PANIC ATTACKS. WHAT IS IT AND WHY DO THEY ARISE?

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

“The splendid valleys and groves of Arcadia are the kingdom of Pan, the Greek god of cattle breeding. He was born with goat legs and a head. His mother, frightened by the appearance and character of the child, left him, and his father, wrapped in hare skins, brought him to Olympus, where Pan brought great joy to all the gods … On a hot afternoon, tired of his studies, Pan falls asleep and nature falls asleep with him. Not a single shepherd dared to break this silence by playing the flute, fearing the wrath of the great god and the panic fear that he could instill in mortals."

The name of this god gave the name to panic attacks (episodic paroxysmal anxiety, anxiety neurosis). PAs are manifested by sudden acute attacks, usually occurring for no apparent reason. If this happens during sleep, then rapid awakening occurs.

During attacks, four or more of the following symptoms occur, the intensity of which reaches its peak within 10 minutes:

1. Feeling of lack of air, shortness of breath;

2. Ripple, palpitations;

3. Discomfort in the left side of the chest;

4. Dizziness, unsteadiness;

5. Shortness of breath, choking;

6. Weakness, lightheadedness, fainting;

7. Chills, tremors;

8. Waves of heat and cold;

9. Sweating;

10. Feeling of derealization, depersonalization;

11. Dry mouth, nausea, or abdominal discomfort;

12. Feeling of numbness or tingling (parasthesia);

13. Fear of death;

14. Fear of going crazy or committing an uncontrollable act. (according to G. V. Starshenbaum)

There are also somatized types of PA - with them, the symptoms are more expressed bodily than through an acute feeling of panic:

ALEXITIMIC PA. It is distinguished by a low severity of anxiety symptoms and a predominance of muscle tension, vomiting, headaches, abdominal pains, senestopathies (unpleasant and painful sensations in different parts of the body).

At CONVERSION PA there are sensations of a lump in the throat, weakness in an arm or leg, cramps, impaired gait or speech, hearing, voice, or vision loss. At the same time, the feeling of anxiety is practically absent, and all attention is concentrated on local bodily manifestations.

It is logical to assume that when such symptoms appear, the first thought will be: "Urgently see a doctor." Anxiety can be so strong that test results can be rechecked several times. With PA, all indicators are usually normal, and it can be concluded that the culprit of this condition is not somatic, but psychological disorders.

It is no secret that the mental and physical life of a person is closely related. Therefore, when one of these components is under stress, the other, as a faithful companion and partner, is also stressed.

MECHANISMS OF THE OCCURRENCE OF PA

Excitation is transmitted by nerve impulses along nerve fibers. In an even mental state, it passes through the sections responsible for the work of the striated muscles, and as a result initiates movement.

In case of excessive stress or anxiety, the nerve impulse goes astray and enters the departments responsible for the functioning of smooth muscles, causing disruption of the autonomic nervous system. It is not under the control of consciousness, therefore vegetative manifestations and the inability to regulate them are frightening.

Panic attacks are characterized by the fear of going crazy and the feeling that "something is wrong with me." “It is impossible to trust your body if it does not obey you” (Dmitry, 32 years old). It should be noted that the manifestations of PA do not pose a threat to the physical condition and life of a person. And in the process of painstaking, but necessary for the psyche, work, the nervous impulse will "remember" the correct path and return to its normal functioning.

The psychological mechanisms of the onset of PA are closely related to the human emotional self-regulation system, which in people suffering from such panic attacks is either not built up or is disturbed. They vaguely distinguish between their emotional states, mainly in the interval "comfortable-uncomfortable", "bad-good", and cannot connect these feelings with the basis of their appearance - therefore they can rarely name the cause of an attack. Since emotions are not recognized and not expressed, tension and anxiety in stressful situations grows and "pours out" into an attack of generalized (that is, general, undifferentiated by reason and content) panic.

Psychologists note a number of common patterns in the life of people suffering from PA. They usually occur between the ages of 18 and 35. This is the period when it is necessary to make a responsible decision that will change the established way of life. The trigger mechanism for the onset of PA may be the need to leave the parental home, the situation of admission to college, the time of making a decision about a wedding, divorce, or ideas about the need to plan the birth of a child - various situations associated with intense, sometimes contradictory, emotions and increased stress. "All my friends have already gone to the" second round ", but I still won't dare to take the first one." (Oksana is 28 years old).

The physiological PA response described above is triggered by excitement from new perspectives, reinforced by anxiety to go beyond the usual framework. And the panic begins.

Often times, people with panic attacks do not have a sufficiently stable and close relationship with their parents. Or parents themselves are very anxious and vulnerable or weak in health, so the child does not have the opportunity to fully feel protected and understood. Without a strong, supportive shoulder nearby, dealing with strong feelings is much more difficult, and converting intent into action is much more terrifying.

Interestingly, such experiences are usually not realized, but remain in the unconscious (which occupies 90 percent in relation to 10 percent of consciousness), therefore, with psychological support, it is important to give yourself time to understand the personal reasons for the emergence of anxiety leading to PA.

The loss of a loved one is also a common cause of panic disorder. Loss does not necessarily mean only the death of a loved one. Larisa, a 62-year-old woman, had a father who died six months before her son's marriage, but panic disorder began just after the wedding, when the young people moved to a separate apartment. It seems that Larisa only wished for happiness for the young, and buying an apartment was her idea, but she could not understand and survive the sadness in connection with the separation of already grown children and fears about the coming old age. First, she developed hypochondriacal fears, daily anxiety for her husband, fears that something might happen to him on the way to work, and then she herself began to have panic attacks every time she left the house. It took at least a year of work to ensure that Larisa could understand the reason for such symptoms, which is the unwillingness to part with loved ones, and the situational trigger mechanism for their occurrence - any situations associated with leaving home. Of course, the symptom was also "reinforced" by the "secondary benefit" available for almost any illness - after all, on weekends, the whole family now sat at home around her.

In the psyche, nothing appears "just like that." So PA has its own "functions" that help the human body "adapt" to the variability of the surrounding world:

1. Liability protection function

In case of impossibility / lack of resources to make a decision or experience changes, the appearance of the user agent completely switches attention to itself.

“I would have changed my job long ago, left my parents, changed my profession … if not for my seizures.”

2. Receiving care from others

With PA, a person is forced to seek help from parents, spouses, friends. Because it is impossible to be alone with your fear. And thus, panic disorder helps maintain or improve communication, even if the relationship may have been strained in the past.

3. The ability to finally start taking care of yourself

In ordinary life, we are all subordinated to the principle of "must", and the PA makes a person take more care of himself. You can negotiate new, more comfortable conditions (work from home); take care of the delivery of products to the online store or to your spouse; finally buy an orthopedic mattress.

Thus, PA is another manifestation of the psyche's ability to find ways and techniques to adapt to external circumstances through a symptom - as Freud himself emphasized, "a symptom always has an adaptive meaning."

Dealing with panic attacks is the business of psychotherapists, although more often than not, PA sufferers turn to neurologists and hope to take medication.

In psychotherapy, painstaking work is carried out to build a system of emotional self-regulation, which includes the ability to distinguish and experience various emotions, understand the reasons for their occurrence and look for adequate ways of expression. The work is not fast, it should be noted, since such a system is being built for a long time and almost from scratch, and clients, having little understanding of what is happening to them, often demand immediate relief. In fact, in the process of work, PAs often turn first into phobias - that is, more structured neurotic disorders, where there is an object or situation that causes an avoidance reaction, then they are simply transformed into fears or fears about certain situations, and then finally come to naught. …