Step 1: Physical Disorders with Panic-Like Symptoms

Everyone experiences the symptoms of anxiety from time to time, caused by any number of things -- changes in our lifestyle, undue stress, tension. These symptoms often reflect a normal response to problems arising in our daily lives. In some cases, however, they may be the symptoms of a psychological or physical illness. The diagnosis of a serious medical problem is not always a simple process.

Because these symptoms are so difficult to assess, both patients and professionals can misdiagnose significant physical or emotional problems. Studies in recent years reveal that a number of physical disorders coexist in patients who have a psychological disorder, and some physical problem may cause 5 to 40 percent of psychological illnesses. In the majority of these cases the health professional fails to make the physical diagnosis.

Nowhere is this confusion more evident and diagnosis more difficult than with panic attacks. If the symptoms of panic are present, there are three possible diagnoses:

1. A physiological disorder is the sole cause of all the symptoms associated with panic. Treatment of the physical problem removes the symptoms.
2. A minor physical problem produces a few symptoms. The individual then becomes introspective and oversensitive to these physical sensations and uses them as a cue to become anxious. His heightened awareness and unnecessary concern will produce an increase in symptoms. If this continues, he can turn an insignificant physical problem into a major psychological distress.
3. There is no physical basis for the symptoms. Some combination of the following will help: education about the problem, reassurance, psychological treatment and medication treatment.

Through a comprehensive evaluation, your physician can determine which, if any, of these physical problems is associated with your symptoms. In most cases, curing the physical illness or adjusting medication will eliminate the symptoms. In some disorders, the symptoms remain as part of a minor disturbance, and you must learn to cope with them.

When a person suffers from anxiety attacks, one of the greatest obstacles to recovery can be the fear that these attacks are the indication of a major physical illness. And in some rare cases that is true. But predominantly, when a person continually worries about physical illness, that kind of worry intensifies or even produces panic attacks. In other words, the less you worry, the healthier you will become. For that reason, I strongly recommend that you adopt the following guidelines if you are experiencing anxiety attacks:

1. Find a physician whom you trust.
2. Explain your symptoms and your worries to him or her.
3. Let your physician conduct any evaluations or examinations necessary to determine the cause of your symptoms.
4. If your primary physician recommends that another medical specialist evaluate your problem, be certain to follow that advice. Make sure that your primary physician receives a report from the specialist.
5. If a physical problem is diagnosed, follow your physician's treatment advice.
6. If your doctor finds no physical cause for your anxiety attacks, use the methods presented in the Panic Attack Self-Help Program to take control of your symptoms. If your symptoms persist, ask your physician or some other source for a referral to a licensed mental health professional who specializes in these disorders.

The most destructive thing you can do when faced with panic attacks is to steadfastly believe that your symptoms mean that you have a serious physical illness, despite continued professional reassurance to the contrary. That is why it is essential that you work with a physician whom you can trust until he or she reaches a diagnosis. No matter how many consultations with other professionals you need, allow one professional to have primary charge of your case and receive all reports. Do not continually jump from doctor to doctor. If you remain fearfully convinced that you have a physical ailment, even when there is a consensus to the contrary among the professionals who have evaluated you, then you can be certain of one thing: your fear is directly contributing to your panic episodes. In Part II you will learn how to control that fear and thereby take control of your symptoms.

Many physiological disorders produce panic-like symptoms. You will find them listed below.

Physiological Disorders with Panic-like Symptoms

Cardiovascular

• Angina pectoris
• Myocardial infarction (recovery from)
• Arrhythmia
• Postural orthostatic hypotension
• Coronary artery disease
• Pulmonary edema
• Heart attack
• Pulmonary embolism
• Heart failure
• Stroke
• Hypertension
• Tachycardia
• Mitral valve prolapse
• Transient ischemic attack
• Mitral stenosis

Respiratory

• Asthma
• Emphysema
• Bronchitis Hypoxia
• Collagen disease Pulmonary fibrosis

Endocrine/hormonal

• Carcinoid tumor
• Pheochromocytoma
• Hyperthyroidism
• Premenstrual syndrome
• Hypoglycemia
• Pregnancy

Neurological/muscular

• Compression neuropathies
• Myasthenia gravis
• GuillainBarr syndrome
• Temporal lobe epilepsy

Aural

• Benign positional vertigo
• Meniere's disease
• Labyrinthitis
• Otitis media
• Mastoiditis

Hematic

• Anemia
• Iron deficiency anemia
• B12 anemia
• Sickle cell anemia
• Folic acid anemia

Drug related

• Alcohol use or withdrawal
• Side effects of many medications
• Illicit drug use
• Stimulant use
• Medication withdrawal

Miscellaneous

• Caffeinism
• Head injury

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