Panic Attacks: Did I Just Have One?

Like a heart attack.
When someone comes into an emergency room complaining of a heart attack, they are treated as though they are having one. But they may be having a panic attack. The symptoms — difficulty breathing, cold sweat, chest pain, rapid heart beat — are identical. Panic attacks occur unpredictably, and are not associated with any particular situations, unlike social phobias. Basically the body has gone into fight-or-flight reaction, dumping large amounts of adrenaline into the bloodstream.

What causes panic attacks?
A panic attack, or something that appears to be a panic attack, could be associated with a medical condition such as hypoglycemia or hyperthyroidism. It could be the result of extreme stress or anxiety. Stress may be related to current stressors. Anxiety may also be due to situational stress, but also may have deeper roots in upbringing or even trauma.

Trauma: Who is Predisposed?

Are some predisposed to develop trauma symptoms?
Why is it that some people are traumatized, others not? Is it genetic? Biological? These are the conventional questions. It turns out that many of the subjective experiences associated with Post-Traumatic Stress Disorder (PTSD) appear to be linked with an autonomic nervous system that has been thrown into overdrive. What does that mean? It means, as a result of some trauma, that nature’s get-up-and-go mechanism is both on high alert and also disinclined to step down from that alert. A constant state of agitation described as “hypervigilance.” Those with PTSD know that state well. Strange faces emerge from a crowd and take on a menacing aspect. The unexpected slam of a door sends the shoulders up around the ears where they hover in tension. The traumatized are ever ready with the potent shot of adrenaline.

The role of temperament.
Some of this is temperamental. Some people are wound tighter than others. It is easy to observe this in infants. Here is a baby that sleeps easily, is comforted after feeding, while another wails uncomforted by sleep, diaper change, breast. Intuitively this seems obvious. Put one of these high strung babies, these first violinists, in a traumatic situation and they might be more apt to emerge traumatized. Possibly.

Diagnosis and Psychoanalysis

The state of psychoanalysis, currently portrayed.
Some interesting articles in the New York Times this past Sunday. One on the status of psychoanalysis in universities. A little misleading, but highlights the current vogue of empirical findings to the gradual exclusion of all else. What’s missing is that there has been a fair body of research based on analytic premises. Much of it is referenced in the psychodynamic diagnostic manual. That book attempts to provide a more balanced and clinically useful guide to diagnosis that the “empirical” one promoted in DSM-IV (the current diagnostic manual of the American Psychiatric Association, widely used in the field and managed care). That Times article here.

Diagnosis and big pharma.
Not to suggest that empiricism is a bad word. Far from it. Here’s a piece regarding the overwhelming power of pharmaceutical companies that appears in the New York Review of Books. One of the books cited, written by two psychiatrists, takes great pains to dismantle the “empirical” basis for DSM-IV. The article is a good introduction to both how faddish and arbitrary the DSM is — and the influence of the psychopharm industry — and how the diagnostic system reinforces prescribing. That one is here.

Kalea Chapman, Psy.D.

Holiday Shopping for Rose City Center at Vroman’s

Support community mental health, in your community.
Shop at Vroman’s on Saturday, December 8th — profits go toward supporting affordable community mental health. Vroman’s is located on 695 E. Colorado Blvd. in Pasadena between El Molino and Oak Knoll.

You’ll need a voucher. I’m attaching it here: rose city fundraiser at Vroman’s. Up to 20% of the sale will go to the local non-profit counseling center, Rose City Center, where I am one of the clinicians. As the voucher notes:

Buy some books, support a cause.
“Rose City Center is a nonprofit organization offering psychoanlytic psychotherapy on a sliding scale. Please visit our website at http://www.rosecitycenter.org or call 626-793-8609.

That’s Saturday, December 8th. You can also shop at Vroman’s Fine Writing, Gifts, and Stationery, located at 667 E. Colorado Blvd, at the corner of El Molino. Finally, you can shop at Vroman’s Hastings — at 3729 E. Foothill Boulevard.

Or just come down and say “Hi.”

Media in Denial

The science-driven view.
Today’s New York Times, in the Science section, runs a rah rah story about the latest research on denial. The piece notes some interesting ideas being related to denial, most interestingly, forgiveness. The new research-informed definition of denial stretches the meaning almost to breaking, a common fate of psychological terms:

In this emerging view, social scientists see denial on a broader spectrum — from benign inattention to passive acknowledgment to full-blown, willful blindness — on the part of couples, social groups and organizations, as well as individuals.

In the past denial had been thought to be a non-willful blindness, but in this new research-driven definition “passive acknowledgment” is considered to be a key facet. The research offers us such surprising findings as: We are willing to overlook small violations of trust from friends, but not from strangers. Or, that a series of research studies revealed, steady yourself, people often idealize their partners.

The humor-driven view.
This reminds me of Ian Frazier’s essay in the New Yorker some years back, titled “Researchers Say”:

According to a study just released by scientists at Duke University, life is too hard. Although their findings mainly concern life as experienced by human beings, the study also applies to other animate forms, the scientists claim. Years of tests, experiments, and complex computer simulations now provide solid statistical evidence in support of old folk sayings that described life as “a vale of sorrows,” “a woeful trial,” “a kick in the teeth,” “not worth living,” and so on. Like much common wisdom, these sayings turn out to contain more than a little truth.

This New Yorker essay, which appears in the December 9, 2002 issue, says volumes more than breathless reports on the latest research findings. It’s well worth reading, here. Or, you can settle for the Times’ story, here.

Kalea Chapman, Psy.D.