Anxiety and Panic: One Cause and a Treatment Approach
The goal of this commentary is to provide you with a better understanding of potential causes of anxiety and panic attacks. While the origins of these disorders are complex and often arise from multiple causes, I will focus on the role of separation and loss for the purposes of this article. More information on the causes, symptoms, diagnosis, and treatment of Panic Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder, can be found here.
It is important to note that my perspective in this article is grounded on my training as a psychoanalyst. Based on years of education and clinical experience, I employ a psychodynamic orientation to think about and treat these disorders.
What is causing my Anxiety?
In the world of psychology, it is commonly held that the precise causes of anxiety have yet to be determined. However, I have noticed––in my over twenty years of experience––that sources of anxiety tend to cluster around separation and loss.
Early symptoms of generalized or social anxiety disorder may appear in childhood after commonplace separations from important caregivers. Research has demonstrated that some caregivers withdraw love when a child first begins to define themselves. This continues to occur in subtle but destructive ways throughout early development and may continue into adolescence and early adulthood. Comments such as “Why do you need to go out with your friends?” imply that there is something wrong with the child’s desire to separate. They instill the idea that pursuit of one’s interests leads to negative repercussions from important caregivers. There are many ways a caregiver can demonstrate this, including expressions of anger and guilt (e.g., “I guess I will just eat alone tonight”) and the withholding or withdrawal of love, support, and comfort (e.g., “Find your own ride to the soccer game then because I won’t be there”). This potential for a loss of love can be terrifying and anxiety provoking, and even induce a state of panic around everyday separations.
During moments of intense anxiety or panic, one often feels a profound sense of loneliness and isolation, even if not consciously thought about. It is no coincidence that the person suffering from anxiety needs reassurance and that panicked individuals need someone by their side. These needs are designed to ward off the painful feelings of loss, loneliness, and isolation. Most individuals who struggle with anxiety and panic attacks are not able to recognize that these coping mechanisms provide a sense of being loved and worthwhile when pursuing their own interests.
Why am I so Anxious? Why do I have Panic Attacks for No Reason?
Let’s examine an adult suffering from anxiety and panic attacks. Oftentimes, they report that they suddenly became panicked for no given reason. In their mind, nothing is happening and nothing has changed; they simply start to get panicked or overwhelmed with anxiety without cause. After close analysis, I find that these situations often occur during times when the affected individual needs to assert independence (e.g., getting a promotion at work) or feels neglected. Anxiety appears in this moment due to the feeling that someone is not there to support, comfort or care for them.
These individuals are easily hurt by any sign that they or their ideas are not a priority. As previously stated, these painful feelings may be unconscious and manifest as anxiety and panic. It is well documented that those with certain anxiety disorders avoid people, places, or events. Rather than avoiding random situations, these individuals withdraw from situations where they were hurt or felt alone and isolated as well as where they believe they could be hurt (e.g., school or a social gathering). These individuals may take life’s inconveniences and challenges as personal attacks and subsequently avoid situations that could result in such feelings.
An Example of How I Treat Anxiety and Panic Disorders
The following is an example of a prototypical patient who suffers from anxiety and panic attacks. In order to protect the anonymity of my patients, I present this case as a composite of many patients’ experiences.
In this example, the patient presents for treatment quite panicked and describes having felt anxious over the weekend. That Sunday, she had a full-blown panic attack and could not leave her apartment to socialize with friends. She had no awareness of what led to the panic attack and was convinced that it just happened out of nowhere. During her session, I could see that she was still quite anxious and was not able to think clearly. My first goal was to reduce her anxiety and help her begin regulating her emotions. I prepared her to think about and deal with potential feelings that were not yet in her level of consciousness.
Keeping in mind that individuals affected by anxiety are not automatically aware of the full complexity of their emotional states, I work to guide them in learning how to do so. I started by clarifying the context and timing of the anxiety and then explored potential causes. Slowly, we began to see that a childhood friend planned a wedding date without first confirming the date with the patient. She became enraged and planned to write her friend an angry goodbye email. I suspected that this was a means of avoiding the hurtful situation and inquired about her need to act precipitately. I recommended that she wait before sending the email, to give her friend a chance to explain herself, reassuring her that we could work together to think about the painful feelings of rejection she might have experienced. This immediately resonated with her, and she began to describe this and other rejections she experienced prior to the panic attack.
In summary, my work focuses on helping those with anxiety disorders understand unconscious thoughts of rejection and manage behaviors (e.g., send an angry email) intended to avoid painful feelings.
There are many factors that lead one to become anxious and panicked. In this article, I identified one cause of anxiety: separation and loss. Such feelings often arise in early childhood and persist into avoidant behaviors as an adult. The main goal of treatment for such individuals is to help them regulate anxious emotions. Once calm, the work shifts toward understanding what actually led to the panic attack and anxiety. If you or someone you know is struggling to manage anxiety, it may be helpful to speak with a qualified mental health professional. If you have any questions about this commentary or if you would like to set up a consultation, please call my office at 212-591-0152 or fill out the form at this contact page. From there, I can review your case and offer you a treatment plan to meet your needs.