Panic Attacks When I Leave Home or Talk on the Telephone

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Reader’s Question

For as long as I can remember I have had depression due to being born with only one arm. Everywhere I went I felt like every single person had to stare at me. I got embarrassed and frustrated, and I started to go out of the house on my own less and less. About three years ago I found myself trying to go to the shop for cigarettes and I had my first bout of total panic. It’s the same every time: my heart races, I sweat profusely, I feel out of breath and I get a knot in my stomach that makes me feel sick. I don’t leave the house on my own anymore.

This affects my life so badly that it even extends to using a phone. If I don’t know the person calling, I won’t pick up for fear of stuttering or sounding stupid, or not knowing what to say, but yet I would happily text because I don’t have to speak. My partner has to do so much for me and I feel like I am a terrible burden. I feel ill at the thought of going out to try and find a job. I have not worked since I left school and I am now 27 years old. I had work experience once and I had to use the phone and type in data, filing, that sort of thing. Every time the phone rang I ran into the staff toilet — I was terrified in case I did something wrong and I was told off. One day I did file some invoices into the wrong file and the manager shouted at me. I felt myself turning red, my heart started racing and I burst into tears. I drove home not being able to see through the tears.

I had a counselor once, but she blabbed on about her problems and her husband more than she focused on me. I need help, I know I do, but not being able to go out and getting freaked out over the phone makes it so hard!

Psychologist’s Reply

There are a couple of different types of anxiety disorders that I’ll describe very briefly because I think each has some relevance to your experience. First, agoraphobia involves having panic attacks when away from home or out in public. Typically the person avoids going out over fear that he or she will have a panic attack and something even worse will happen, such as having a heart attack, or fainting, or being terribly embarrassed. Social anxiety disorder involves intense anxiety over being concerned that one will be scrutinized or judged by others when out in public. The overriding fear is doing something that is terribly embarrassing or draws negative attention from others. You can see that there are some similarities in the two types of anxiety disorders, and it sounds like you may experience aspects of both.

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Having felt self-conscious about your arm probably did not help any tendencies you have toward being an anxious person. Fortunately, we do not need to know the origins of your anxiety to intervene successfully. Regardless of the specifics, your experiences have resulted in being classically conditioned to feel panic and anxiety in particular situations, such as speaking on the telephone, being out in public alone, and interacting with strangers. That is, those settings have become cues that trigger automatic responses by your body to feel panic. Because it’s a conditioned response, you have no control over it, and realizing that the fears are irrational does not stop the automatic process your body goes through.

Anxiety and panic are unpleasant, to put it mildly, so it’s natural to want to escape those situations, and to avoid them altogether if possible. The problem is that doing so reinforces the association your body has made between these settings and anxiety. Unfortunately, each time you flee or avoid these anxiety-prompting situations, the anxiety disorder is made worse. The good news is that behavioral treatments tend to be highly effective, frequently in a relatively short period of time. These interventions are based on learning and practicing relaxation so that you can gradually expose yourself to the troublesome situations and begin breaking those negative associations that trigger the panic. Often this process is referred to as systematic desensitization.

There are resources online that provide more information as to the steps involved in systematic desensitization and behaviorally treating social anxiety and agoraphobia, so searching under those terms is a good place to start. Many people find it helpful to undergo the treatment program with the aid of a behavioral therapist. If you choose this route, which I encourage you to do, it’s important that you screen potential counselors to ensure that they are knowledgeable about systematic desensitization and the behavioral treatment of social anxiety and agoraphobia. So, be sure to use those terms when first making contact with a potential therapist. Simply do not stop until you find someone with whom you can successfully work to conquer these anxiety disorders. Tens of thousands of people have had very similar experiences and successfully treated them.

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