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 thephysical 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 panicattacks
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 mechanicsrequired, 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 thinking, 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.
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