YOUR ANXIETY MAY BE FROM A PHYSICAL CONDITION

 

Maya looks like someone in the war zone. Her hands tremble as she nervously puffs away at a cigarette. Her eyes dart as she speaks to you. Her face looks wan and tight. Her leg shakes as she sits hunched and cross-legged.

Everything seemed to make Maya’s heart flutter and her body shake. As a child, she would not go to children's parties because the bursting balloons frightened her. She was excused from going to church because she would frequently faint or become sick during the service. She didn't go to malls to hang out with the other kids because the barrage of advertisement, noise, and crowds overexcited and upset her.

By adolescence, panic attacks struck without warning and frequently. Out of nowhere, her heart would race, her body would tremble and the room would spin. The first one struck at 13 when she was sitting alone in her room reading. She screamed, “I’m dying!” and her mother rushed her to the emergency room.

Her life felt a living hell and she contemplated suicide more than once. By her 20’s, a psychiatrist diagnosed her with panic disorder. He told her she must learn to “relax” and prescribed the anti-anxiety drug Valium. The medication helped somewhat and she became dependent on it, relying on it through her 30’s, when she switched to Xanax and soon became dependent on that drug.

From her twenties through her forties, she was continually in and out of individual and group therapy. One psychologist identified her anxiety as a response to maternal rejection and fear of abandonment. This rang true. Maya’s conception was accidental and her mother repeatedly told Maya how she had not wanted her; Maya always feared her mother would leave her.  

Another psychologist identified her anxiety to stem from a fear of strangers. This rang true also. Her father abandoned the family when she was three. Maya’s mother had to work long hours and Maya was cared for by a string of babysitters.  Frightened of being left alone with new people, she would cry and cling to her mother’s leg as her mother fled out the door.

Yet, in spite of therapy and drugs, she barely functioned.  At work, her heart beat so wildly she could hardly focus on what her clients said. Constantly anxious, shaky, ill-tempered, fatigued, and jumpy during sex, she had little to give to a relationship and, at 37 her seven-year marriage had broken up.  

She coped by self-medicating with stimulants, like cocaine and nicotine. And though these substances generally increase panic, they helped drown out Maya’s constant excitability.

HYPERTHYROIDISM AND ANXIETY  

In her 40’s, a physician recognized Maya’s symptoms, including a resting pulse of 110, sweats and tremors as possible hyperthyroidism and gave her the appropriate blood work. It revealed elevated thyroid levels. He prescribed Lopressor, a beta blocker to bring her heart rate down. For the first time in her life, Maya felt normal.   

The misdiagnosis of Maya’s panic as a psychiatric condition and subsequent delay of proper medical treatment cost her dearly. After a year of medication, her thyroid had to be removed and she must take medication for the rest of her life. As for her emotional state, she is now happily married, panic free, feels no need for psychotropic medication or stimulants, and experiences normal anxiety and worry.

YOUR ANXIETY MAY BE FROM A PHYSICAL CONDITION       

       Anxiety disorders are the number one mental health complaint among women, and second only to drug and alcohol abuse among men. Yet, like Maya, an untold number of sufferers might not have mental illness.   

       Anxiety symptoms are not specific to anxiety disorders.  They can represent a multitude of physical conditions:  illness; a neurological insult to the brain; sensory processing problems; something in the food you’ve eaten or in the environment.  

       Biological problems from sugar imbalance to heart problems to vitamin deficiencies can produce symptoms identical to a panic attack. 

       Head injuries, brain tumors, strep throat or encephalitis can create obsessive-compulsive disorder.  

       Sensory defensiveness, or hypersensitivity to ordinary sensation--a tap on the shoulder, background conversation, sunlight--can create symptoms that mimic psychiatric conditions from generalized anxiety to obsessive-compulsive disorder to depersonalization.  

      Environmental pollutants and allergens can produce panic like symptoms.

Consider some common “mimickers” of anxiety symptoms:

·         Hypoglycemia can create irritability, a fast heart beat, fatigue, lightheadedness, shakiness and panic attack

·         Hyperthyroidism can cause a pounding heart, sweats, tremors and panic attack

·         Hyperventilation can create muscle tension, lightheadedness, a rapid heartbeat and panic attack

·         Inner-ear balance system dysfunction can cause vertigo, disorientation, disassociation and panic attack

·         Sensory processing disorder (SPD) can create anxiety, confusion, disorientation, distractibility, irritability, tension and fatigue

FAMILY & FRIENDS ASSUME YOUR ANXIETY TO BE A MENTAL DISORDER

      Yet, if you feel jittery, worried or panic, people will likely view your symptoms as purely psychogenic–a result of stress, sensitivity, low self-esteem, a learned fear, poor coping, dependency, negative thinking or weak character–and assume your angst under voluntary control. Frustrated and well-meaning family and friends advise “Chill out” or “Don’t let everything get to you.” Feeling like a moral noodle, you blame yourself for your anxiety and panic when you may have virtually no control over its path.

      Turning to professionals may engender equal misunderstanding. Experts in their field may have little information about areas in which they do not specialize.  Psychiatrists, psychologists, counselors, social workers and mental health workers see behavior primarily from a psychopathology lens. These specialists of the mind may be largely unaware of the many non-psychiatric conditions that can create anxiety symptoms. 

