To be diagnosed with panic disorder, you must suffer at least two unexpected panic attacks, followed by at least one month of concern over having another attack. You may also be prone to situational panic attacks and worry about the physical and emotional consequences of your attacks. You may be convinced that the attacks you suffer indicate a serious illness and you will submit to frequent medical tests. Even after all the tests come back negative, you will probably remain worried that you do have a serious condition. You may even try to avoid the scene of a previous attack, hoping you can prevent another one.

The age of onset of panic disorder varies from adolescence to mid-thirties. Very few suffer from panic attacks in childhood.

Agoraphobia, or the fear of having a panic attack in a place from which you cannot escape, often coincides with panic disorder. You may refuse to leave your home, or develop a fixed “safe” route, such as between home and work, from which you cannot deviate. It may feel impossible to travel beyond what you consider your safety zone without suffering severe anxiety.

To diagnose your condition, your physician will probably ask you …

1. For no apparent reason do you have repeated, unexpected attacks during which you are overcome by intense fear or discomfort?

2. During this attack do you experience a pounding heart, sweating, trembling or shaking, shortness of breath, choking, chest pain, nausea or abdominal discomfort, “jelly” legs, dizziness, feelings of unreality or of being detached from yourself, fear of dying, numbness or tingling sensations, chills or hot flashes, or a fear of places you can’t escape from?

3. For at least one month following an attack have you felt persistent concern about having another one, having a heart attack, or “going crazy,” or have you changed your behavior so you won’t have another attack?

4. Does having to travel without a companion trouble you?

Mild anxiety can be a good thing. Without it, you’d be constantly drifting off to sleep, probably couldn’t hold a coherent discussion or achieve any of your goals. Mild anxiety is necessary for learning to take place.

As anxiety increases, your perception of what is going on around you decreases. Your hands or underarms may start to perspire, pulse and respiration increase, you may have “butterflies” in your stomach, diarrhea, frequent urination, tension headaches, fatigue, and/or increased muscle tension. You may speak more quickly, or more slowly, than usual.

When severe anxiety occurs, you start to pay attention only to parts of experiences and begin to block out the threat you feel. Learning does not occur at this level of anxiety, and your attention span is short. Your chances of understanding what is happening to you or of taking reasonable action are nil. You may focus on one small detail or on scattered details from many experiences. You may perspire profusely, and your pulse and blood pressure rise even higher. You may breathe rapidly in the upper part of your chest, and your lips and mouth may be quite dry. You may stammer, speak loudly, rapidly, in a high-pitched voice, or be hesitant. You may tremble, shiver, hold a rigid posture or clench your fists. Nowadays there are powerful medications to treat anxiety. One of them is Valium that we discuss here. Another one is Xanax, and there are some more…

Panic is the most extreme level of anxiety. You may blow things way out of proportion, may experience terror and feelings of unreality and be unable to communicate with other people. Because the higher levels of anxiety are so distressing, you may convert your anxiety to anger, which can bring you back to feeling in control again, even though your anger is unreasonable. You can also convert your anxiety into withdrawal by calling in sick, canceling appointments, or retiring to bed. You may convert your anxiety into physical symptoms such as high blood pressure, tension headaches, diarrhea, fatigue, or other physical symptoms.

You will be asked questions about your feelings of anxiety, ner-vousness, fear, and depression. You may be asked whether similar

solve them, if you’ve tried those actions recently, and whether they help now.

Some questions you may be asked are: “What was the attitude toward drinking in your family?” or “Did your parents or grandparents tend to drink when under pressure?” or “Did anyone in your family ever have problems with nerves, such as having a nervous breakdown?” or “How is your anxiety interfering with your life?”

Because many physical problems can lead to anxiety symptoms, your health-care practitioner will also try to rule out diseases of the heart, thyroid, kidney, nervous system, lung, and blood by doing a physical examination. You may also be asked about nutritional deficiencies (including lack of B-vitamins and iron) as well as what drugs you take, and how much alcohol you take, because they can also make you anxious.

Sarah, a thirty-two-year-old kindergarten teacher suffered from panic attacks and agoraphobia. By taking the Self-Diagnosis of Anxiety Maintenance Checklist (see valium), she discovered that her actions, including negative self-talk, poor nutrition, and a negative lifestyle, added to her anxiety.

