Panic Attacks and Adrenaline Rushes

Reader’s Question

Hello, I hope you can help me answer this question. I have suffered from anxiety since I was 16. I had mononucleosis that was left untreated due to a mix-up at the Doctor’s office and 3 months after testing positive I had surgery for a possible malignant tumour on my collar bone. When all was said and done my tiredness — which no one believed, as no one yet knew I had mono — became depressing to me not as I was not being heard, which of course led into massive anxiety about going places. I had always been painfully shy and afraid of rejection since I was small and these events kicked it into overdrive to the point where for most of my life I have done the best I could to stay away from people, being what others referred to as a shut in. I had to work though and slowly learned ways around the anxiety in my early 20’s until I have pretty much rid myself of the thought patterns at 31, except in extreme circumstances. For example, I even travel now but of course in a new airport, etc. I have panic attacks. I can control them so no one notices and when I arrive places I still stay indoors a lot unless to do groceries but ALWAYS with someone I deem safe (my Husband). I could and have done things on my own and manage but almost always only go out with someone as I feel more safe and free.

The question is this, lately physically I have massive adrenaline rushes from fear. But my thoughts during these times are completely under control. Has my body just become used to anxiety or because I have been under stress as of late is it having a memory about anxiety? Or do I have actual Anxiety Disorder and not just a thought problem pattern brought on by illness? Or am I completely missing something as someone suggested I may have Avoidant Personality Disorder? Can I treat any of the above without medication?

Psychologist’s Reply

From your description, you may have Panic Disorder with Agoraphobia. As you describe, the panic features may have subsided over the years, but only because you have altered your lifestyle to accommodate them. Folks with Agoraphobia often develop “safe” friends and traveling companions, safe routes of travel in their community, safe businesses they can visit, and other protective strategies based on their fear of panic attacks. Staying indoors a lot is another key feature of Agoraphobia. If we think about it, Agoraphobia makes us develop strategies to avoid new situations, solitary experiences, or stressful events — all as an attempt to avoid anxiety or a panic attack.

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Your recent massive adrenaline surges are most likely related to current stresses in your life…with a difference. If a person doesn’t have agoraphobia and has not experienced a significant problem with panic attacks — then anxiety is simply anxiety or “nervousness”. In a new airport, rushed traffic, family/personal stresses, etc. the individual feels nervous and anxious, at the same time recognizing that the situation at-hand has created the anxiety. In your situation — in agoraphobia and panic attacks — your brain does have a memory of the panic attacks and is constantly on-guard to prevent them. Thus, when you have daily life stresses — which might be viewed as routine by those around you — you have both the anxiety of the event AND the memory of panic attacks. The combination often produces a neurotransmitter “rush” which far exceeds the normal reaction under those circumstances. You are right that memory is involved. For additional information, I’d read my article on Emotional Memory on this website.

Treatment for Panic Disorder with Agoraphobia often involves a combination of treatments including long-acting antianxiety medications (Buspar, Klonopin, etc.), individual psychotherapy, and behavior/group treatments. Medication is often a key part to treatment and for good reason. If you have been traumatized by a roller coaster and experience panic and Emotional Memory with recollection of the event — you may go for several months before riding a roller coaster comes up in normal conversation. That situation is a good candidate for psychotherapy. If you’ve had panic attacks and agoraphobia for ten years, your brain has thousands of traumatic memories (prior panic attacks, panic situations, anxieties, etc.). If we had you wear an anxiety monitor, we would see that EACH DAY produces hundreds of references to your ten years of agoraphobic captivity. Each one of those Emotional Memories change your mood, feelings, and neurotransmitter system. With such a flood of chemistry during the routine day, antianxiety medications work best in keeping the anxiety level low from a neurotransmitter standpoint. This is why it’s more difficult to treat prolonged exposure to trauma than specific traumatic events. It’s easier to treat someone who was traumatized by a physical assault than someone who has lived in an abusive-home situation for six years for example.

I would recommend starting a professional treatment program. First contact may include a psychiatrist, psychologist, or clinical counselor/social worker. As I mentioned, a multidisciplinary approach is recommended with your symptoms.

By the way, this is not an Avoidant Personalty Disorder. Avoidant PD has a completely different dynamic than your situation.