The Dark Alley - What are indications of Panic disorder and Anxiety Disorder ?
John, a middle-aged adorned with a physique reminiscent of Atlas, finds himself in a tender struggle when deprived of the solace that exercise provides to soothe the depths of his anxiety. The mere thought of being unable to partake in his beloved workouts becomes a poignant trigger, unleashing a sudden cascade of panic. In these moments, he loses himself completely, his senses carried away on the turbulent currents of anxiety that he recalls from his youthful memories. (the patient name, gender, and story are changed and modified for the protection)
Panic disorder and generalized anxiety disorder (GAD) are distinct mental health conditions with overlapping and divergent characteristics. Both disorders are recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While both involve significant anxiety, they differ in presentation and treatment needs.
Treatment options for both disorders share some similarities but also require nuanced approaches. Cognitive-behavioral therapy (CBT) plays a key role in both cases, aiming to alter unhelpful thought patterns and coping mechanisms. Additionally, selective serotonin reuptake inhibitors (SSRIs) are often used for both disorders, as they help regulate mood and anxiety. However, the use of benzodiazepines, which offer rapid anxiolytic effects, typically differs between the two diagnoses due to concerns about dependence and limited long-term efficacy in GAD.
The Dark Alley
In the midst of the ordinary hustle and bustle of the clinic's routine, John, a middle-aged and robust gentleman, graces the establishment with his presence. His sole purpose, a testament to vulnerability in the midst of the mundane, is to seek solace for the persistent ache in his lower back, as a clandestine pain pirouetting beneath his skin for months. Yet, in the embrace of the clinical x-ray's scrutiny, a profound revelation unfurled – a fractured spine, a tale delicately inscribed within the very essence of his bones, revealing a narrative of resilience and fragility entwined.
Instead of dwelling on the treatment of his fracture, John, with eyes reflecting a vulnerability masked by strength, utters a question that echoes a deeper desire: "Can I do exercises?”
Intrigued by the shades of his exercise routine, I inquire about the kinds of exercises that he typically indulges in. Without the luxury of a gym membership, John finds solace in lifting weights within the confines of his home. Concerned about the impact of weightlifting on the healing process of his spinal fracture, I gently suggest a pause on weightlifting, steering him towards the gentler embrace of jogging around his neighborhood.
The mere suggestion of jogging, however, unravels a cascade of emotions within him, triggering a sudden breakdown accompanied by a relentless panic attack. His breath quickens, his body trembles, and beads of sweat materialize on his forehead. The once calm and controlled demeanor slips away, leaving behind a soul in turmoil. In a tender attempt to guide him back to tranquility, I encourage him to lie down on the patient bed, imploring him to inhale and exhale deeply, coaxing his body into a state of relaxation.
Despite hearing my soothing voice and comprehending my gentle commands, John remains unable to respond and follow through. After what seems like an eternity, a glimmer of progress emerges as he tentatively begins to take deep breaths, allowing the shadows of panic to gradually dissipate.
In a moment of vulnerability, John shares a painful fragment of his past—a time when he endured relentless bullying in the harsh reality of the slums he called home. The journey back from school was marred by encounters with a group of heartless teenagers who would stop, taunt, and inflict physical pain upon him, forcing him into a relentless cycle of running to escape the torment. Faced with this haunting past, lifting weights became his sanctuary, a coping mechanism to alleviate the weight of anxiety.
Now, the mandate to cease weightlifting feels like a cruel decree, extinguishing the flicker of hope he clung to. The alternative, a seemingly innocuous act of walking or jogging around the neighborhood, is tainted by the specter of his traumatic memories. Although he may jog during the daylight, the thought of venturing into the area triggers overwhelming anxiety, casting his world into darkness once more and pushing him to the brink of a panic attack.
Embarking on healing, John grapples not only with a fractured spine but also with the fragments of his past that intertwine with the threads of his present. As the provider, my role extends beyond the physical realm, encompassing the intricacies of his emotional landscape, guiding him through the shadows towards the light of recovery and renewal.
https://medicalcriteria.com/web/panic-disorder/
Panic Attack
Panic attacks are characterized by abrupt episodes of intense fear or discomfort that peak within minutes and can be profoundly distressing. These episodes typically involve a constellation of both physical and psychological symptoms.
The occurrence of panic attacks can be unpredictable, arising spontaneously or triggered by specific situations. While the frequency and severity can vary considerably between individuals, the attacks themselves are usually brief, lasting approximately 10 minutes. However, the after-effects can be significant, often leaving individuals with lingering anxiety and apprehension about future episodes.
How do people express the symptoms of panic disorder?
Verbally:
Describing physical sensations: Individuals experiencing panic attacks may articulate sensations such as a racing heart, difficulty breathing, or a sense of impending doom. They might express feeling dizzy, nauseous, or shaky.
Expressing fear and anxiety: Those with panic disorder may convey intense fear and anxiety through statements like "I feel like I'm going to faint" or "I'm worried I might have a heart attack."
Seeking reassurance: During a panic attack, individuals may seek reassurance from others, asking questions such as "Am I okay?" or "What's happening to me?”
Nonverbally:
Physical symptoms: The visible signs of panic disorder include sweating, trembling, or hyperventilating. A person may exhibit a pale or flushed complexion and engage in behaviors like pacing or rocking back and forth.
Facial expressions: Individuals experiencing panic attacks often display facial expressions characterized by fear or terror. They may have wide eyes or dilated pupils.
Body language: In response to a panic attack, individuals may adopt certain body postures, such as curling up in a ball or holding their hands to their chest. They might also avoid eye contact and withdraw from social interactions.
What are indications of panic disorders?
Based on DSM-5, you need to have both part A and part B of criteria in order to indicate the panic disorders
Part A: Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.