Self-Diagnosis of Anxiety Maintenance Checklist

0. Not having valium or other medical treatment

1. Avoiding situations or objects that make me anxious. (post 9)

2. Using negative self-talk. (post 9)

3. Holding mistaken beliefs. (post 9)

4. Not sharing my feelings. (posts 9 and 10)

5. Not being assertive. (post 10)

6. Holding too much body tension. (posts 8 and 9)

7. Lack of self-nurturing skills. (posts 9 and 10)

8. Poor nutrition. (post 5)

9. Leading a high-stress life. (post 7 and

10. Not having meaning or a sense of purpose to my life. (post 10)

Go back and pick three of the ten causes of anxiety and pledge to work on them daily for the next month. Write the word pledge after each of the three. Work through the posts that relate to your choices first, before reading the rest of this website.

1. I feel uncomfortable and experience building tension or discomfort that seems to come out of the blue when I think about a particular situation.

2. I avoid specific situations that make me feel uncomfortable.

3. I have at least four of the following symptoms at the same time: shortness of breath or feeling smothered; heart palpitations (rapid or irregular heartbeat); trembling or shaking; choking; dizziness or unsteadiness; nausea or abdominal distress

4. I worry excessively, and so I feel restless, keyed up or on edge, irritable, easily fatigued, have trouble falling or staying asleep or I wake up tired, have tense and tight muscles, have difficulty concentrating, and/or find my mind going blank.

5. I have recurring intrusive thoughts such as hurting or harming a close relative, being contaminated by dirt or a toxic substance, fearing I forgot to lock my door or turn off an appliance, and/or have unpleasant fantasies of catastrophe.

6. I perform ritualistic actions such as washing my hands or counting to relieve my discomfort because I have fears that keep entering my mind.

7. I have witnessed or been subjected to a life-threatening experience and have persistent symptoms that have lasted for at least a month, including repetitive and distressing thoughts, nightmares, flashbacks, attempts to reenact the situation, emotional numbness (out of touch with your emotions-feeling no anger, sadness, guilt, or relief), feeling detached from other people, losing interest in activities that once gave me pleasure, sleep or concentration problems, startling easily, irritability and/or have outbursts of anger

Key to Your Answers:

If you checked #1 (just thinking about a situation brings on dis-comfort), you have anticipatory anxiety.

If you checked #2 (your discomfort arises only in response to being in a specific situation), you have what is called situational anxiety and you are likely dealing with agoraphobia, or fear of going to specific places or being alone. If your discomfort is related to being in social situations and is related to avoiding humiliating or embarrassing yourself, you may be suffering from a social phobia.

If you checked #3 and you include among your symptoms shortness of breath or feeling smothered, you have panic attacks. If your anxiety forces you to avoid certain situations, you have a phobia. If the avoidance is of places, such as driving on freeways, going to doctors, riding in elevators, using public transportation, going over bridges or going through tunnels, eating in restaurants, going to work, and so forth you are likely dealing with agoraphobia.

If you checked #4 you probably have a generalized anxiety dis-order.

If you checked #5 you may have an obsessive-compulsive disorder with obsessions only.

If you checked #6 you are probably dealing with an obsessive-compulsive disorder with both obsessions and compulsions.

If you checked #7 you are probably in post-traumatic stress or nonspecific anxiety condition.

Much of this website is devoted to helping you learn new ways to cope with anxiety by taking valium. Although many actions can keep an anxiety condition going, the following are the most common and are the easiest to change:

1. Avoidant Behaviors As long as you continue avoiding situations or objects that cause you anxiety, your anxiety will continue. Avoiding a situation doesn’t eliminate it. You continue to worry and spend a great deal of energy to make sure you don’t have to confront the situation or object. The key to unlearning your phobic reaction is to approach the upsetting situation or object in small steps. Imagery and desensitization are key to this effort and are discussed in post 9.

2. Negative Self-Talk We all talk to ourselves in our minds. Sometimes it’s so automatic and subtle you don’t notice it. Self-talk can be positive and encouraging or can be negative and create more anxiety. It is the following kinds of self-talk that must be silenced, ineluding: “What if I have another panic attack?” “I’ll never be able to deal with this!” “What if I lose control of myself?” “What will people think if I lose control?” “I’m having a heart attack-I just know it!” “My legs feel so weak, I can’t walk.” This kind of talking scares you even more and aggravates the physical aspects of anxiety.

