The goal of this brief commentary is to provide you with a better understanding of what causes stress, anxiety and panic attacks. Since these disorders are quite complicated with more than one cause, for the purpose of this article I will focus only on the role of separation and loss. For a general overview of the causes, symptoms, diagnosis and treatment of Panic disorder, Generalized Anxiety Disorder, and Social Anxiety disorders please refer to each of my articles on my website under the ‘services’ tab.
As usual, it is important to put my bias up front, I am a trained psychoanalyst, so the perspective I take is solely from a psychodynamic orientation which is built upon my educational background and years of clinical experience.
What is Causing My Anxiety and Why Do I Get Overwhelmed with Panic?
In general, it is commonly thought that the precise causes of anxiety have not been determined. However, over the past twenty years I have noticed that there are a few factors of causation that tend to cluster around separation and loss. Symptoms of generalized or social anxiety disorder may begin to appear in childhood around everyday separations from important caregivers. In my practice I often hear stories of caregivers who withdraw love at the child’s first move to define him or herself. This continues to play out in subtle but destructive ways through early development and may continue all the way 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 your desire to separate and should you decide to pursue that which is of interest to you, I (the caregiver / parent in this case) will be upset with you. There are many ways a parent can demonstrate that they are upset, such as with anger, inducing guilt (I guess I will just eat alone tonight) or by withdrawing from and withholding love, support, and comforting. This potential for a loss of love can be terrifying, anxiety provoking, and even induce a state of panic around everyday separations.
In moments of intense anxiety and panic, what is often felt, but not consciously thought, is a profound sense of loneliness and isolation. It is no coincidence that the person suffering with anxiety needs reassurance and the panicked individual needs someone by their side. Both of these needs are designed to ward off these painful feelings of loss, loneliness and isolation. Most individuals who are struggling with panic attacks and anxiety are not able to recognize that when they are alone, what goes missing is 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 fast forward to the adult who is suffering from anxiety and panic attacks. Oftentimes they report that they suddenly became panicked for no given reason. In their mind nothing is happening, nothing has changed, they just start to get panicked or overwhelmed with flooding anxiety. Close analysis has led me to see that at a given moment the individual may be anxious about asserting one’s independence (getting a promotion at work) or that they feel neglected by someone; someone is not there for them, supporting them, or making them feel comforted and cared for.
These individuals are easily hurt by any sign that they and/or their ideas are not given preference. As I mentioned earlier, you don’t always see the hurt and painful feelings, oftentimes what manifests is anxiety and panic. It is well known that with certain types of anxiety disorders people start to avoid certain places or events, they withdraw. This withdrawal, I am suggesting, is not just from random people and places that make them anxious. They withdraw and get panicked about situations where they were hurt or were made to feel alone and isolated. Alternatively, they may withdraw from and avoid places and social gatherings where they believe (again, this is not necessarily conscious) they can be hurt, such as school, or social gathering.
How are Anxiety Disorders Treated?
An Example of How Anxiety and Panic Disorder are Treated:
In order to protect the identity and anonymity of my patients I will not talk about any one experience or patient. The following example describes a prototypical patient who suffers with overwhelming anxiety and panic attacks. The patient presents for treatment and describes having felt anxious over the weekend. On 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. She also could not pinpoint the cause of her anxiety. She was still quite anxious and was not able to think, I could see. The first goal was to reduce her anxiety and help her begin to regulate her emotions. I worked to prepare her to think about and deal with potential feelings that were not yet in her level of consciousness.
Individuals who suffer with Anxiety Disorders, whether it is Generalized Anxiety Disorder or Panic Disorder, are not automatically aware of their various emotional states and need to learn what goes on inside oneself. I used the following interventions, ‘you became anxious… the complaints you describe are all physical expressions of anxiety .. you were in a state of complete panic .. let’s try to find out what made you anxious.’ Slowly we began to see that a childhood friend planned a wedding date without first confirming the date with her. She was enraged and planned to write her an angry goodbye letter. In terms of testing the reality of the situation I helped her wonder about her need to act precipitately (this is avoidance of the situation that hurt her). I reassured her that should she decide to wait, and give her friend a chance to explain herself, that we, together, could think about the painful feelings of rejection and hurt that she might have experienced. This immediately resonated with her and she spoke about this and other rejections she experienced prior to the panic attack.
The main point I am trying to make in this simple example is how quickly any inconvenience is taken as a personal attack, a rejection of some sort, and how individuals who struggle with Anxiety Disorders are always in danger and are in fact overwhelmed by a feeling of abandonment that is typically far from awareness.
There are many factors that lead one to become anxious and panicked. I have attempted to identify just one cause of anxiety that potentially starts in early childhood. The cause I outlined above is driven by separation and loss. I tried to describe what happens when a parent does not foster autonomy and individuation and the consequences this has later in life when one feels ‘separate’ from the other. Broadly speaking, the main goal of treatment is to help this kind of person regulate these emotions. Once in a restored regulated state of mind the work to understand what actually led to the panic attack and anxiety can be better understood. If you or someone you know is struggling to manage anxiety it may be helpful to contact and talk with a qualified mental health professional. If you have any questions about this commentary or if you would like to set up a consultation to talk about your emotional state feel free to reach out.