Part B: Patients have recurrent panic attacks (frequency is not specified) in which ≥ 1 attack has been followed by one or both of the following for ≥ 1 month (1):
Persistent worry about having additional panic attacks or worry about their consequences (eg, losing control, going crazy)
Maladaptive behavioral response to the panic attacks (eg, avoiding common activities such as exercise or social situations to try to prevent further attacks)
In addition, Part C and Part D eliminate another reasons that cause the panic disorder:
Part C: The disruption in question cannot be ascribed to the physiological impact of a substance, such as a drug of abuse or medication, nor to another medical condition, including but not limited to hyperthyroidism or cardiopulmonary disorders.
Part D: The observed disturbance cannot be more aptly accounted for by another mental disorder. Specifically, the onset of panic attacks does not exclusively manifest in reaction to apprehension in social situations, as observed in social anxiety disorder. Neither does it emerge in response to specific phobic objects or situations, characteristic of specific phobia. Furthermore, the occurrence is not linked to obsessions, a hallmark of obsessive-compulsive disorder, nor is it triggered by reminders of traumatic events, indicative of posttraumatic stress disorder. Additionally, the disturbance is not associated with separation from attachment figures, a distinctive feature of separation anxiety disorder.
General Anxiety Disorder
Generalized Anxiety Disorder (GAD) is a mental health condition characterized by excessive and persistent worry or anxiety about various aspects of life.
People with GAD often find it challenging to control their worries, and the anxiety is not limited to specific situations or events.
Thus, imagining world where even the smallest cloud casts a shadow of worry. Where the hum of daily life vibrates with a constant undercurrent of anxious anticipation. That's what living with Generalized Anxiety Disorder can feel like. It tends to be more pervasive and can be related to a range of concerns, such as health, work, relationships, and everyday activities.
How do people express the symptoms of GAD?
Imagine feeling like your mind is a swirling storm of worries, even about ordinary things. That's what it can be like for people with Generalized Anxiety Disorder (GAD). It's a common mental health condition that makes it hard to control worry and anxiety, impacting various aspects of daily life.
Here are some common symptoms of GAD:
Worrying: It's not just the occasional "what if."GAD involves constant, excessive worry about everything from work and relationships to finances and health, even when there's little reason to fret.
Restlessness and edginess: GAD can make you feel like you're constantly on edge, easily fatigued, and unable to concentrate. It's like having a low-level battery that's always draining.
Muscle tension: GAD can tighten your muscles, leading to aches, pains, and a general feeling of physical discomfort. It's like carrying a backpack full of worries that weighs you down.
Irritability: Feeling on edge can make you easily snappy and impatient with others, even yourself. It's like having a short fuse that's always flickering.
Sleep problems: The constant worry can make it hard to fall asleep and stay asleep, leaving you feeling exhausted and foggy-headed. It's like trying to sleep with a swarm of buzzing bees in your head.
Difficulty concentrating: GAD can make it hard to focus on tasks, whether it's work, studying, or simply watching a movie. It's like your mind is a pinball machine, bouncing from one worry to another.
Physical symptoms: GAD can also manifest in physical ways, causing headaches, stomachaches, trembling, sweating, or dizziness. It's like your body is reacting to the emotional storm inside you.
Perfectionism: Striving for perfection can be a positive quality, but for people with GAD, it can become a source of constant anxiety and fear of failure. It's like setting an impossible bar for yourself and feeling crushed when you inevitably fall short.
Remember: GAD is a real and treatable condition. If you're experiencing any of these symptoms, reach out for help. Talk to your doctor, a therapist, or a trusted friend or family member. There's no shame in seeking help, and with the right support, you can manage your GAD and live a fulfilling life.
What are indications of general anxiety Disorder?
The GAD-7 Screening survey is used to help the indications of GAD. Base on the score, you can discuss with your healthcare provide to help you identify the severe of GAD. You can download free GAD-7 at the bottom of the blog.
If you score 8 or more on a special test, there's a good chance you might have a type of anxiety called GAD. This test isn't perfect, but it's a good starting point.
If you score 0-4, you likely have minimal anxiety.
If you score 5-9, you might have mild anxiety.
If you score 10-14, you might have moderate anxiety.
If you score 15 or more, you might have severe anxiety.
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Basic Treatments for Panic Disorder and General Anxiety Disorder
Anxiety disorders, like panic disorder and generalized anxiety disorder (GAD), are incredibly common and can seriously impact your daily life. Unfortunately, they often go undiagnosed or are mistaken for physical problems.
Getting an accurate diagnosis is crucial. Doctors need to carefully consider all possible causes of your symptoms, including other mental health conditions. There are even free tools like the GAD-7 and the Severity Measure for Panic Disorder that can help.
The good news is that treatment works! A combination of medications and therapy, especially cognitive behavioral therapy (CBT), has proven highly effective. While medications like selective serotonin reuptake inhibitors (SSRIs) can help manage symptoms, remember that some, like benzodiazepines, come with risks and should be used cautiously.
Exercise can also be a powerful tool in managing anxiety. And although research on alternative therapies like supplements is still ongoing, some may offer additional support.
If you're taking medication, know that stopping too soon can lead to a relapse. Typically, doctors recommend continuing for at least a year before slowly tapering off.
If you're struggling with anxiety, remember you're not alone. Talk to your doctor, explore your treatment options, and take control of your mental health.
In our next blog, we'll dive into the details of treating panic disorder and generalized anxiety disorder.
References
https://www.aafp.org/pubs/afp/issues/2015/0501/p617.html
https://www.merckmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/panic-attacks-and-panic-disorder?query=panic attacks
https://medicalcriteria.com/web/panic-disorder/