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In the last section, we discussed three aspects to keep in mind when diagnosing clients, which were diagnostic differentiation; common panic disorder personality types; and panic disorder controlled by substance abuse.
Over the course of your experience with clients suffering from panic disorder, have you found that some conditions seem to run in conjunction with panic disorder?
In this section, we will examine four of these conditions and how they are connected with panic disorder. The four conditions we will examine are inner ear disorders; menstruation and pregnancy; mitral valve prolapse; and enzyme impairment.
♦ Condition # 1 - Inner Ear Disorders
If situations such as rocking boats, elevators, cars, or any other vehicle associated with motion seem to trigger panic attacks in your clients, you might consider an inner ear disorder as the culprit. Brent had been coming to me for panic disorder treatment. Because he frequently experienced attacks in the car, Brent had developed agoraphobia and refused to go out.
Brent stated, "I don’t know what’s wrong with me. I’m fine when I get in the car. I sit down. I start driving. After about 10 or 20 minutes, it just hits me and I can’t control it." I asked Brent to describe his symptoms. He said, "Well, first I get sick. Real sick. Like the car is going to fly out from under me. Then I start getting scared, ‘cause I don’t know what to do. It even happens in situations where I’m not even driving, like the subway or bus."
I suspected that Brent was suffering from an inner ear ailment. I recommended that he go to an ear-nose-and-throat specialist, otherwise known as an otolaryngologist. The doctor discovered that Brent had been suffering from an acute inner ear infection. After medication and a change of diet, his panic attacks gradually lessened.
♦ Condition # 2 - Menstruation and Pregnancy
On the other side of the spectrum, pregnancy seems to have the opposite effect on panic attacks. Several clients of other physicians stated that the intensity and frequency of their attacks greatly decreased while pregnant. This decline in symptoms was not in any way related to medication, psychotherapy or stabilization of life situations and was attributed solely to the pregnancy. After the birth, the attacks returned, and in their previous intensity.
I have found it useful to warn my female clients to expect these fluctuations in their attacks. In this way, they will not tend to attribute the sporadic nature of the attacks to anything chemically or emotional wrong with themselves.
♦ Condition # 3 - Mitral Valve Prolapse
This condition is generally considered to be benign, not resulting in heart attacks or cardiac arrest. However, during stressful periods, enough blood cannot reach the brain, causing feelings of dizziness or lightheadedness. To compensate, the body speeds up the heart rate, which might alarm the client into thinking they are having a heart attack. This, obviously, results in a panic attack. One of my clients, Evan, had been diagnosed with this disorder when he was younger and it soon became a frequent cause of panic attacks. I suggested that Evan strengthen his heart through exercise.
By continually working this muscle, it could soon pump more blood through the valves in one beat, which meant there was less a need to speed up during stress. Evan decided to run every day for 20 to 30 minutes. The next time Evan came under stress, his heart did not have to speed up its rate, thus Evan avoided a panic attack.
♦ Condition # 4 - Enzyme Impairment
Martha, a client of mine who frequently suffered from panic attacks, also suffered from an enzyme impairment. Martha had never eaten correctly, and her diet consisted of sweets, fast and fried foods, frozen dinners, and other unhealthy choices. The vitamin imbalance in her system overwhelmed her enzymes and they could not process the food properly. I asked Martha to completely change her eating habits.
Instead of processed foods and sweets, I suggested she stick to all natural foods like fruits and vegetables. Also, I suggested she take one multi-vitamin in the morning to counteract any deficiencies she might have.
In this section, we discussed four conditions that seem to run in conjunction with panic disorder, which were inner ear disorders; menstruation and pregnancy; mitral valve prolapse; and enzyme impairment.
In the next section, we will examine depression co-occurring with anxiety disorder. We will look at primary depression; primary anxiety disorder; and the combination of primary depression and anxiety disorder.
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