The only thing we have to fear is fear itself. Franklin Roosevelt This issue of the Newsletter focuses on panic disorder and agoraphobia. An estimated 1.5 - 3.5% of people experience panic disorder at sometime in their lives, and up to 50% of these people will also develop agoraphobia. Panic attacks frequently occur among people with other anxiety disorders, and many more people experience milder or less frequent panic symptoms. This Newsletter includes articles on panic, psychological treatments of panic disorder and comorbid panic and alcohol dependence. Stories written by people who have experienced panic and agoraphobia are also included and a section on self-help strategies and guidelines for carers and families. Thank you to all the people who have shared their experiences for this Newsletter, and to Ernie and an anonymous member for their poems on OCD. You may have noticed a new ‘motto’ which appears on the front of this Newsletter : ‘ Promoting Recovery and Empowerment’. This motto arose from a three day management review, training and planning workshop which was attended by the OCADF Committee of Management, staff and volunteers. Many positive outcomes resulted from the workshop, including the development of a 3 year strategic plan for the Foundation, identification and formalisation of standards for our services, and the emergence of a clearer vision for the Foundation. This vision was crystallised within the words of the new mission ‘motto’. We believe that these goals of promoting recovery and empowerment should be the primary focus of all the Foundation’s services, and importantly should underpin the ‘philosophy’ and standards of the OCADF. The new vision and the sense of shared and strong purpose among the Committee, staff and volunteers is very exciting and, I believe, will lead to improved services and support for all those who use our services. Kathryn I’Anson Director / Newsletter Editor Each of us has unsuspected power to accomplish what we demand of ourselves, if we care to search for it. Claire Weekes OCADF Newsletter WINTER 1998 1 “The term ‘panic’ is derived from the name of the Greek god Pan. According to Greek mythology, the cloven-footed, dwarfish Pan was a lonely and moody god. He had an impish sense of humour and played practical jokes on humans. If a wanderer happened to pass the cave where he was hiding, Pan would jump out with a shrill and terrifying scream. The acute terror felt by the wanderers who experienced this treatment came to be called ‘panic’. A panic is now defined as an episode of intense fear of sudden onset, usually peaking within a minute. The fear, often bordering on terror, is generally accompanied by unpleasant bodily sensations, difficulty in reasoning, and a feeling of imminent catastrophe which can be expressed as ‘Something terrible is happening to me’; ‘I am in great danger’.” PAN Extract from: Panic Disorder : The Facts, by Stanley Rachman and Padmal de Silva, 1996, Oxford University Press. Panic Attack I have been an anxious person all my life, but the first panic attack struck in my late ‘30’s. Needing to buy a few articles at the local supermarket, I drove there alone one evening, thinking I was in a ‘safe’ situation - the protection of being in the car, not many people about, and only a short distance to travel. I entered the shop and walked towards the rear. After a few steps my legs began to feel strange and weak, my body felt peculiar and light, and my head felt as though it was losing all sense of reality - like withdrawing into a strange dream. A feeling of terror gripped me and I just wanted to run and get out of there. At the same time another strong feeling was trying to get through - to do what I had come for and make the purchases. I forced my body to keep moving and look for the articles - every step was an effort (like wading through cotton wool). I wondered if other people were watching me, noticing my distress. I desperately tried to appear normal and my fear rose as I thought I might embarrass myself and look stupid. Somehow I got the articles from the shelves (not many, thank goodness), managed to pay for them and reach the car. My hands were shaking and I thought I would collapse in a heap. I sank into the car seat thinking that the feelings would subside - but not so! The overwhelming urge now was to get back to the safety of home before I disintegrated, and the only way to do it was to drive myself there. I would not have got out of the car and phoned for help for a million dollars. I started the car and amazingly my feet hit the right pedals and my hand operated the gear stick - but in my mind I was thinking - how do I do this - how do I put in the clutch, change gear and push the accelerator - it all seemed foreign like I had never done it before. As I drove along, all coordination seemed