Feeling Anxious and Panicky

written by Dr Rabin Gonzaga on 25 December 2005
I HAVE been feeling very anxious for some weeks now. We have been told at work that we may be laid off due to the economic climate and this has been a source of stress for all of us. I mean, how am I going to pay my housing loan, car loan and meet my monthly expenses? Sometimes, I cannot sleep at night thinking about this problem.
 
“It happened yesterday when I was walking to the LRT station when I felt unsteady and my heart was beating very fast. Soon, I felt dizzy, my chest was tight, there was a feeling of pins and needles in my hands and feet, and I felt cold and started sweating profusely.
 
“As I entered the train, I felt ‘closed in’ and trapped. I couldn’t breathe. I felt like I was going to pass out or something terrible was happening to me. I felt like I was falling and everything seemed unreal around me.
“ I got off at the next stop and sat down, putting my head between my legs and took slow deep breaths. I felt nauseated but slowly I started to feel myself again. It was the most frightening experience of my life. I rushed to see my doctor, who sent me to the hospital for a check-up. He said I could have been having a heart attack! How can that be? I am young, only 25 years old! At the hospital, they told me I have an anxiety disorder and had suffered a panic attack. What does this mean? Does it mean I am going crazy?”
 
The above description is a fairly typical experience of a person who has an anxiety disorder and panic attacks. It is a real experience that was described to me not too long ago. Everyone has felt anxious at some time in their lives. Some degree of anxiety is necessary in order for us to function in situations that require our undivided attention and concentration. Anxiety is commonly experienced before an examination, while waiting for a doctor’s/dentist’s appointment or while waiting for crucial/important news. 
 
For some people, anxiety symptoms are severe and recurrent. But what exactly is anxiety and what are panic attacks? According to the Oxford dictionary, anxiety is defined as “troubled feeling in the mind caused by fear and uncertainty about the future”. Panic is defined as “a sudden, irrational feeling of great fear”.
The definition of anxiety implies a causative factor, while that of panic is regarded as “irrational”. In practice, some people experience anxiety but cannot identify specific factors in the present/future that make them feel anxious.
 
Anxiety is an “alerting” signal; it warns of impending danger and enables a person to take measures to deal with a threat. Fear is a similar alerting signal and should be differentiated from anxiety. Fear is a response to a threat that is known, external, definite or non-conflictual in origin. Anxiety is in response to a threat that is unknown, internal, vague or conflictual in origin.
 
In mental health terms, anxiety and panic attacks can, by virtue of their symptoms, be considered a continuum of the same disorder. It is common for people who suffer anxiety to have panic attacks and vice versa, but what is the physiological basis for anxiety and panic? Anxiety Disorders can be further divided into other conditions such as Phobias and Obsessive Compulsive Disorders. For the sake of this article, the main focus will be on Generalised Anxiety Disorder and Panic Disorder.
 
In order to consider this, it is important to consider the normal “stress response” or “fight and flight response”. A sudden shock or threat may cause extreme fear. Just imagine how you would respond if you were a victim of a snatch theft. You would suddenly feel very alert and vigilant, you may go cold with fear, your heart may beat fast, and you may start to shake. You may chase after the thief, and get angry and feel aggressive.
 
 
This is the normal “fight and flight” response, which help us to take defensive action to protect ourselves when we are threatened. It is an in-built, “involuntary” (or called autonomic) response that comes from the nervous system, which gets activated in times of emergency.
 
The autonomic nervous system is activated and responds immediately without conscious prompting. The brain sends out signals to the muscles and internal organs to prepare for an emergency. The heart beats faster to deliver more oxygen to the body for preparation of a response. The breathing rate is increased, sweat glands increase sweat production and hormones like adrenalin are released into the bloodstream. This reaction is essential as a protective mechanism for the organism. Now the organism is ready to “fight or fly”.
 
In abnormal anxiety states and in panic attacks, this “fight or flight” response is activated inappropriately when there is no direct threat present. It may be that some people have a lower threshold for the appearance of this response or the control mechanism involved in the “fight and flight” mechanism is less efficient. On a practical level, pathological anxiety is differentiated from “normal” anxiety by reports from the sufferer and observations from the sufferer’s family and friends.
 
A useful assessment would include the persons’ reported internal states, their behaviours and their ability to function. The experience of anxiety and panic attacks has two components: (1) the awareness of the physiological (bodily) symptoms; and (2) the awareness of being nervous and frightened i.e. the cognitive aspects which include thinking, learning and perception. This is important in understanding the origin and the treatment implications of these disorders.
 
The lifetime prevalence (a measure at a point in time of the number of persons who had the disorder at some time in their lives) of an anxiety disorder is between 2% and 8%, depending on the literature surveyed. In contrast, the lifetime prevalence of panic disorders is between 3.6 and 5.8 %, again depending on the literature surveyed. These disorders tend to occur in early adulthood (late teens to early 20s) and can persist throughout adulthood. They can also co-exist with disorders such as Depressive disorders, Bipolar Disorders and other psychiatric illnesses.
 
In essence, it is important to seek help from a mental health professional for an assessment to understand the nature of the problem and discuss the treatment options. It is then up to the individual to make an informed choice on the best combination of treatments available to suit their needs.