Not Just Any Old Butterflies

By Kara Baskin
Special to The Washington Post
Tuesday, January 9, 2007

I'm 27 years old, newly married, happily employed -- and, for two months this fall, I was petrified to leave my house. I have panic disorder.

According to statistics from the National Institute of Mental Health (NIMH), panic disorder afflicts roughly 6 million Americans, and women are twice as likely to suffer from it as men are. The attacks usually begin in one's 20s. Trembling, sweating, heart palpitations, shortness of breath, chest tightness and nausea are a few of the symptoms that come on like a lightning storm, out of the blue.

I know. I'm a textbook case: My first attack happened a week before my graduation from college. I was in bed, painting my nails bright red, when my heart began racing. I had the sensation that I was watching myself from above -- not alive but not quite dead. (I'd later learn that a sense of dreamlike unreality -- depersonalization -- is a hallmark of panic.)

I wondered at first if I were being punished for drinking too much at a party the night before. Perhaps someone had spiked my drink. (Nobody had.) What if I were actually dying? (I wasn't.) This is panic's flailing logic. Other sufferers I know count coins to ground themselves; some clean out their closets. Back then, when the attacks were new to me, I used to match celebrities with their home towns. (I recall murmuring, "Rosie O'Donnell, Merrick, Long Island," repeatedly.)

Ten minutes after they began, the feelings would vanish as inexplicably as they had descended upon me. That's the upside, I've since learned: A panic attack usually lasts just a few minutes; however, the memory of the fear haunts sufferers long after the symptoms disappear.

Without missing a beat, I'd return to my smug Type A existence. Yes, smug. Ever since I reached adulthood, I've flaunted hyperactivity like a new BlackBerry, the ultimate on-the-go Washingtonian, always complaining about how much I "had" to do while what I was really doing was refusing to sit still with my emotions.

Occasionally, the wrongheadedness of my lifestyle would tug at me -- leaving me crying for my beloved grandparents, who were aging; for my gentle, brilliant father, who was trying to help me and couldn't; for my mom, whom I wanted to protect from my problems; and for my fiance, Brian, who lived at the mercy of my emotions. But for the most part, it remained a nasty little itch that kept me running from flashy job to fancy dinner until I'd crash at 3 a.m.

For the ultimate control freak like me, finding myself quite literally paralyzed by fear was demoralizing. Determined to beat this thing into submission, I went to the ER (twice). Once I called an ambulance. (The EMT, upon finding nothing remarkable about my condition, looked at me as though I'd called him for a morning tryst.) I also saw an allergist, a gastroenterologist and an internist (because I was embarrassed to return to the gastroenterologist) and then a cardiologist. Each one confirmed the humiliating truth: I was physically healthy.

A generation ago, sufferers like me were generally told they had "nerves" or, more clinically, "anxiety neurosis," Jerilyn Ross, a psychotherapist and director of the Ross Center for Anxiety and Related Disorders in Washington, told me. Some were treated with electric shock therapy; others were locked in psychiatric wards. We are inheritors of the mysterious nervous conditions that have long plagued humankind, and more commonly womankind -- like the Victorians' broad diagnosis of "hysteria."

It wasn't until the 1980s, when the American Psychiatric Association began to make differential diagnoses, that the term "panic disorder" came to be accepted. Still, it remains woefully misunderstood by even the most well-meaning physicians. The symptoms that panic sufferers describe (such as shortness of breath) mimic serious physical illnesses. But the doctor often finds nothing wrong. So, Ross tells me, the typical panic patient sees 10 doctors before receiving an accurate diagnosis. And in doing so, we begin to feel like hypochondriacs, running from one specialist to the next, not realizing that our enemy is our mind, not our body.

According to the NIMH, panic disorder appears to be inherited and is often accompanied by other serious problems such as depression, drug abuse or alcoholism; once diagnosed, it is also one of the most treatable of all anxiety disorders.

That's the message I heard from Ross, who is president and chief executive of the Anxiety Disorder Association of America and whom I consulted when I began to research the disorder.

"Panic is real, it's serious and it's treatable," she says, and she speaks from experience, having overcome a phobia herself. I could have used her mantra on my honeymoon three months ago. This is when panic began to dominate my life. After the wedding, separated from my hectic Washington life, there we were: me, my new husband and my neuroses, marooned on a tropical island. I refused to leave our suite on Maui, taking comfort in the familiar cadence and tinny laugh of "Roseanne" reruns on TV, which soothed me to sleep. When awake, I mapped routes to the nearest hospital. Just in case.

Many panic sufferers become agoraphobics, first fleeing and then staying away from panic-inducing situations. That's what I did when I came back to Washington. I was so paralyzed by fear that I couldn't bear to ride the Metro or drive a car. I locked myself away -- and so exacerbated my problem. "By staying in the situation, and allowing yourself to be with the feelings, rather than leave, you'll desensitize yourself," Ross explains. "Every time you leave a situation, you think, 'Phew, thank God.' The fear builds. To break it, keep yourself in the situation."

Easier said than done when your mind and body are getting the message that they are in danger, and the flight-or-fight response kicks into gear.

The treatment for panic is typically some combination of the antidepressants known as SSRIs, which blunt the symptoms; anti-anxiety medications such as Valium for quick relief; and, over the long term, cognitive behavioral therapy. I'm now in treatment, taking medication and learning in therapy to recognize my destructive patterns of thinking and reacting, with the goal of replacing those patterns with more productive ones.

And I feel better than I have felt in years. I've also begun researching my illness, confident enough now to share my experience in the hope that it helps others. Many fellow sufferers are high-achieving and intelligent, it turns out. (Maybe it takes ingenuity to create such ghastly what-if-I'm-dying scenarios.) Put-together on the outside, hearts pounding within. And, while millions of us suffer from panic disorder, Ross estimates that less than a third of us know it and thus seek the treatment we need.

In therapy, I've learned that panic symptoms are scary, but they're also manageable. "If you have butterflies in your stomach, just give them a color," Ross says. I've always liked red. ยท

Comments:health@washpost.com. For a panic disorder self-test, visithttp://www.rosscenter.com. For additional resources, go tohttp://www.nimh.nih.gov/healthinformation/anxietymenu.cfmandhttp://www.adaa.org.


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