3. Mistaken Beliefs It is these mistaken beliefs that bring about negative self-talk. If you believe you are losing control, you can talk yourself and everyone else around you into believing that it’s true. If you’re programmed to believe life is meant to be hard, then you will think something is wrong when things go your way or people offer help. If you believe the world is a dangerous place and people can’t be trusted, you will live a life filled with suspicion and will veer away from taking the risks necessary to overcome many anxiety conditions. See post 9 for more information on mistaken beliefs and how to overcome them.

4. Denial of Feelings When you deny anger, frustration, sadness, and even excitement, you can feel more anxious and not know why. You may have discovered that after you let out your anger or have a good cry, you feel more at ease, calmer. Expressing your feelings is a good way to reduce your anxiety. Valium also helps here.

5. Lack of Assertiveness Assertiveness is the vehicle that allows you to express your feelings in a respectful but honest way to other people. If you’re not assertive, you may fuss and stew inwardly or avoid the person or the expression of how you feel. You may think it’s not nice to be open about what you want and need because you might alienate the other person. The problem with not being assertive is that it builds resentment and confinement, two feelings that aggravate anxiety conditions. You can learn to be assertive. Find out more in post 10.

6. Muscle Tension When you feel uptight, you have tight muscles, and this restricts your breathing, healthy heartbeats, diges tion, circulation, thought, and just about all body processes. You may have learned that when your body is tense, your mind races. When you relax your muscles, your mind will slow and calm. Anxiety cannot exist in a relaxed body, so the key is to use relaxation skills to be at peace. Vigorous exercise and deep muscle relaxation can help you remain calm. See posts 8 and 9 for more information.

7. Lack of Self-Nurturing You may have a deep sense of insecurity due to a parent’s neglect, abandonment, abuse, overprotection, negative criticism, alcoholism, or chemical dependency. Growing up in this kind of household means you never received consistent or reliable nurturing as a child and so you never learned how to take care of yourself in a loving and nurturant way. You probably feel anxious and overwhelmed by the adult demands placed upon you, and this can lead to perpetuating your anxiety condition. Learning to nurture your “inner child” is the way to grow and learn to be a responsible adult. See posts 9 and 10 for more information.

8. Poor Nutrition Drinking lots of coffee and sodas, eating junk and fast foods, sugar, food additives, foods your body is sensitive to, and eating while doing something else can increase your anxiety. Just eliminating caffeine from your diet (including the caffeine in over-the-counter medicines) can relieve a great deal of anxiety and worry. See post 5 for more information.

9. Stressful Lifestyle Lack of time-management skills, not grieving losses and changes, burning the candle at both ends, smoking, drinking, and taking drugs can worsen your anxiety condition and even bring it on. See posts 5-9 for more information on how to reduce your stress. f you want to learn more about your anxiety, charting your reactions in specific situations. can be very helpful. Because anxiety is

often unexplained discomfort, identifying what is happening right before, during, and after your anxious moments can help you decide what to do to reduce it. Use the Self-Diagnosis Checklist to determine when you have anxiety.

Because GAD lacks some of the dramatic symptoms of panic attacks or phobias, it may be difficult to diagnose. To make a diagnosis, your physician may ask you …

1. Do you worry excessively most days, and has this been happening for at least six months?

2. Do you worry unreasonably about work or school or your health?

3. Do you believe you can’t control how much you worry?

4. Do you feel restless, keyed up, and on edge a lot of the

time?

5. Do you tire easily?

6 .. Is it hard for you to concentrate?

7. Are you irritable?

8. Are your muscles tight and tense?

9. Do you have trouble falling asleep or staying asleep, or do you toss and turn and get up feeling tired?

10. Does your worry interfere with your daily life?

Will, a twenty-eight-year-old mechanic, was having trouble falling asleep. He tossed and turned and woke up feeling tired. He felt on edge a lot of the time and as a result got into arguments with the other mechanics; he had unreasonable worries about the work he was doing and didn’t feel he had any control over his discomfort. Will’s physician diagnosed him with generalized anxiety disorder and gave him a prescription for an anti-anxiety drug (valium).