Panic Attacks And Comorbid Disorders

Video: Panic Attacks And Comorbid Disorders

Video: Panic Attacks And Comorbid Disorders
Video: Panic disorder - panic attacks, causes, symptoms, diagnosis, treatment & pathology 2024, March
Panic Attacks And Comorbid Disorders
Panic Attacks And Comorbid Disorders
Anonim

Beginning About "self-treatment" of panic attacks. The psychosomatic problem is part of the physiological

So … let's say we passed the examination and it turned out that everything is in order with our body, and the PA is the very psychological symptom that everyone is talking about. Are medications really so useless in PA therapy? Will those self-help recommendations that the Internet is replete with really help, or, on the contrary, will they aggravate the situation? Can we really get rid of PA once and for all by working with a psychologist-psychotherapist?

Approaching the psychological part of this question, one can start with the common misconception that drug treatment for PA does not help. Despite the fact that I do not prescribe any drugs myself, I work closely with other specialists, so I can clearly see the difference between clients undergoing drug therapy and not. There is no need to create an artificial gap between medicine and psychology, especially in psychosomatic issues, and even more so today, when there are so many drugs that are not addictive and have such side effects as before.

Ironically, clients with PA, until they turn to a psychotherapist, do “self-help” for a long time, and only when PA begin to grow overgrown with phobias and other mental disorders, they understand that something seems to be going wrong. At the same time, they need to go to school / work, ride the subway and the elevator, give a lecture or interact with people, and then every exit from the house becomes a ritual feat … psychotherapy is a long process that does not tolerate haste and does not promise magical healing here and now … So at the initial stage, drug therapy helps to maintain social activity, and also helps the client to reach the psychotherapist (Moreover, as I wrote in the previous article, drug therapy helps in the case of physiologically caused PA (for example, with hormonal storms, withdrawal syndrome, etc.). Timely diagnosed and corrected PA can disappear from our life as quickly as they once appeared in it.

If we are not talking about the so-called comorbid disorders - neurotic disorders associated with panic. After all, the fact is that all kinds of phobias and other "satellites" are not at all symptoms of PA, but separate disorders that indicate only that there is a progress of aggravation. They can be either independent or join the PA, most often these are:

- generalized anxiety disorders;

- phobias;

- obsessive-compulsive disorder (OCD);

- post-traumatic stress disorder (PTSD);

- depression;

- alcoholism and somatoform disorders (to the question of "heart", "ulcer", etc.).

It is the addition of these disorders that scares people and indicates that panic disorder has been released into free swimming. But most importantly, it is the very self-help advice that we read about in the articles about PA that helps them develop. So at first the client simply counted the pillars in order to distract himself from a possible attack of the PA, and after a while he realized that until he counted all the pillars, the anxiety would not be reduced in any way (OCD). First, the PA happened at home, in an absolutely comfortable and calm environment, and then they tried to intensify the attacks, until the metro and minibuses suddenly became a potentially dangerous place (phobia). At first, 100 grams at dinner helped to fall asleep without fear of a vegetative crisis, and then binges and so forth began (alcoholism). I wrote in the first article about how "neglected" PAs provoke psychosomatic disorders and diseases. Does this mean that PA is a terrible disease? NO. This suggests that any disorder needs a timely competent assessment and appropriate correction, and not distractions or, on the contrary, amplification.

Even a psychotherapist does not offer the same model for PA correction based on his client's anamnesis. If it is obvious that the PA is just a PA, then the so-called. strategic therapy, which may suggest, under control, "experience and intensify the attack", but if the patient has a history of cardiovascular diseases, including heart surgery, I think everyone will be calmer from the analytical approach. You can work with a phobic component, the so-called. "By the flood method", but it is not necessary to work by the "flood method" if there is a suspicion of diseases of the central nervous system. In a sense, the not so chosen approach is effective in the therapy of PA, as the initial data that the client has (his physiological predisposition, character traits, personality structure and history itself) and his desire to get rid of the spectrum of acquired disorders.

Here you can immediately ask a simple question: "Does psychotherapy help get rid of PA once and for all?" And immediately answer honestly: "No". But in order to understand this answer, it still makes sense to turn to the very psychological reasons that can provoke panic disorder. And, again, you will find many reasons for these in the network, and often they are so universal that, if desired, each client-patient can confirm them in himself. In fact, the reason can be anything at all, something that was not even suspected (.

