bodies that respond more intensely to environ mental stimuli
such as noise, odors, medications, and
temperature variations. This is an
inherited trait like eye or hair color. For
example, if you give people like this a
glass of water with a bitter substance in
it, they would be able to discern its taste
in smaller quantities than the average
person. Like all human traits, this type of
sensitivity has a positive and negative
side. On the positive side, people with this
type of body tend to be more aware of their
surroundings because more information is
coming into the brain. They also are often
more intuitive and sensitive to the
reactions of others. In fact, this trait is
often what others like best about them. It
often helps people with this characteristic
listen and empathize better as well as notice when something is wrong in another person.
People with a less sensitive body often miss the subtle,
nonverbal messages of others. People with reactive bodies are
also often more emotionally reactive in both a positive and negative way. They can be the life of the party as well as more visibly upset than others when something bad happens.
A simple way to understand the negative side of this biological
trait is to imagine a house where the electrical wiring is inadequate.
The electrical system works fine as long as it is not overburdened.
When too many electrical appliances operate at the same time,
however, the system is overloaded and circuit breakers begin to
trip. In a similar manner, it is easier for a person with a reactive
body to experience an exaggerated fight or flight response when
overburdened with mental, physical, or emotional stress.
Once panic disorder develops, a person with a sensitive body
finds his or her body becoming even more reactive. Another factor to keep in mind is that a person with a body that is not overly
sensitive often finds that it becomes overly reactive after a period
of prolonged anxiety. It is similar to the way in which a person is
more emotionally reactive when sick or tired. The good news is
that once a person learns how to manage and reduce the symptoms of anxiety, this reactivity will slowly return to the level it was
prior to the development of panic disorder.
· Stress: When recalling the time just before the first panic attack
occurred, people usually recall a number of factors that were
producing a high level of physical or mental stress.
Unfortunately, prior to the onset of panic disorder people are
often out of touch with their bodies. After the initial panic
attack they become overly focused on their bodies. Because
they are not aware of how stressed out they are, they continue
to do all the things they usually do and often expect to be as
effective as they usually are. Much more will be said about this
in Lesson 3, on stress management. The result is that their first
panic attack really was just a stress response what Brian's
doctor meant when he said his first attack was just "nerves."
Unfortunately, Brian didn't really understand what this meant,
and the doctor didn't explain it to him or give him any guide
lines on how to manage his stress more effectively.
· Hyperventilation: Hyperventilation (breathing more rapidly or
deeply than is necessary) can produce many of the symptoms
characteristic of anxiety and offers a second possible explanation for the initial symptoms that trigger panic disorder. The
first major panic attack for many people was actually a hyper ventilation
episode. For others, like Brian,
hyperventilation accompanies most panic
attacks and accounts for many of the
distressing symptoms experienced. It is
quite probable that many people have both
the biological sensitivity described above
and the tendency to hyperventilate. In some
people the tendency to hyperventilate may
itself have a genetic component. A more detailed description of the actual mechanics
required, and half the people with this condition experience no
symptoms. Of the 50 percent who do notice symptoms, the
main one is palpitations either in the form of premature con
tractions of the heart or rapid heartbeat. Other symptoms are
breathlessness and vague chest pains. Andrea would experience
occasional rapid heartbeat and discomfort in her chest. She had
all the HAP traits and soon found herself constantly aware of
her heart and breathing and becoming alarmed whenever her
heart "did something funny." Fear of the symptoms, which
were harmless but misunderstood, soon led her to become so
anxious that she began to experience panic attacks
Illnesses that are life threatening or that produce unpleasant
symptoms can also cause so much anxiety that they begin to
trigger panic attacks. For example, one source reports that
about 14 percent of cardiac patients suffer from panic disorder.
Cardiac patients who have several of the HAP traits described
earlier can, like the person with MVP, become so overly
focused on their body that they begin to become frightened by
normal bodily reactions and trigger the fight or flight response.
The more alarmed they become, the stronger the response.
· Adverse medication or drug reaction: Many medications and
recreational drugs can cause symptoms characteristic of a panic
attack. In one case, Kumar, a client of mine suffering from
hypothyroidism a condition where the thyroid does not pro
duce sufficient thyroid hormones experienced such anxiety. During Kumar's initial
treatment, his prescription of replacement synthetic
thyroxin was higher than needed, causing
many anxiety symptoms. Being an extreme perfectionist with
very black and white thinking, Kumar's drug induced symptoms soon triggered internalizing and negative anticipation,
which led to the development of the anxiety/panic cycle.
Frank presents another example. While experimenting with
cocaine, his heart started pounding so hard it frightened him.
After the experience, he became obsessed with the fear that he
might have damaged his heart. As he focused more and more
on anything that might be abnormal, he became so anxious that
he began to trigger panic attacks.
It is important to note that not everyone who has a panic attack like
Brian's will develop panic disorder. One of the keys to the development
of this problem is how you think about your symptoms. As with most
people, Brian's initial panic attack was the result of several things inter
acting. First, he had three of the above factors: a reactive body, stress,
and hyperventilation. When Brian recalled the time just before his initial panic attack at work, he explained that he had been going to school
full time and working at a tiring job, had recently broken up with his
fiancée, and had recently experienced the death of his father. His first
panic attack had actually simply been a stress reaction. Brian didn't
understand this, however; his beliefs about himself told him that he
should be strong and able to continue to do all the things he was doing.
