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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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“I was driving home after work,” David reported. “Things had been very stressful there lately. I was tense but looking forward to getting home and relaxing. And then, all of a sudden—boom! My heart started racing, and I felt like I couldn’t breathe. I was sweating and shaking. My thoughts were racing, and I was afraid that I was going crazy or having a heart attack. I pulled over and called my wife to take me to the emergency room.”
David’s fears turned out to be unjustified. An emergency room doctor told David, a composite of several therapy patients seen by one of us (Arkowitz), that he was suffering from a panic attack.
The current edition of the Diagnostic and Statistical Manual (DSM) defines a panic attack as an abrupt and discrete experience of intense fear or acute discomfort, accompanied by symptoms such as heart palpitations, shortness of breath, sweating, trembling, and worries about going crazy, losing control or dying. Most attacks occur without obvious provocation, making them even more terrifying. Some 8 to 10 percent of the population experiences an occasional attack, but only 5 percent develops panic disorder. Contrary to common misconception, these episodes aren’t merely rushes of anxiety that most of us experience from time to time. Instead patients who have had a panic attack typically describe it as the most frightening event they have ever undergone.
Research has provided important leads to explain what causes a person’s first panic attack—clues that can help ward off an attack in the first place. When stress builds up to a critical level, a very small additional amount of stress can trigger panic. As a result, the person may experience the event as coming out of the blue.
Some people may have a genetic predisposition toward panic, as psychologist Regina A. Shih, then at Johns Hopkins University, and her colleagues described in a review article. The disorder runs in families, and if one identical twin has panic disorder, the chance that the other one also has it is two to three times higher than for fraternal twins, who are genetically less similar. Although these findings do not rule out environmental factors, they do strongly suggest a genetic component.
Panic disorder imposes serious restrictions on patients’ quality of life. They may be plagued by a persistent concern about the possibility of more attacks and may avoid situations associated with them. To receive a diagnosis of panic disorder, patients must also worry that they might have another attack where it would be embarrassing (say, in a public setting such as a classroom), difficult to escape (such as when one is stuck in traffic), or difficult to find help (for example, in an area with no medical facilities nearby). Panic disorder accompanied by extensive avoidance of these situations results in a diagnosis of panic disorder with agoraphobia; in extreme cases, sufferers may even become housebound.
From Normal Anxiety to Crippling Fear
What are the roots of such incapacitating attacks? Psychologist David H. Barlow of Boston University, who has conducted pioneering research on understanding and treating panic disorder and related disorders, and others believe that panic attacks result when our normal “fight or flight” response to imminent threats—including increased heart rate and rapid breathing—is triggered by “false alarms,” situations in which real danger is absent. (In contrast, the same response in the face of a real danger is a “true alarm.”)
When we experience true or false alarms, we tend to associate the biological and psychological reactions they elicit with cues that were present at the time. These associations become “learned alarms” that can evoke further panic attacks.
Both external situations and internal bodily cues of arousal (such as increased breathing rate) can elicit a learned alarm. For example, some people experience panic attacks when they exercise because the physiological arousal leads to bodily sensations similar to those of a panic attack.
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27 Comments
Add CommentThank you for publishing this much needed article. I have dealt with Panic Disorder/Anxiety Disorder combined with PTSD for years. Now my youngest son, eleven years old has experienced it to the point of a DSMII diagnosis. What happened? Divorce went from nice to nasty overnight. It was just enough additional stress to trigger it. So many people, my father and former as well, that just look at this and call it imaginary or just another way to get attention. I will be sure to email them each a copy - if for no other reason, than to hopefully open their eyes that Panic is valid...very valid.
Reply | Report Abuse | Link to thisThis is good information for people with this disorder and for the family/friends of those people. Education has been the key to keeping my panic attacks at bay. I have suffered from panic disorder since the death of my fiance and baby (at the same time) 6 years ago. My first attack was the "mother" of all attacks and I thought I was dying. It was, by far, the most miserable and terrifying feeling I have ever felt in my life. NO ONE understands unless they have experienced it, and I didn't either until it happened to me. Removing caffeine from my diet has helped as well.
Reply | Report Abuse | Link to thisSo if a person has panic attacks each time they have to give a presentation and avoids doing anything remotely like a presentation then it seems to be they quality for the diagnosis of panic disorder with agoraphobia if their concern is being "seen" to be having a panic attack (vs. just being scrutinized)...and yet would instead be given a diagnosis of specific social phobia....it seems to me that there is an overlap between panic disorder and some forms of social phobia..
Reply | Report Abuse | Link to thisIn the case I mention is the danger not in fact real though? (in other words if you were to have a panic attack while giving a presentation you do run the risk of lowering your social status--it that not in fact a "danger"? not all danger amounts to being eaten by lions no?
"In the case I mention is the danger not in fact real though? ... not all danger amounts to being eaten by lions no?"
Reply | Report Abuse | Link to thisThis is a problem with treating some phobias. I have a terrible fear of riding in automobiles, and have never been a licensed driver which limits my life (I live in a rural area). One thing that I've noticed through the years is that if I had any other phobia, say of snakes or lighning, one of the first things people will do to assuage the fear is point out how much more likely I am to get mangled or killed in a horrible car accident than I am to get bitten by a snake or hit by lightning. But when it comes to an actual fear of cars, all they can do is basically lie and say the statistics aren't true and I'm safe, or they can say how the end justifies the means and it's worth the risk (is it? why worry about being crippled for life when you can get to the grocery store 10 minutes faster!). I'm not the sort who can be fooled with that, which has left my therapists with no other option than to find a medication that can calm me. Um, hello? Should I be learning to drive while sedated? Oh, I'll be much safer then... The point being, when is a fear of something justified, and does it always need to be treated as an abnormality? Should we force everyone who fears heights to become tightrope walkers for their own good, or just let them keep their feet on the ground?
"The point being, when is a fear of something justified, and does it always need to be treated as an abnormality? Should we force everyone who fears heights to become tightrope walkers for their own good, or just let them keep their feet on the ground?"
Reply | Report Abuse | Link to thisI would agree that your fear is in fact valid. Because car travel is such an everday event people don't tend to fear it. I would agree that is probably makes more sense to allow people to "keep their feet on the ground" but what happens say if all the development is now above ground and people have no option but to live up high.... In North America, in most places, car travel is the only option for some if they need to work and there is nothing local so I suppose doctors will tend to medicate and get people over the fear just so they can function in a world where car travel can be necessary... I think lots of phobias and even some mood disorders are simply modern day maladaptions (i.e. todays world with its skyscrapers/cars/tons of people/noise/stimulation is simply too much for many us wired for a very different world--I personally suspect bipolar hypomania and mania and even panic disorder is really just "overexcitement").... Your fear of car travel is valid and my fear of looking nervous while presenting are valid--I suspect we'll have to try to extinuish our fears to a certain extend because both of those activities are so prevalent in today's world. Good luck!
I have been in combat and other extreme situations and have felt fear. In those environments it is "easy" to over come, training and knowledge take over. But like the anecdote in the articel once I was driving 2 blocks from my house and had my one and only panic attack. I thought I was having a heart attack, I did not know what was going on. I had just ended a 6 month assignment for DHS, but was home and safe.
Reply | Report Abuse | Link to thisThanks for publishing this!
Eyespot and Zannah, I have studied and worked in this area, so let me see if I can answer some of your questions.
Reply | Report Abuse | Link to thisAs you point out, Eyespot, diagnosis can be difficult, and diagnostic schemes used by mental health workers and scientists are by no means perfect. Panic disorder tends to be a classification made when the criteria for a specific phobia or social phobia aren't present. In the example you give about social phobia and specific phobia, some of the key questions that would be made in diagnosis would be about how specific the panic attacks are to social situations; and to what extent the person is afraid of embarrassment, as opposed to being afraid of the panic itself. The diagnosis should always get at the route causes of the problem, but this can be very difficult, particularly with psychiatry being such a young scientific endeavour. Also, it is not necessarily within a person's conscious capability to state what the reasons for their fear are, which limits our ability to rely on direct questioning alone.
Zannah, Eyespot is right in saying that for a fear of something to be given a diagnosis (such as simple phobia), it must interfere with your ability to function, to live everyday life as you would like, to a significant extent. So certainly a fear of heights, if a person never had need or desire to go to height, would probably not be seen in a psychiatric clinic.
Finally, of course you are right in observing that many anxiety problems might have real fears at their route. But a cognitive therapist might also look at ways in which the phobic person exaggerates the probability of the event (even though car accidents are common, it's by no means likely that on a single drive the shops, you will have an accident) or exaggerating the consequences of the fear (commonly accidents dont incur any serious injury and minor mistakes in a presentation wont be remembered by anyone but the speaker).
But apart from these questions about risks, consequences, etc., there is the other half of picture which needs to be considered. Many researchers in this area would agree that fear is as much about judging your own ability to deal with a situation as it is about appraising the danger of a situation. This judgment might be made consciously, or unconsciously, a kind of rapid appraisal of the situation and your abilities. Fear of driving or of giving speeches might be as much about appraisal of personal ability to deal withas exagerrating danger. Exposing oneself to the situation might then give confidence about control.
resp to edj2008--thanks for your insights...
Reply | Report Abuse | Link to this"...to what extent the person is afraid of embarrassment, as opposed to being afraid of the panic itself..."
Ah...true..in my case the panic attacks do not bother me in and of themselves because I recognize them for what they are--it is only their ability to embarrass me or derail my performance that I dread so I suppose specific social phobia would be more accurate...
"or exaggerating the consequences of the fear (commonly accidents dont incur any serious injury and minor mistakes in a presentation wont be remembered by anyone but the speaker). "
I wish "minor mistakes" were my concern!...I had the horrible experience of experiencing my first full on panic attack at the beginning of a presentation (in front of family/peers and coworkers)...I froze and my voice literally 'cut off'...I thought I was having a stroke...so I never made it through my presentation (apparently I just walked out the door)...and unfortunately this imprinted in a big way (this was about 15 years ago and my heart is pounding and my stomach dropping just remembering it)....it has had a big impact on my career (in the sense of limitations I impose on myself).... I am trying to work up the courage to try and overcome this problem but the fear is very intense and has 'spread' and now I worry I will never be able to fully extinguish it...
I am high school student and live in Japan. I have't completely mastered English, so I couldn't understand this article in detail. But I was interested in this report so much.
Reply | Report Abuse | Link to thisIs posible that man made treats are highest than biological capacity of response to stress in natural conditions.A street crowded coulbe most dangerous to mind that a wild forest menaces.The situation produce panic as a limit one like fears to be kill or wounded?
Reply | Report Abuse | Link to thisMine does not end. Even if I manage to go to sleep, it continues as soon as I wake up, with nausea and a feeling of great dread. Pretty soon my brain begins to fire fearful thoughts at me, so fast and relentlessly, I can't talk to myself fast enough to counteract them. And all day, waves of nausea and panic even though I try not to react. It's as if a machine takes over. This goes on for days. I could not survive without medication.
Reply | Report Abuse | Link to thisInteresting to see a picture of a black man, true, blacks have to be on their guard, probably that guy in the picture went to his boss and gave an idea, boss said it was rubbish then immediately boss claimed idea as his own, no wonder he is panicking he got no credit rather his white boss got the credit after the white boss told him he is talking garbage and should be a basket ball player or boxer, that is where his real talents lie, its a tough world, that is why people are on the edge.
Reply | Report Abuse | Link to thisAs a clinical psychologist, I have long observed in my patients a taxonomy of anxiety/panic that have been unable to find in the literature. I note three kinds of anxiety/panic (1) anxiety/panic that is associated with a mood disorder, so that anxiety is one face of what the DSM regards as a depressive illness (2) anxiety/panic of a post-traumatic nature (3) anxiety/panic that arises as part of the onset of a psychotic disorder, e.g. the onset of schizophrenia or dementia.
Reply | Report Abuse | Link to thisThis taxonomy covers all the patients I have ever seen (in 22 years of seeing patients). The taxonomy suggests guidelines for treatment: (1) SSRIs (2) talk therapy, and SSRIs and/or a sleep aide (3) antipsychotic medication. The differential diagnosis is sometimes tricky and requires a thorough history.
Anybody recognize any useful ideas in here? Jeff Mitchell, Ph.D.
I have suffered from a few panic attacks, one so debilitating that it took three weeks to fully recover from. The best and most lasting relief I've found is from using EFT, or Emotional Freeing Technique. www.eft.com is the official website but another good source to learn the technique (which is free to learn) is from www.tapping.com which has some great free videos to lead you through the basic "recipe." EFT is like acupuncture but without needles. It looks crazy and seems completely counter-intuitive BUT IT WORKS. I've been using it for three years now and it's just a great way to deal with all kinds of stress and problems besides panic attacks. I highly recommend trying it even if you take a look and think, man that's just crazy, that can't work! It's free and easy to learn, it's 99.9% harmless (anything can be dangerous if you try hard enough...) and just about anyone can do it. What have you got to lose?
Reply | Report Abuse | Link to thisNamaste.
Dang, I got the official website address wrong! It's www.emofree.com Sorry for any trouble this may have caused.
Reply | Report Abuse | Link to thisWhen I was younger I would experience panic attacks that would frequently be followed by eating binges.
Reply | Report Abuse | Link to thisI had never fit any specific diagnosis before, and this might have been because my issues had a physiological basis. Now that I have full blown diabetes, I experience anxiety leading to long lasting panic episodes almost every time that my blood sugar drops too low. It would seem that my undiagnosed pre-diabetic hypoglycemia was the cause of my panic attacks.
An interesting thought: that if your body really is discretely dying, it will throw itself into panic to survive.
When I was younger I would experience panic attacks that would frequently be followed by eating binges.
Reply | Report Abuse | Link to thisI had never fit any specific diagnosis before, and this might have been because my issues had a physiological basis. Now that I have full blown diabetes, I experience anxiety leading to long lasting panic episodes almost every time that my blood sugar drops too low. It would seem that my undiagnosed pre-diabetic hypoglycemia was the cause of my panic attacks.
An interesting thought: that if your body really is discretely dying, it will throw itself into panic to survive.
When I was younger I would experience panic attacks that would frequently be followed by eating binges.
Reply | Report Abuse | Link to thisI had never fit any specific diagnosis before, and this might have been because my issues had a physiological basis. Now that I have full blown diabetes, I experience anxiety leading to long lasting panic episodes almost every time that my blood sugar drops too low. It would seem that my undiagnosed pre-diabetic hypoglycemia was the cause of my panic attacks.
An interesting thought: that if your body really is discretely dying, it will throw itself into panic to survive.
Again, I repeat my suggestion about EFT: www.emofree.com, www.tapping.com Phobias, panic attacks, fears of all kinds can be greatly helped by using this gentle technique. You don't even need to talk about your fears with anyone and can do it yourself! For free! The neat thing about it is it doesn't eliminate your logical response to danger, it only stops the physical cascade of symptoms that can unnecessarily limit a person's life. For example, a person with a fear of heights would not, by removing the fear, suddenly start to indulge in risky behavior involving high places, it would only stop the extreme and debilitating response to heights.
Reply | Report Abuse | Link to thisI was cured of panic disorder and panic attacks (1998-2000) by cognitive behaviorial therapy, increasing the amount of exercise I get, and fish oil supplements.
Reply | Report Abuse | Link to thisI've used EFT, or Emotional Freeing Technique, for the last three and a half years to gain control of and relief from my anxiety and panic attacks. I highly recommend it as the best and cheapest way to get free of all kinds of problems but especially anxiety and panic attacks. It's free to learn and easy to implement. It does take persistence and the willingness to be a detective about what is causing your problems. I use it on a daily basis with great results in all aspects of my life. Here is the url for the official site: http://www.emofree.com/
Reply | Report Abuse | Link to thisStress can cause panic attack, and it can catch you when you least expected it. Out of the blue, you will have palpitations as if having a heart attack and your hands will start to tremble – these feelings will cause you anxiety that will just trigger another attack and the cycle goes on. Articles like this are very important to educate everyone about what panic attack really is. I have read a similar article, No, It's Not A Heart Attack @http://overcomingpanicattacks.com/symptoms-of-panic-attacks-heart-attack/
Reply | Report Abuse | Link to thisI also have a panic disorder along with PTSD. I have noticed lately, that something that sets it off is when someone is talking very fast ..to my face or on the phone. It's almost like a sensory overload type thing. Has to happened to anyone else?
Reply | Report Abuse | Link to thisI really recommend this: It really helped me a lot!!!
Reply | Report Abuse | Link to thishttp://panicawayfromyou.blogspot.com/
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Reply | Report Abuse | Link to thisIt really help!