Q: I

Seem to have some of the symptoms of panic disorder...

July 10, 2000|By Dr. Allen Douma.

Q: I seem to have some of the symptoms of panic disorder. I am 36 and believe I have no more stress than anyone else. However, when I have to drive over a bridge (I live on an island), I feel like the bridge is going to collapse and I need to drive off the side of the road. I try to visualize my husband holding up the bridge for me and that seems to help a bit. Also, I enjoyed flying until the last few years. Now I feel trapped and closed in on in a plane and I have to get out and be on solid ground.

A: Anxiety about crossing bridges (especially high ones or long ones) or riding in airplanes (especially crowded ones) is quite common. Many people can endure their level of this anxiety without help while others simply cannot function without help.

The mental health community's terminology can be quite puzzling at times. Anxiety disorders are a distinct group of disorders associated with abnormal reaction to fearful situations. Panic disorder is one of these disorders. Panic attacks are discrete episodes of severe anxiety.

Panic disorder is characterized by short-lived, recurrent, unpredictable episodes of panic attacks and intense anxiety. In this case, anxiety can include intense apprehension, fearfulness or terror, and feelings of impending doom.

Panic-disorder anxiety is often accompanied by physiologic symptoms such as difficulty breathing, rapid heart rate, palpitations, headaches, dizziness, nausea and choking or smothering sensations.

However, panic attacks can occur as part of a number of other anxiety disorders, not just panic disorder. Three types of panic attacks are defined in terms of the relationship between onset of the attack and the presence of situational triggers.

The first is unexpected panic attacks when there is no association with a situational trigger. Occurrence of unexpected panic attacks is required for a diagnosis of panic disorder.

Next are situational bound panic attacks, which always occur on exposure to or in anticipation of a situational trigger, e.g., stepping onto a crowded airplane.

Finally, situationally predisposed panic attacks, which are similar to situational bound panic attacks except the panic attacks do not always occur at the time the trigger is presented. If you experience this form of panic attack, you would not always have intense anxiety every time you crossed the bridge.

Another anxiety disorder is called agoraphobia. The term is from the Latin, fear of the marketplace. Agoraphobia has now been more specifically defined by mental health professionals as intense anxiety about being in situations from which escape would be difficult in the event of an unexpected problem.

The differences between these (and other) anxiety disorders may seem small, but they are important in terms of treatment. That's why the first step is to establish the type and severity of anxiety disorder you are dealing with.

Treatment of anxiety disorders is a three-pronged approach: drugs, behavioral techniques and psychotherapy. As you know, there are many anti-depressant, anti-anxiety and other drugs on the market that provide a wide range of therapeutic effects. These drugs require a prescription and most have substantial side effects.

