Anxiety, Panic, and Phobias: Seeking Help

WebMD Live Events Transcript

Panic disorder, generalized anxiety disorder, social anxiety, phobias, obsessive-compulsive disorder, PTSD -- an estimated 2.4 million Americans suffer from these conditions. Therapist Jerilyn Ross, MA, LICSW, joined us on May 4, 2004, for a frank discussion about these disorders and when to seek professional help.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD Live, Jerilyn. How prevalent are anxiety disorders? How do you know when your anxiety is a disorder?

Anxiety disorders affect around 19 million Americans. All of us have anxiety at various times of our life; however, for the 19 million Americans who suffer from an anxiety disorder, their life is often greatly compromised and limited. Things that most of us do without even thinking about them, such as getting in our car, speaking up at a meeting, driving over a bridge, or even going shopping, are things that people with anxiety disorders often have great difficulty doing or, in some cases, cannot do at all.

When somebody is either avoiding common everyday places or situations or has obsessive thoughts they can't get out of their head or can't stop worrying to the point it interferes with their life, these people may, in fact, have a condition that is real, that is serious, and is treatable.

"Even though we have very good treatments, both psychotherapy treatments and medicines, we don't always know immediately which treatment will work best for which people."

I'm suffering from severe panic attacks. I have been having the attacks for the last eight years, but it has been during the last year and a half that it has become extremely debilitating. It was at that point that I suffered from a thyroid disease (Grave's), I had a thyroid storm, and since then I have had a thyroidectomy.

Since this happened I can't remember much about this time in my life. I thought it was probably the meds, but someone on the boards said it might be PTSD. When I think back upon the event I become so consumed with the feeling that I'm going to die it just takes over everything. I start feeling like I'm going to have a heart attack, my pulse races, and my palms become sweaty. I have a huge fear that I'm going to faint and either lose control or die.

I take 3 milligrams of Ativan a day, but it doesn't seem to work. Last week my doctor put me on Lexapro and I just couldn't handle the side effects. Now I feel like I'm at square one again. I have a husband who is so sick of my panic attacks, and he doesn't understand why I just can't get over it. I'm ready to do whatever it takes to get better for me and my family.

What should be my next course of action, and is it possible to have psychological effects from a thyroid problem? And is it also normal for people with panic disorder to feel like they are at death's door every time they have an attack?

Oftentimes the symptoms of panic disorder mimic the symptoms of many other physical illnesses, such as thyroid disease. And it's sometimes difficult to tell whether the symptoms are caused by an illness like thyroid disease or heart disease or low blood sugar, or if they're strictly caused by panic disorder. So it's important to have a full medical workup and identify any underlying illnesses such as Grave's disease that might be causing panic attacks. If there is evidence of a physical illness and in spite of treatment the panic attacks continue, then the person may have panic disorder.

Panic disorder, for those who don't know about it, is when somebody will experience extreme fear and terror that seems to come out of the blue and can make a person feel as if they're dying, going crazy, going to pass out, or having a heart attack. In fact, one of the most important things we want people with panic disorder to know is that as frightening as these attacks are, they are not dangerous; they do not cause people to die, go crazy, pass out, or develop any other illness. As a matter of fact, when people have a panic attack their blood pressure increases. In order to pass out, your blood pressure has to decrease. So unless there is some other underlying reason why somebody might pass out, such as they have the flu, they haven't eaten all day or slept, or they have some other illness, it is almost impossible to pass out from a panic attack.

As far as treatment, I want you to know that panic disorder can be treated. However, even though we have very good treatments, both psychotherapy treatments and medicines, we don't always know immediately which treatment will work best for which people. So it's important for someone like you to know that if you tried a certain medication and it didn't work, or you had uncomfortable side effects, you need to talk to your doctor about trying something else.

You may also want to add what we call cognitive behavioral therapy, which is a very specific kind of treatment that will help you learn tools and techniques to both understand and overcome the feelings and fears you have associated with having the panic attack.

I would also encourage you to go on the web site for the Anxiety Disorders Association of America, which is, and download some of the information and share it with your husband, because it's very difficult for loved ones to understand why people just can't "snap out of it." But that would be like telling somebody with a broken leg to just go ahead and shake your leg and it will get all better. While we can't expect someone who hasn't experienced a panic attack to know how terribly frightening and overwhelming it is, what we do want them to understand is that this is not just something in their loved one's head, nor are they doing it for attention, nor is it something that, without treatment, they can control. Therefore, it has to be treated with the same respect and tolerance as a physical illness.

Over the last couple of years, I've become more and more uncomfortable in certain social situations. When I'm in social situations, I have an uneasy feeling. I have thoughts that I'm doing something wrong or people are noticing me. I also have a hard time focusing on conversations (live and phone) and I loose my train of thought. I've noticed these kinds of things for the last 1.5 years or so but it seems to keep getting worse. Is this anxiety?

While I can't diagnose somebody over the Internet, I can tell you that what you're describing sounds very much like an anxiety disorder called social phobia, or social anxiety disorder. This is a condition where the person has a morbid fear of embarrassing themselves in public or of being scrutinized by others. It is a fear of doing or saying something that will call attention to yourself, a fear of appearing anxious around other people, or in some way doing something that will humiliate yourself.

There are two kinds of social anxiety disorder:

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