Jerilyn Ross experienced her first panic attack at age 25 while on a dream trip to Europe with a friend. While in a mountainside cafe in Salzburg, a young Austrian man asked her to dance, and she felt elated. Then suddenly she felt terrified. She was dizzy and sweating; her heart was pounding wildly. She felt pulled like a magnet to the window and on the verge of losing control and jumping out.
She managed to excuse herself and fled the building. The vacation continued with no more attacks, but she was dogged by an oppressive sense of nervous anticipation.
Back home in New York, the next panic attack occurred during dinner at her boyfriend’s 17th-floor apartment.
Soon her height phobia, with its accompanying anxiety and restrictions on her movements, spread through her life. She was choosing jobs, social engagements and friends on the basis of location.
Reading a magazine article about phobic people whose lives were as restricted as hers led her to call a hospital clinic. She began treatment of the sort that now is called cognitive-behavioral therapy. It involves gradual exposure to anxiety-provoking situations and strategies for countering scary, distorted thoughts.
Now Ross is a therapist, author and president of the Anxiety Disorders Association of America, a professional and educational group based in Washington, D.C.
Anxiety disorders used to be “misunderstood, misdiagnosed and trivialized,” Ross said. “But now we’re seeing a huge increase in understanding, recognition and diagnosis.”
They are the most common mental disorders. More than 19 million Americans will suffer from anxiety disorders during any given year, according to the National Institute of Mental Health, but only a third of them receive treatment.
Yet research into the causes of these complex disorders has multiplied. Many studies have focused on the specific brain areas and circuitry involved in anxiety and fear. Scientists are also trying to sort out the interplay of genetic, behavioral and developmental factors that contribute to anxiety disorders.
A big shift came in the 1980s, when diagnostic criteria were refined and knowledge of the chemical workings of the brain led to development of more drug therapies.
“Clinicians have become more astute in looking for and assessing anxiety disorders,” said Dr. William Gilmer, medical director of the Asher Depression Center at Northwestern University Medical School. “They oftentimes co-exist with depression and other things.
“Someone may come in and complain about sleeping problems or may come to the emergency room complaining about chest pains or breathing problems. Physicians in general have become much more aware of what panic disorder is.”
Patient-advocacy groups have done a “tremendous job in educating patients and their families,” Gilmer said. And ironically, so have pharmaceutical companies with direct-to-the-consumer advertising.
For example, when SmithKline Beecham received Food and Drug Administration clearance to market their drug Paxil for treatment of social phobia, “people who had never sought treatment before came out of the closet,” he said. “It’s a disorder in which there is a lot of shame, bewilderment and distress.
“The same thing happened a decade ago with obsessive-compulsive disorder. Judith Rapoport wrote a book, ‘The Boy Who Couldn’t Stop Washing.’ She and other specialists appeared on talk shows, and people who had been suffering from this illness for years, if not decades, suddenly knew they were not alone.”
When therapist Mark Pfeffer runs ads in local publications for his Panic/Anxiety/Recovery Centers in Chicago and Wilmette, he lists an array of anxiety symptoms.
“A lot of people call me and say, ‘I read the list in your ad, and I think that’s what I have,’ ” he said. “It’s maybe the first time they realize there’s a label [for what they’re experiencing].
“But people usually come see us when their problem is interfering with their life and they’ve had enough.”
Chicagoan Rosemary Burke was suffering from panic attacks and social phobia when she sought help from Pfeffer’s center.
“I started having panic attacks while waiting in line at a grocery store or any crowded place where
I was going to use a credit card or check,” she said.
“Life got rough. I had a constant sense of dread, thinking, ‘Oh, my God, is this going to happen again?’ I was extremely depressed and I remember thinking if I got hit by a car and died, it would put me out of my misery.”
A short course of the medication Paxil and
20 group sessions that taught her about her body’s physiological reactions and how to restructure her thinking about them, she said, finally gave her relief.
“I’m not going to say I’ve never had a panic attack since I’ve gotten out of the program, but they’ve been minimal and they don’t have the same level of power over me. And the anticipatory anxiety is gone.”
Northwestern’s Gilmer noted that not all people who experience panic attacks have panic disorder.
“Panic attacks can occur in social phobia, in obsessive compulsive disorder and in depression,” he said. “They also can occur simply in response to some kind of feared event.
“A person with pure panic disorder has panic attacks that come out of nowhere. The panic attacks can occur out of the blue while a person is sitting at home watching television, although there may be situations that are more likely to trigger them.”
Dr. Emil Coccaro, section chief of adult psychiatry at the University of Chicago, said that “with panic, the part of the brain that controls ‘fight or flight’ just starts firing at a very high rate, what we call autonomic overload.”
It’s the fibers of norepinephrine-producing cells in the locus coeruleus, a nucleus of the brainstem, that fire. Norepinephrine is a neurotransmitter, a chemical that’s transmitted across the spaces (synapses) between nerve cells.
“When the person who has a panic attack is exposed to a stimulus–a bridge, anything they’re phobic about–it sets off action in the locus coeruleus,” Coccaro said, even though in reality there’s no imminent danger.
The discovery of neurotransmitters led to the development of medications to modify the chemical transmission.
Now the usual treatments for anxiety disorders are medications and cognitive-behavioral therapy.
“The combination is probably more effective than either one alone,” Gilmer said.
The categories of disorders
Here are brief descriptions of the five categories of anxiety disorders:
– Panic disorder–Sudden feelings of fear that strike repeatedly and without warning. Physical symptoms include shortness of breath, dizziness, tingling, hot flashes, heart palpitations, fear of dying or going crazy. Can lead to agoraphobia, avoidance of public places and situations associated with the panic attacks.
– Phobias–Extreme disabling, irrational fear of something that poses little or no actual danger. Phobias typically cause people to limit their lives.
– Generalized anxiety disorder–Chronic, exaggerated worry about everyday life events and routine activities that persists for at least six months; accompanied by restlessness, fatigue, trembling, muscle tension, poor concentration, headaches, insomnia and nausea.
– Obsessive-compulsive disorder–Repeated, intrusive and unwanted thoughts or rituals that seem impossible to control such as cleaning, checking, repeating and hoarding.
– Post-traumatic stress disorder–Persistent symptoms resulting from traumatic life experiences; symptoms include nightmares, flashbacks, numbing of emotion, sudden anger or irritability, being easily startled. May also include panic attacks (see above).
— C.L.
Source: Anxiety Disorders Association of America
