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When Danger Seems All Too Real
by Roberta Greenwood

Adrian Monk, portrayed by Emmy-winning actor Tony Shalhoub in the hit television series “Monk,” is an extremely gifted but highly anxious private consultant. Just about everything in his environment – dust, spiders or crowds – can send him into a spiral of anxiety. Shalhoub’s character manages to convince his viewers that his quirky symptoms are hysterically funny.

Ask the almost three million Americans who suffer from the often terrifying symptoms of anxiety attacks and it’s anything but. Present in almost twice as many women as in men, anxiety attacks, commonly called “panic attacks,” can result in heart palpitations, sweating, trembling, chills and nausea, which lead many to believe they’re in immediate danger of a serious physical ailment.

Panic attacks, as defined by the American Psychology Association, are a sudden urge of overwhelming fear that comes without warning and any obvious reason. “When you’re feeling panicky, you’re always telling yourself something that isn’t true,” says David D. Burns, M.D. and author of When Panic Attacks. Burns explains that two of the most common triggers of panic attacks are mind reading (assuming you understand the motives and feelings of others) and fortune-telling (making predictions without evidence). Both lead to intense and often irrational fear, which produces the common and frightening symptoms of panic attacks – racing heartbeat, shortness of breath, and the feeling of losing control. These alarming physical reactions cause many patients to believe they’re in a life-threatening situation although in truth, they may not be in danger at all.

According to Dr. Wayne J. Katon, M. D., professor of psychology for more than 30 years at the University of Washington, panic attacks are the “fight-or-flight response gone awry.” This automatic fear response prepares humans to cope with or run away from danger, he explains, and when people’s bodies mobilize them for danger at inappropriate times, they are often frightened by the symptoms. “More than 80 percent of patients with panic disorders present themselves for treatment with a medical symptom,” says Katon. “They complain of headaches, belly aches…they’re fearful of a heart attack. It’s common to hear statements such as ‘I can’t get enough air,’ and ‘I feel like I’m going crazy.’”

Although the panic attack itself isn’t dangerous, most people feel that their physical symptoms indicate a serious health threat and that concern often leads to additional panic. It can then become a continuing and escalating cycle, with some patients reporting panic attacks even while sleeping. Generally, these attacks pass in a few minutes because the body can’t sustain the ‘fight-or-flight’ response longer than that. Occurring suddenly, most attacks give no warning, and aren't related to any actual threat.

“This is a brain-to-body disease,” explains Katon. “Many patients think their doctors don’t believe them when they complain of the physical problems that frighten them. They fear they’re going crazy when, in fact, these attacks are the disregulation of bodily systems.” Katon works in an ongoing program with family doctors, training them to recognize and offer treatment for the underlying mental health issues that accompany panic attacks. “Most Americans receive their first mental health care from their primary care physicians, so it’s important that we learn to ask the appropriate questions,” Katon says. “In these disorders, thoughts cause symptoms – the patient isn’t imagining the condition.”

WHEN AN ATTACK OCCURS

Research published by the Anxiety Disorders Association of America (ADAA) indicates that most attacks come on without warning during an ordinary activity such as shopping or walking down the street. Patients feel confused and worry that something terrible is going to occur. While upsetting, many people report such attacks, and one or two occurrences aren’t generally reason for concern. It’s when the persistent fear of future attacks becomes overwhelming that a panic disorder may be present.

Panic disorder, a much more serious condition, is diagnosed when a patient suffers frequent panic attacks – often resulting in disabling mental fears. This disorder often causes patients to begin limiting their life experiences as a means to control the attacks – a symptom that Katon says is extremely distressing. “Without treatment, the patient becomes fearful of normal life – and catastrophic thinking is often present,” states Katon. “What’s important to understand is that this disorder can be successfully treated in more than 70 percent of all cases in a relatively short period of time.”

Katon believes that the most important step in treatment is educating the patient; most people are greatly relieved once they understand what a panic attack is. It’s important for patients to see a professional for a correct diagnosis; continuous symptoms that don’t go away within an hour might indicate a physical problem. Once diagnosed properly, cognitive therapy helps patients identify possible triggers of their attacks; “interoceptive exposure” often follows. This regimen of desensitization is sometimes used to cure phobias and, in the case of panic disorders, can teach patients that the physical symptoms they fear (rapid heart rate, sweating, dizziness) need not develop into full-blown attacks. Katon advises that medications may also be needed; antidepressants show highly favorable results. The ADAA confirms that panic disorders, once treated, don’t lead to any permanent complications.

“What’s important to remember about panic attacks and panic disorder is the excellent success rates we’re achieving with appropriate treatment,” Katon concludes. “I want to leave patients with hope: this is a curable condition that doesn’t have to limit your life.”

LEARN MORE AT:

www.adaa.org
Anxiety Disorders Association of America

www.apa.org
American Psychological Association

www.nmha.org
National Mental Health Association

Roberta Greenwood is a frequent contributor to Seattle Woman.

©2006 Caliope Publishing Company