the locker room. She sits down; the symptoms intensify, and her chest tightens. She wants to scream but can’t get enough air. She’s sure that she’ll pass out and hopes someone will find her before she dies of a heart attack. She hears someone and weakly calls for help. An ambulance whisks her to a nearby emergency room.
At the ER, Maria’s symptoms subside, and the doctor explains the results of her examination. He says that she has apparently experienced a panic attack and inquires about what may have set it off. She answers that she was exercising because of concerns about her weight and health.“Ah, that explains it,” the doctor reassures. “Your concerns about health made you hypersensitive to any bodily symptom. When your heart rate naturally increased on the treadmill, you became alarmed. That fear caused your body to produce more adrenaline, which in turn created more symptoms. The more symptoms you had, the more your fear and adrenaline increased. Knowing how this works may help you; hopefully, in the future, your body’s normal physical variations won’t frighten you. Your heart’s in great shape. Go back to exercising.“Also, you might try some simple relaxation techniques; I’ll have the nurse come in and tell you about those. I have every reason to believe that you won’t have another episode like this one.”
Maria had one panic attack and may never experience another one. If she believes the doctor and takes his advice, the next time her heart races, she probably won’t get so scared. She may decide to see how things go before seeking treatment for her problem. However, if she has a recurrence, treatment works pretty well for this issue.
HELP! I’M DYING!
Panic attack symptoms, such as chest pain, shortness of breath, nausea, and intense fear, often mimic heart attacks. Alarmed, those who experience these terrifying episodes take off in the direction of the nearest emergency room. Then, after numerous tests come back negative, overworked doctors tell the victim of a panic attack in so many words that “It’s all in your head.” Many patients with panic attacks doubt the judgment of the physician and strongly suspect that something important was missed or wasn’t found.
The next time an attack occurs, panic attack victims are likely to return to the ER for another opinion. Even a second or third visit may not convince those with panic attacks that the feeling wasn’t caused by a heart problem. The repeat visits frustrate people with panic attacks as well as ER staff. However, a simple 20- or 30-minute psychological intervention in the emergency room decreases the repeat visits dramatically. The intervention is pretty simple — just providing education about what the disorder is all about and describing a few deep relaxation techniques to try when panic hits.
Panic’s companion
Approximately half of those who suffer from panic attacks have an accompanying problem: agoraphobia. Unlike most fears or phobias, this anxiety problem usually begins in adulthood. Individuals with agoraphobia symptoms live in terror of being trapped and unable to escape. They desperately avoid situations from which they can’t readily escape, and they also fear places where help may not be readily forthcoming should they need it.
The agoraphobic may start with one fear, such as being in a crowd, but in many cases the feared situations multiply to the point that the person fears even leaving home. As agoraphobia teams up with panic, the double-barreled fears of not getting help and of feeling entombed with no way out can lead to paralyzing isolation.
You or someone you love may struggle with agoraphobia if
You worry about being somewhere where you can’t get out or can’t get help in case something bad happens, like a panic attack.
You tremble over everyday things like leaving home, being in large groups of people, or traveling.
Because of your anxiety, you avoid the places that you fear so much that it takes over your life, and you become a prisoner of your fear.
For example, imagine that you quake at the thought of entering large sports stadiums. You see images of crowds pushing and shoving, causing you to fall over the railing, landing below, only to be trampled by the mob as you cry out. You may be able to live an entire blissful life avoiding sports stadiums. On the other hand, if you love watching live sports events, or you just got a job as a sports reporter, this fear could be really bad.
Luciana’s story, which follows, demonstrates the overwhelming anxiety that often traps agoraphobics.
Luciana celebrates her 40th birthday without having experienced significant emotional problems. She has gone through the usual bumps in the road of life like losing a parent, her child having a learning disability, and a divorce ten years earlier. She prides herself in coping with whatever cards life deals her.
Lately, she feels stressed when shopping at the mall on weekends because of the crowds. She finds a parking spot at the end of a row. As she enters the mall, her sweaty hands leave a smudge on the revolving glass door. She feels as though the crowd of shoppers is crushing in on her, and she feels trapped. She worries she might faint, and no one would be there to help her. She’s so scared that she flees the store.
Over the next few months, her fears spread. Although they started at the mall, fear and anxiety now overwhelm her in crowded grocery stores as well. Later, simply driving in traffic scares her. Luciana suffers from agoraphobia. More and more she feels like staying in her house.
Many times, panic, agoraphobia, and anxiety strike people who are otherwise devoid of serious, deep-seated emotional problems. So, if you suffer from anxiety, it doesn’t necessarily mean you’ll need years of psychotherapy. You may not like the anxiety, but you don’t have to think you’re nuts!
Phobias: Spiders, snakes, airplanes, and other scary things
Many fears appear to be hard-wired into the human brain. Cave men and women had good reasons to fear snakes, strangers, heights, darkness, open spaces, and the sight of blood — snakes could be poisonous, strangers could be enemies, a person could fall from a height, darkness could harbor unknown hazards, open spaces could leave a primitive tribe vulnerable to attack from all sides, and the sight of blood could signal a crisis, even potential death. Fear fuels caution and avoidance of harm. Those with these fears had a better chance of survival than the naively brave.
That’s why many of the most common fears today reflect the dangers of the world thousands of years ago. Even today, it makes sense to cautiously identify a spider before you pick it up. However, sometimes fears rise to a disabling level. You may have a phobia if
You have an exaggerated fear of a specific situation or object.
When you’re in a fearful situation, you experience excessive anxiety immediately. Your anxiety may include sweating, rapid heartbeat, a desire to flee, tightness in the chest or throat, or images of something awful happening.
You know the fear is unreasonable. However, kids with specific phobias don’t always know that their phobia is unreasonable. For example, they may really think that all dogs bite. (See Chapter 19 for more on phobias in children.)
You avoid your feared object or situation as much as you possibly can.
Because your fear is so intense, you go so far as to change your day-to-day behavior at work, at home, or in relationships. Thus, your fear inconveniences you and perhaps others, and it restricts your life.