to have left my legs. Instead of my feet moving automatically from pedal to pedal I had to think what to do with them - and the same with the gear stick. My mind seemed to be somewhere else and all my body was consumed with distress. I was terrified that I would suddenly forget everything, my arms and legs would stop functioning and I would have to stop. The traffic was light, I hugged the side of the road, not wanting to stop because I would never be able to start again. Only one kilometre to travel but it seemed like one hundred. Only one red light to pass and I had to get it. One minute to wait until the light turned green and it seemed like one hour. I was a danger on the road. I feared that my shaking feet would miss the pedals and I would stall the car. On finally pulling up outside my front door I leant on the car horn until my husband came outside. When he asked what I thought I was doing, all I could say was ‘I’m frightened - get me inside’. After sitting on the couch for half an hour my body and mind seemed to calm down. I was very bewildered and angry to realise that a panic attack could ‘get me’ in a ‘safe’ situation and cause such distortion of function and feeling. I began to worry about where and when these terrible feelings and sensations would happen again. Anon. OCADF Member, 1998 2 WINTER 1998 OCADF Newsletter ARTICLES & RESEARCH PANIC ATTACKS AND PANIC DISORDER (Extracts from published article, 1998) by Dr. Don Jefferys Clinical Psychologist Associate Department of Psychiatry, Austin Hospital, University of Melbourne Introduction A panic attack is a discrete period of intense fear or discomfort accompanied by at least four of thirteen possible cardiac, neurological, gastrointestinal, respiratory or psychological symptoms (see Table 1): most report seven to thirteen symptoms. It is the symptom profile that may mimic other medical disorders (see Table 2), that leads to the misdiagnosis and the high utilisation of medical services of those who suffer panic attacks. TABLE 1 TABLE 2 1. PALPITATIONS , POUNDING HEART OR ACCELERATED MEDICAL DISORDERS AND SUBSTANCES HEART RATE THAT CAN MIMIC PANIC SYMPTOMS 2. SWEATING ALCOHOL WITHDRAWAL 3. TREMBLING OR SHAKING AMPHETAMINES 4. SENSATIONS OF SHORTNESS OF BREATH OR SMOTHERING ASTHMA 5. FEELINGS OF CHOKING CAFFEINISM 6. CHEST PAIN OR DISCOMFORT CARDIAC ARRHYTHMIAS 7. NAUSEA OR ABDOMINAL DISTRESS CARDIOMYOPATHIES 8. FEELING DIZZY , UNSTEADY , LIGHTHEADED OR FAINT COCAINE 9. DEREALISATION (FEELINGS OF UNREALITY) OR CORONARY ARTERY DISEASE DEPERSONALISATION (BEING DETACHED FROM ONESELF ) CUSHING ’S SYNDROME 10. FEAR OF LOSING CONTROL OR GOING CRAZY DRUG WITHDRAWAL 11. FEAR OF DYING ELECTROLYTE ABNORMALITIES 12. PARAESTHESIA (NUMBNESS OR TINGLING SENSATIONS ) HYPERPARATHYROIDISM 13. CHILLS OR HOT FLUSHES HYPERTHYROIDISM HYPOGLYCAEMIA HYPOTHYROIDISM MARIJUANA MENOPAUSAL SYMPTOMS The Panic Attack MITRAL VALVE PROLAPSE A panic attack commonly peaks in ten minutes and lasts for PHEOCHROMOCYTOMA PULMONARY EMBOLUS thirty minutes, with less intense and residual symptoms lasting TEMPORAL LOBE EPILEPSY from minutes to hours. The residual symptoms include TRUE VERTIGO weakness, fatigue, trembling, uneasiness and impaired concentration, symptoms that are often as distressing as those occurring during the attack. It is the escalating intensity of symptoms during an attack that differentiates a panic attack from other anxiety states, particularly generalised anxiety disorder. During the attack, individuals report feelings of impending doom, believe they are going to die, lose control, or go crazy. They often fail to comprehend what is occurring and most desire to escape their situation. Three types of panic attacks are now commonly described. It is the presence or absence of a specific trigger that differentiates between types. Spontaneous or uncued panic attacks occur unexpectedly day or OCADF Newsletter WINTER 1998 3 night and are often the first attack experienced, an attack vividly recalled by most. Nocturnal panic attacks occur during non-REM sleep; the symptoms are often more intense and worrisome for the sufferer. Panic attacks may be situationally bound, that is, they almost always occur on exposure to, or in anticipation of, entering a feared situation. Situationally predisposed attacks are not necessarily tied to a cue, that is they may or may not happen, they may occur sometimes, or only after repeated exposure while in the feared situation. In contrast to spontaneous panic attacks, those that are situationally bound or predisposed, have a gradual onset and are less intense; they continue, however, to be debilitating and feared. It is the panic attacks that are situationally bound that occur in the other anxiety disorders, social phobia, specific phobia, post-traumatic stress disorder and obsessive compulsive disorder.