Break out of your prison of panic

The Panic Doctor is Dr. Richard C. Raynard, a Ph.D. Licensed Psychologist who at one time was phobic himself.  He tells his story in his own words to help you see that you are not alone in your struggle, that panic can strike anyone, and that there is hope for overcoming your panic.

Panic is bewildering and the frightening array of symptoms can be overwhelming. An attack can seem to come without warning and without any obvious reason. It can be intense.  Read on to see if these symptoms sound familiar to you, then read further to see what you can do to free yourself from the prison of panic... 

Do you Panic?

Symptoms can include:

• racing heart
• palpitations
• "jelly" legs
• pounding heart
• accelerated heart beat
• sweating
• nausea
• stomach cramps
• abdominal distress
• trembling or shaking
• dizziness
• lightheadedness
• tight feeling in throat or chest
• shortness of breath
• chest pains
• feeling smothered
• choking sensations
• feeling weak or faint
• unsteady
• hot or cold flashes
• blurred vision
• derealization (feelings of unreality)
• depersonalization(feeling detached from oneself)
• poor concentration
• numbness
• tingling in limbs
• fear of losing control
• fear of going crazy
• fear of dying  

Explanation of Symptoms

Panic feels overwhelmingly physical.  Most commonly, about six or seven of the physical symptoms come on at one time.  They feel like they are located mostly in the body, not the head, although the feelings of unreality or losing control are among the most alarming perceptions.  Most of my patients strain the English language to describe their experience: "A bolt of lightning went through me", "I was on fire inside", "My body was exploding", "I felt I was going crazy", "I thought I was dying or having a heart attack". Physiologists say there are more bodily systems upset in panic than in first-degree burns. The experience of panic is quite unimaginable to those who have not experienced it.  Non-sufferers minimize panic, because it is not very visible and makes little sense. Even spouses and friends can become impatient and incredulous in a short time.  From the start, panic is misunderstood and overlooked.

If you have experienced one or two of these symptoms at one time, you experience high levels of anxiety.  If you have four or more symptoms at one time, you are probably experiencing panic attacks.*  Panic attacks are the most common emotional disorder in our country, least often treated, yet treated with the highest success rates.

* IMPORTANT NOTE:

For accurate diagnosis, a clinical interview and professional judgement is needed, and other medical and/or emotional disorders ruled out. See your mental health professional, see links to qualified professionals, or Contact The Panic Doctor.

In addition to the symptoms described, a panic attack is also distinguished from ordinary "flight or fight" responses that are instinctive to humans when we are in a dangerous situation because symptoms occur suddenly, without warning. The level of fear is far out of proportion to the actual situation you are in, and in fact, it's often completely unrelated! The symptoms generally pass within a few minutes, as the body does not sustain these responses unless alarming thoughts and/or worries are added to keep them going. Repeated attacks can continue when caught in the "anxiety cycle".

What situations trigger anxiety or panic?

Everyone is surprised at the suddenness of the first panic attack.  It seems "out of the blue" and without cause. Yet, soon after the first attack, it becomes clear that the panic ocurs only in some situations and not in others. You start to avoid these situations. A pattern emerges, called agoraphobia, the most common mental disorder, affecting about 7% of adults at a given time. About 11% of phobics become housebound within the first six months of onset.

Do you panic in any of the following situations?

• Driving
• Stores or Malls
• Enclosed Spaces
• Crowds
• High places
• Meeting people
• Unfamiliar places
• Hospital, doctor, dentist
• Speaking up in front of others
• Waiting in lines
• Open spaces
• Being alone
• Flying in an aircraft
• Being criticized
• Bugs, dogs, balloons, etc.

  (for a more complete list & Phobic Situation Scale visit Situations)

If you panic only in one situation, you may avoid it and worry a lot, but your phobia is probably limited.  If you panic in enclosed spaces, you may have claustrophobia. If you panic only in social situations, you may have a social phobia. Panic in several kinds of situations is typical of agoraphobia. If you have anxiety or panic in situations other than these, you could be in very high stess situations or have an obsessive disorder, post-traumatic stress, or other conditions.

For more information about specific situations, see Situations page.

Do you worry excessively?

Once panic has started, worry and avoidance keep it going, creating a vicious cycle. Worry goes by many names - anticipatory anxiety, second fear, alarming thoughts, the what-ifs - but it is the prime mover that propels you to panic. Worry is anticipating the future in the worst way, before anything has happened, and getting upset at what you picture. These are usually not pretty pictures. In fact, we easily project the worst, because our worst memories are often the best remembered.

Do you say "yes" to any of the following:

• It is hard to stop worrying

• My worries ruin good times

• I worry in the evening

• I lose sleep worrying

• I worry myself into high anxiety

• I worry about the future

• I worry when I am alone

• I worry about the same things over and over

• I wake up worrying

In my book Panic Free, Chapter 5, entitled Worry - Disarming the Terrorist Within, I introduce you to worry, how it creates anxiety and keeps you a prisoner of panic, and most importantly, what you can do to put an end to this devastating cycle.

Do you avoid situations where you have had panic?

Besides worrying, avoiding is the other major cause of panic - a sustaining cause that keeps panic growing. The more situations you avoid, the more you will fear them. Panic thrives on not-knowing, darkness and uncertainty because worry rushes in to fill the lack of our direct experience. Sadly, this leads only to more anxious symptoms and more avoiding.

This viscious circle of avoiding can take place entirely within your mind, with no one noticing. It can be diagramed like this:

The ways of artfully dodging panic situations are many, varied and subtle. Those who panic can get good at both actively and passively avoiding.  We avoid panic situations to escape the shocking feelings of panic. And, since avoiding works so well in the short run, we hold on tightly to our avoiding tactics. The immediate effect of avoiding is relief; a powerful, instant reward. The darker effect is that avoiding makes you increasingly helpless. In the long term, avoiding unravels our progress and sabotages success.

      *This section on contains excerpts from Dr. Raynard's book Panic Free, Avoiding, Chapter 7, pg 81.

Consequences of Panic

Without appropriate treatment, panic disorder can have serious consequences, and at a minimum will become a disruption in your life. The immediate danger with panic is that it can lead to phobias. We've explored this in the section above when we looked at the Anxiety Cycle. Once you become stuck in this cycle, you are at risk for developing phobias and even agoraphobia, because you believe that by avoiding and staying out of these situations you will avoid provoking a panic attack (see Sensitivities for more on this). For some, the fear of an attack is so real and so debilitating that they prefer to spend their lives trapped inside their homes - sometimes even confined to a single "safe" room within their home (severe agoraphobia).

Case:  Martha, a 56 year old married woman, was referred by her daughter, who was alarmed by her mother's growing isolation. I agreed to a home visit, as she had not left her house in two years. Her home was shuttered and dark, and her husband introduced to to her as she sat between two tall rows of boxes that led to her chair in the den. She was surrounded by a small refrigerator, electric stove, radio, magazine stacks and other items. She explained she first panicked 33 years ago in a crowded train, and had slowly retreated as her sensitivities grew, and eventually gave up her work and friends. Now she could only be comfortable in the den, needing her husband to escort her to the bathroom. Sadly, she could not even visit her two sons and families who lived only a few houses down the street. She tried her best not to think of her condition. After counseling, she was able to visit her two sons and their families. Later, I wondered how many recluses of the world started as highly avoidant phobics.

*This case is an excerpt from the book Panic Free by Dr. Richard Raynard, Trafford Publishing, 2006, 311 pp

Even if you don't develop severe phobias, your quality of life can suffer immensely. Men and women who panic often find themselves having difficulty sleeping, experience headaches and other stress related symptoms, suffer from low self-esteem, depressive episodes, and/or develop problems in their relationships and difficulties at work. Once panic develops into phobia, quality of life further diminishes as you find yourself more susceptible to:

• spending less time on hobbies and other pleasures
• spending less time with family and friends
• becoming financially dependent on others
• feeling emotionally helpless
• becoming chronically depressed
• feeling less healthy
• developing problems with alcohol and other drug abuse
• risk of attempting suicide
• spending more time in hospital emergency rooms
• suffering financial losses

What can you do to stop this?

The facts about panic have barely trickled down to you.  I'd like to bring the facts to you in a way which will motivate you to put an end to your suffering once and for all.

Physicians are not well trained in emotional conditions, though they are sought out for these more than any other professional.  Mental health clinicians themselves often minimize the seriousness of panic, and may pay more attention to trauma, addictions, and depression, for example.  When faced with a patient who panics, it is easy to get misled down a path of treating the many other issues which are prevalent in a phobic person's life, such as work stress, family or relationship conflicts, medication issues, childhood trauma or events which may have influenced your panic, low self-esteem, self-medication with alcohol and other problematic self-remedies and so on.

There is an uneasy silence about panic in both professionals and the public.  Most doctors would rather diagnose a physical condition than a mental one. The experience of panic itself feels weird and unlikely to get a sympathetic ear. Even though up to 1/3 of adults panic at least once a year, most try to forget it and not mention it to anyone.  "Burning up", "electric jolts" and similar phrases show how hard it is to describe to others. Panic is easily the most hidden emotional disorder there is.

Phobia is also the least treated of all mental conditions. Only 24% of phobics ever get treatment over a lifetime. And, it takes an average of 10 years or more to get appropriate treatment. Clinicians often don't specialize in panic disorders and treat a related depression or relationship problem instead. Physicians are increasingly encouraged to treat it as a "mood disorder" with medication alone.

Even when treatment is found, it may be misdirected. Treatment methods in mental health how number in the hundreds, and you may not find the most effective one. The public may perceive medication as the most available, or even the only, approach. In fact, the most reliable findings for years have shown that counseling with cognitive-behavioral therapy and medication together is most effective.

Panic disorders and phobia are highly treatable. Treatments are extremely effective with the right choice of therapies, and most people who successfully complete treatment go on to lead normal lives.

So, how do you find effective help?  See Treatments for details in finding the most effective help for your panic, as well as specific questions to ask when seeking a qualified professional.  If you would like information about Dr. Raynard - The Panic Doctor - visit the Credentials page.  

To be panic free is a reasonable hope,

no matter how long or severe your attacks have been.

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