One of my clients, a happily married mother of three, suffered from PA with a phobic disorder. The reason was the repressed child psychotrauma - an attempt at rape, which she had completely forgotten about. This information fell out of her memory almost at the same age of 10, and made itself felt with such impulses, only 20 years later.

Another client, without realizing it, became a "victim" of watching the "Battle of Psychics". She was so impressed that she unconsciously identified herself with the heroes and opposed all these obscurantist scenes, and after a while she could no longer live without rituals and prayers that alleviate the anxiety of waiting for the PA.

Divorce, illness or loss of a loved one, violence, lingering stress and exhaustion in young mothers on maternity leave, conflict between wife and lover / work and family, and any other difficult choice, all of these can equally provoke an attack. Anxiety, which develops into PA, and after a phobia, can become simply a consequence of those very low self-esteem and self-confidence, an excellent student's syndrome or an achiever, or it can simply be the result of a violation of social interaction at a young age.

Be that as it may, neurotic disorders have two very subtle characteristics.

1. Initially, these disorders keep the physical health and appearance of the patient unchanged. At the same time, psychological disorders, which are not particularly noticeable to anyone and cannot be felt, make it possible to relieve oneself of responsibility. Objectively, it turns out that the client seems to be healthy, but there is no demand from him. This helps men avoid making any important decisions, and women, on the contrary, attract attention (not usually, maybe vice versa, but more often so). That is why such disorders have a very pronounced secondary benefit function. And in the event that the client is unconsciously not ready to part with the benefits that this disorder gives him, he begins to sabotage therapy in every possible way. Refuses to carry out assignments because “they make him even worse”, avoids discussing “these” topics, and so on. Thus, this is the very psychological "weakness" that allows you to catch on to panic attacks - the unconscious use of the disorder as an assistant in solving certain psychological problems.

2. The second feature is that such disorders can be compared to some kind of inner monster who feeds on the struggle with himself. That is, the more attention the client pays to getting rid of the user agent (and the company), the stronger and more often they become. And when the work, on the contrary, is carried out indirectly, all for the same reason of secondary benefit, the patient begins to sabotage this work too, resorting, naturally unconsciously, to a deliberate demonstration of symptoms.

This vicious circle can only be broken if the client really wants to get rid of the secondary benefits that this disorder gives him. Hence such double-sided statistics, some clients get rid of PA and Co quickly and efficiently, while others, on the contrary, are “treated” for years, and no psychotherapy can help them.

But with the latter, not everything is so simple, and again we are talking about the very same psychosomatics. When those clients who learn to coexist with PA and comorbid disorders (mainly people who refuse psychotherapy, and the symptoms of the disorders are muffled by antidepressants and tranquilizers, intermittently, from attack to attack), and use the secondary benefit that these disorders give them provides, very soon it happens that the user agent stops working. In the sense that others get used to such a completely harmless disorder, and they themselves ignore it and in every possible way push the alarmist partner to ignore it. PAs lose their functions of secondary benefit, and a person has not figured out the accumulated difficulties and has not learned to solve them adequately, what should he do? And the subconscious mind helps to use the very hormones that have been accumulating all this time in the organs and have not been worked out in any way. They receive "permission" to activate psychosomatic somatoform disorders. And PA gradually "fade away" (they are no longer needed), and the client already has actual somatic disorders and diseases. If you remember, this is probably the 55% - 67% of somatic patients with PA in history, which were discussed in the first article.

Since vegetative crises happen to each of us, and we cannot insure ourselves against them, I believe that in the treatment of panic attacks, whether they are physiologically or psychologically determined, the most important thing is timely diagnosis. Therefore, my recipe for someone who has encountered PA is this: consultation at least with a therapist and a neuropsychiatrist (and primary PA caused by physiological reasons can be stopped immediately), if necessary, individual, appropriate to the case, the selection of drug psychotropic treatment, and consultation of a psychotherapist (clinical / medical psychologist, a qualified specialist in psychosomatics). And then everything is in the hands of the panicking one;)

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