Anxiety is a normal healthy emotion. It’s thought to be a function of our survival instinct. When we become anxious, our brain gets a bit more active and certain types of anxiety can actually increase our performance in sport or test-like situations. Why? Because anxiety helps us get ‘psyched up’ in response to some kind of threat. When the bushes rustle, our brains needed something to get it focused and figure out whether we’re about to fight some kind of jungle cat. Unfortunately, sometimes our brains get it wrong. For some reason, almost one in five of us (about 14% of adults and 3-5% of kids have an anxiety diagnosis every year) will turn this normal emotion into a disorder. This mini-series will show you how and why.
Panic Disorder (PD)
PD is characterised by panic attacks. Panic attacks aren’t just a burst of concern about something. They are an extended rush of distress and anxiety. We’ve got you classic physical symptoms; heart palpatations; dizziness; chest pain; tingling; numbness; breathlessness. But we’ve also got some cognitive ones, thoughts like a fear of dying or a fear of losing control! These two kinds of symptoms combine in a tangle of extreme distress that lasts an average of ten to fifteen minutes. But almost anyone can suffer a panic attack. I mean, really, drinking too many redbull/vodkas and dancing could start those physical symptoms, or going for a run, and then you might think you’re having a heart attack and BAM, we’re looking at a panic attack. What takes it to the next level, the Panic Disorder level is that you start worrying about having a panic attack. It’s no longer just an attack of anxiety, but a general anxiety about having an attack of anxiety. Real convoluted right?
What you’ll find is that there are basically two categories of people diagnosed with PD. There’s ‘pure’ PD, where people are simply worried about panic attacks happening (albeit constantly). But there’s a second type of PD. For these people, that fear of panic attacks extend to certain situations and places. They begin to avoid certain things to avoid having a panic attack. These are called ‘agoraphobic fears’ and this type of PD is called PD with agoraphobia (funnily enough). Basically, certain things like public transport, tunnels and other enclosed spaces or crowded areas are avoided in fear of causing a panic attack. This is where the classic ‘agoraphobia’ comes from; staying inside avoids all those things.
Well, the PD itself appears to be a mental reaction to physical symptoms that then feeds that mental reaction again. The agoraphobia however, seems to be mostly socialised into certain people. Let me explain. Some people are more likely than others to have an ’emergency response’ to stressful events. This is a genetic thing. It explains why lots of people have panic attacks, even though only some develop PD (about 8-10% of people has had an occasional, unexpected panic attack). For those with PD, it appears to be that they are more vulnerable to stress as well. So get more easily stressed out and more likely to have a panic attack as a result. What happens after a few panic attacks is that the persons brain has associated these panic attacks with internal symptoms and sometimes external situations. So you might be out on a morning run, your body recognises a raised heart rate and you think your having a panic attack, so you start having one! Or you might have a panic attack on the bus and forever more, no matter what the panic attack was about, you feel like the bus is going to cause another panic attack. See, only about 40-50% of panic attacks happen during stressful situations. That mean 50-60% happen because of these ‘learned alarms’, these events associated with panic attacks, whether they’re known or unknown by the person! The other major factor appears to be taught. Either through some helicopter parenting or over-protective care (especially if you were a sick child, or something like that), those with PD appear to have been taught that these normal bodily sensations are dangerous. People without PD appear to attribute panic attacks to a particular situation. Those with PD get a surge of anxiety following any physical symptom (for any reason), which leads to more physical sensations, which leads to more anxiety. And so on. Eventually this could lead to a panic attack, but in the meantime it just means constant anxiety in response to your bodies natural working.
On the plus side, PD is reasonably treatable. ‘Gradual exposure’ techniques (slowly introducing physical symptoms) coupled with anxiety coping methods sees a significant reduction in anxiety, panic attacks and agoraphobia in about 70% of those with PD. Agoraphobia can also be heftily mitigated by the presence of ‘safety signals’, that is a person with which the person with PD feels safe or the clear possibility of a rapid escape; things that mean they’ll be better able to get to a safe zone (usually home) in the event of a panic attack.
So how can we help?
Easy. Easy for us, I should say.
- Firstly (and always) encourage the person to go find a clinician that’s right for them. Don’t be discouraged by bad psychologists and cold psychiatrists. You will find someone to help.
- You might even try online, at places like the Mindspot Clinic, for treatment online.
- Also, help them work out their safety zone. Once you’ve got that, you can help them spread their wings a little if they want. As long as they know they can be safe, the chances of a panic attack decreases significantly.
- Finally, be understanding. Suffering a panic attack is analogous to feeling like you’re dying. Bloody terrifying. Support the heck out of them and understand when they say ‘no, I’d prefer just to stay home today’.
Anxiety rears it’s head in many ugly and interesting forms when it goes wrong. Check out our other articles on the subject, here, here and here. Those links talk about approach anxiety, the truth behind OCD and a little known disorder that I’d bet a lot of you have and didn’t even realise. Giving you the dirt on your search for understanding, psychological freedom and ‘the good life’ at The Dirt Psychology.