      Rarely exploring beyond the psyche for the origin of anxiety, they tend to diagnose patients purely on the basis of their symptoms and dispense anti-anxiety or antidepressants, and suggest psychotherapy, and stress reduction techniques, like meditation and deep breathing.  

      Primary care physicians, the ones generally in the front line of patient complaints, quickly assume the patient to be stressed, neurotic, or a hypochondriac and, some barely hiding a smirk, dish out anti-anxiety drugs like candy.  

      The prevalence of psychiatrists and other medical practitioners who diagnose anxiety disorder for complaints ranging from headaches, backaches, nervousness, insomnia, or panic attacks made Valium the most popular psychiatric drug of the 1970’s, and one of the most profitable drugs of all time; in 1988, it was the number-one prescribed medication in the US with $400 million in worldwide sales. Today Xanax has replaced Valium as the anti-anxiety medication of choice and is one of the most sought after pills on the market.

DIRE CONSEQUENCES OF MISDIAGNOSING ANXIETY AS A MENTAL DISORDER

      Such misdiagnosis and mistreatment of anxiety symptoms can have dire consequences. To begin, psychotropic medication commonly used to treat anxiety can have side effects and, in the case of anti-anxiety drugs (benzodiazepines), dependency and addiction.  Even worse, a serious organic condition, such as hypoglycemia, hyperthyroidism, or a brain tumor can progress undetected and the condition may worsen.  

      Psychotherapy may help you cope better with the anticipatory anxiety that often becomes ingrained as a learned, secondary response to non-psychologically triggered anxiety.  But the focus of your problems, which varies with the particular school of thought, may be entirely erroneous, even absurd. 

• Cognitive therapy will consider your anxiety a learned reaction, reinforced by negative thinking. 
• Family therapy might see it as a result of dysfunctional family dynamics.  
• Psychodynamic therapy might probe your childhood for clues to your anxious state, while a feminist perspective might blame it on repression of female identity in a male-dominated world.  

      All of these mindsets may be entirely unrelated to your core issue and further your confusion, frustration, and invalidation, literally adding insult to injury.  You may struggle, perhaps for years, in psychotherapy that is expensive, time consuming and too often misses the mark -- or may be entirely unnecessary.   In many cases of organically triggered anxiety or depression, such as sugar imbalance caused by hypoglycemia (low blood sugar), a common mimicker of anxiety and panic, or diabetes, medical treatment alone removes the anxiety and panic. 

      As drugs, psychotherapy and, often, an endless pursuit of self-help techniques and stress reduction strategies fail to pay off, you consider yourself weird, neurotic, weak and to blame for your symptoms, and even a bad person. Frustrated and unable to cope successfully with ordinary situations, you may watch your career and personal life fall apart without knowing how to stop the downfall. 

      Despairing of getting better, you may suffer depression. Almost half of the people who suffer repeated panic attacks develop major depression. Twenty percent of people with panic disorder have attempted suicide.

IDENTIFYING IF YOUR ANXIETY IS TRIGGERED MENTALLY OR PHYSICALLY

      How do you know if the primary trigger of your anxiety symptoms is psychological or biological?  Here are some guidelines for biologically induced anxiety or panic:

You experience:

•              Sudden, unexplainable and random panic

•              Irritation or even panic to bright lights, loud or piercing noises, odors others don't   notice, light touch or certain textures, or crowds

•              Sickness or light-headedness from chemicals in the environment that others find innocuous

•              Giddiness when confronted with heights or vast space; easy loss of balance; vertigo

•              Disorientation, confusion, or spaciness

•              Sudden change in behavior or feelings radically different from usual

•              Anxiety or panic in absence of obvious psychological markers:  relationship problems; low self-esteem; unstable emotions; moodiness; non-productivity

•              Anxiety predictably at certain times of the day:  following a meal; after consuming too much sugar, carbohydrates or caffeine

•              Anxiety predictably in response to:  smoking cigarettes; exercising; feeling uncomfortably hot or cold; feeling overwhelmed by an overstimulating environment; being under the influence of drugs or alcohol or when trying to stop consumption; being ill; menstruation, childbirth, or menopause for women

•              Heightened agitation, tension, anxiety or panic that has not responded effectively to psychotropic drugs or therapy

GETTING HELP FOR PHYSICAL CAUSES OF ANXIETY 

If you suspect your anxiety may be biologically triggered, what can you do? Basically, you have to become your own detective and systematically sift through the many possible non-psychological triggers of anxiety symptoms:  sensory; medical; nutritional; neurological; neurocranial; musculoskeletal; or environmental. As many of you will discover your anxiety or panic to have multiple determinants it’s important to approach the diagnosis and treatment of your symptoms holistically. 

For detailed information on physical triggers of anxiety and holistic treatment options, check out The Anxiety Myth:  Why Your Anxiety May Not Be “All in Your Head” But from Something Physical.

Sharon Heller, Ph.D. is a developmental psychologist and author of popular psychology books, including Too Loud, too Bright, too Fast, too Tight, What to do if you are sensory defensive in an overstimulating world (HarperCollins, 2002) and Uptight & Off Center, how sensory processing disorder throws adults off balance & how to create stability (Symmetry, 2015). She lives in Delray Beach, Florida.