He didn't understand that his initial symptoms were simply a very
strong message that he was doing too much. Because of this, when his
doctor said his symptoms were simply due to "nerves," Brian began to
think that this diagnosis was impossible and that there must be some thing
terribly wrong with him that the doctor had
missed. In addition to the above factors,
Brian had a high need to be in control of himself, to appear normal, and to avoid anything that might cause
others to disapprove of him. This, coupled with his lack of awareness of
how stressed out he really was, caused him to worry that the mysterious
and frightening symptoms would recur and again produce that terrible
sense of being out of control. This fear caused Brian to become very
aware of internal sensations such as his heartbeat and rate of breathing.
This increased awareness of the body is called internalization or body
scanning. As Brian became more aware of his body, he began to imagine what might happen if the frightening sensations were to occur in
various situations, a type of worry called negative anticipation or what if
thinking. The combination of not understanding what had happened,
internalization, and negative anticipation caused the development of an
anxiety/panic cycle, which can be diagrammed as follows:
A normal reaction in the body~ The reaction is noticed, causing ~ The fear triggers the fight
or flight response
t
The increased fear produces a ~ The increased reaction in
stronger fight or fight response ~the body produces more fear
Thinking in terms of Brian's brain circuitry, we could say that the
sensations associated with Brian's first panic attack rapid heartbeat,
muscle tension, rapid breathing, lightheadedness, and so on had
become stored in his amygdala as signs of danger. Thus, whenever he
experienced these symptom seven when they were normal and at a
very low level of intensity they would trigger the fight or flight
response, and his attention would immediately be drawn to them. For
example, when Brian walked up a flight of stairs shortly after the initial episode of frightening symptoms, he immediately noticed his
increased heartbeat and increased rate of breathing. Instead of recognizing
these as normal reactions to walking up
stairs, the fear response caused him to
think, "
Oh my gosh, here they (the frightening symptoms) come again!" This triggered the fight or flight
response and exacerbated the physical reactions he was noticing. This
series of reactions, in turn, increased his fear, producing an even
stronger fight or flight response. Within seconds Brian had talked
himself into a self-generated panic attack.
As more and more normal situations were associated with danger,
Brian began experiencing these self-generated panic attacks regularly and was now suffering from panic disorder. Brian eventually developed agoraphobia and often avoided situations where he feared a
panic attack might occur. As Brian's world grew smaller, his tendency
to use rigid th\inking, need for control, and need for approval became
more exaggerated. He was caught in a series of vicious circles.
The rate at which the anxiety/panic cycle develops seems to
depend upon what is causing the initial unpleasant symptoms, the
intensity of the symptoms, how many of the high anxiety personality
traits a person has, and how exaggerated the traits are. Like many
others, Brian, Andrea, and Kumar can remember vividly their first
major panic attack and developed panic disorder shortly after it
occurred. For others, the anxiety/panic cycle develops over months or
years. Sometimes it seems to come and go.
The Development of
Panic Disorder
The tendency for panic disorder symptoms to increase and
decrease over time usually occurs in the following manner. Mavis, a
successful businesswoman with a very reactive body, had many anxiety symptoms during a period of high stress at work. The symptoms
worried her, and she restricted her activities for a while. While Mavis
didn't realize it, restricting her activities gave her body a rest. As a
result, her body ceased to overreact to normal stimuli. Since the disturbing symptoms were no longer present, she gradually resumed
normal activities. Eventually, she again encountered a period of high
stress at work. Mavis's reactive body responded with anxiety symptoms that were
more severe than the first time, which lead
to the development of the anxiety/panic cycle and panic disorder.
From the above it should now be clear that what separates those
who do develop the anxiety/panic cycle from those who do not is the
way they think about their symptoms. While having a reactive body, a
tendency to hyperventilate, a medical condition, or an adverse drug
reaction can contribute to the development of an anxiety/panic cycle,
the important factor is the way a person thinks about his or her anxiety symptoms. People with some or many of the personality traits
described earlier are more likely to overreact to the initial symptoms,
begin to watch their body carefully, and worry The tendency for panic disorder symptoms to increase and
decrease over time usually occurs in the following manner. Mavis, a
successful businesswoman with a very reactive body, had many anxiety symptoms during a period of high stress at work. The symptoms
worried her, and she restricted her activities for a while. While Mavis
didn't realize it, restricting her activities gave her body a rest. As a
result, her body ceased to overreact to normal stimuli. Since the disturbing
symptoms were no longer present, she gradually resumed
normal activities.
Eventually, she again encountered a
period of high stress at work. Mavis's reactive body
responded with anxiety symptoms that were more severe
than the first time, which lead to the development of the anxiety/panic cycle and panic disorder.
From the above it should now be clear that what separates those
who do develop the anxiety/panic cycle from those who do not is the
way they think about their symptoms. While having a reactive body, a
tendency to hyperventilate, a medical condition, or an adverse drug
reaction can contribute to the development of an anxiety/panic cycle, about what the symptoms mean and what might happen if they cannot be controlled. In
essence, anxiety becomes a sort of "boogeyman" that follows them
around.
They flee from any indication that this boogeyman is coming.
Unfortunately, most of the symptoms they flee from are normal. They
just don't understand this important point.
? 19972012
Anxiety Panic Attack Resource Site.
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Feeling alone? Think people don't understand what you are
going through? If so, you should come to our message
board. There are several thousand members and I can assure
you they will be there for you when you need them the most.
They understand what you are going through and eventually you
will do the same for them when they need someone to talk to.
you can 
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hose
suffering from anxiety attacks and panic attacks. Email:
