- The Washington Times - Tuesday, January 11, 2005

Anna Somers once feared the color red.

Mrs. Somers was caring for her infant daughter and refused to give Rosa, now 7, Popsicles, yogurt or anything else that was red, afraid that if Rosa got hurt, she would not know the difference between a cut and a stain.

The Vienna woman, 39, says she cried constantly and was overly protective of Rosa, behaviors that led her to be diagnosed with postpartum depression. She began taking anti-depression and anti-anxiety medications and underwent traditional therapy.

“My anxiety was not getting any better,” Mrs. Somers says, adding that she continued to have panic attacks with intrusive thoughts and fears centered around her daughter. “I was terribly fearful that harm would come to her, that I would be at fault because I’m her mother.”

Mrs. Somers was re-diagnosed with panic disorder and obsessive-compulsive disorder and in January 2000 began cognitive behavior therapy. She was exposed to what she feared and learned how to eliminate some of her behaviors and inappropriate avoidance techniques.

“I’m back to myself again, and no one can put a price on that,” says Mrs. Somers, whose father and brother also have been diagnosed with an anxiety disorder, a broader category that includes panic disorder, social and specific phobias, and obsessive-compulsive disorder, among other conditions.

She and her family are not alone. One person in 75 experiences panic disorder in his or her lifetime, according to the American Psychological Association in Northeast.

A person diagnosed with panic disorder needs to have at least one panic attack followed by concern or worry for at least a month about having another attack or an associated medical problem, says David L. Kupfer, a licensed clinical psychologist in Falls Church and an APA member.

“Panic disorder is worry about worry or panic about panic,” says Mr. Kupfer, who holds a doctorate in clinical psychology. “Physical symptoms and anxiety help increase each other.”

Panic attacks, which can occur without the disorder, consist of sudden fear that comes on without warning or reason and involves any number of symptoms, including rapid heartbeat, difficulty breathing, dizziness or lightheadedness, trembling, sweating, chills and chest pains, along with a fear of going crazy or dying, as described in the APA’s Web site, www.apa.org.

Anyone can have a panic attack, and up to 30 percent of the population has had one, says Dr. Julia Frank, associate professor of psychiatry at George Washington University in Northwest.

Psychologists say panic attacks can be triggered by a psychological event, such as stress or an increase in anxiety or worry, along with low blood sugar, respiratory difficulties and too much caffeine, a stimulant. The triggers do not necessarily cause panic disorder.

“Anxiety itself can be normal and helpful,” says Dr. Thomas Mellman, professor and vice chairman for research in psychiatry at Howard University in Northwest. “The problem of panic disorder is the disconnect between the normal adaptive response [and the anxiety]. It’s too intense and too random to be helpful.”

The body’s fight or flight mechanisms misfire or malfunction, leading to panic, Dr. Mellman says.

“Genetics and heredity seem to be an important determinate,” he says. “There are a number of studies going on trying to determine what those genetic factors are. Several candidate genes are under study, but none are implicated as causal.”

Unlike panic attacks, panic disorder cannot be brought on by substance-related and medical causes, says Dr. David Goldstein, psychiatrist and director of the Mood and Anxiety Disorder Clinic at Georgetown University Medical Center in Northwest. Panic disorder is a psychiatric condition with stress as the main cause, he says.

“They usually know they’re having panic, but they often think it’s because they have a bad heart problem or that they’re going to die,” Dr. Goldstein says, adding that typically the first person to see those with a panic disorder is an emergency room physician instead of the patient’s regular doctor. “They usually don’t identify or recognize it’s a psychiatric problem.”

Those with panic disorder may respond by changing behaviors to avoid having another attack instead of seeking treatment, Dr. Goldstein says. They may avoid public places or situations that might trigger an attack, cause embarrassment or lack readily available help, he says. Panic disorder can lead to agoraphobia and other phobias, although it is the attack itself, not an object, that is feared.

“It often is bewildering to people. Not knowing these are panic attacks adds to the vicious cycle of anxiety,” Dr. Mellman says. “The first step is educating people about the nature of panic disorder and reassuring them they don’t have a catastrophic medical condition.”

Panic disorder can be treated with psychotherapy and, in more severe cases, medications that help with the acute management of panic, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and anti-anxiety drugs.

Insight-oriented psychotherapy, one form of treatment, involves identifying the emotional triggers and personal history that may be causing a patient’s attacks, says Raymond Crowel, clinical psychologist and vice president of the National Mental Health Association, a nonprofit organization in Alexandria that aims to improve the quality of the nation’s mental health services.

Cognitive behavior therapy focuses on ways to reduce anxiety rather than the causes, Mr. Crowel says.

This type of therapy involves identifying patterns that might contribute to a panic attack, confronting the situations that bring on the attack and resisting avoidance behaviors.

In about 12 weeks, the patient is taught new ways of coping with a panic attack through a variety of methods, such as anxiety management, deep breathing and relaxation techniques.

Relaxation helps because the body cannot be tense from an attack and relaxed at the same time, Dr. Goldstein says. Patients can focus on the physical symptoms associated with anxiety instead of worrying about what could happen, Mr. Kupfer says.

For example, if their heartbeat increases, they learn to focus on the physical symptom and notice that their heart continues to beat, he says.

Or patients might take a paradoxical approach, focusing on the worst that could happen and trying to make their bodies more anxious than before, Mr. Kupfer says. Patients afraid of losing their breath hold their breath and try to pass out, something they cannot make themselves do, he says.

“The paradoxical approach gives a person a deeper assurance that the feared disaster will not occur,” Mr. Kupfer says. “They learn specific techniques for responding in calm and accepting ways to their anxiety, and they learn basic trust and faith they will be OK.”

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