When Fear is a Disease

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Phobias and Panic

Since phobias could be labelled "panic with an object", i.e., they are panic crises which occurr only in specific situations or places, it is important to understand how a panic crisis is formed.

For this, it might be interesting to compare your brain to a car which is fitted with an anti-theft alarm device, of the kind which is touched off just by rocking its chassis a little bit.

This  "alarm device" is located in one of the most ancient parts of our brain, particularly what we call the "limbic system", which is responsible for controlling "fight-or-flight" reactions. Our internal alarm sounds only in situations where there is real danger. For many people, however, the alarm sounds for no apparent reason (by analogy, this happens in cars sometimes, as you may have seen, in parking places). This is what we call the panic attack.

For other people, the alarm is switched on in improper situations and places, such as inside a lift, enclosed places or on your way in the traffic. This is what we call a phobia.

The panic disorder is a mixture of both things: the panic attack and the phobia.

In the first phase of the panic disorder (or syndrome) the person is subjected to random panic attacks, for no reason whatsoever. In the second phase, the person starts to have the same symptoms in places or situations where the panic crisis had happened. Thus, if a panic attack occurred inside an automobile, the patient becomes afraid of driving alone or stops driving altogether. If it occurred in an enclosed space, the patients is loath to go to the interior of banks, shopping malls and movie theaters. Or stays very near to the exit doors, just in case. For many, the simple act of thinking, remembering or even seeing a picture of the situation is enough to detonate a panic attack.



Whoever suffers phobia feels an enormous fear every time he or she encounters (or even imagines...) the original phobic stimuli which unleash the panic attack. At least four of the following symptoms are usually observed:
  • breathlessness,
  • heart fluttering (palpitation),
  • chest pain or pressure,
  • a sensation of suffocation or drowning,
  • dizziness and vertigo,
  • a sensation of detachment from reality ("air head"),
  • tingling sensations in several part of the body,
  • heat or cold waves,
  • sweating, dry mouth,
  • a sensation of fainting, trembling or shaking,
  • a fear of dying or becoming mad, or losing control.

What largely differentiates a person with phobia from one with simple, "normal" fear, is that the patients start to avoid at any cost the places, situations and objects wich unleash the panic attacks, thus changing completely their life routine and even profession.

Oftentimes, phobic patients have their lives complicated by two factors. First, they usually lose confidence on their own ability to overcome the panic symptoms and start avoiding any places where they feel they will be unable to get help. Secondly, they tend to exaggerate or overvalue their own symptoms, feeling that they will die, or have a heart attack or stroke, or that they are afflicted with some misterious, severe or uncurable disease.

The biggest consequence of the first complication is that of a progressive isolation from life in general, an impoverishment of life which becomes an impediment to the day-to-day activities of a normal person. The biggest consequence of the second complication is an eternal search for medical care for imagined ills and a general reorientation of life towards constant preoccupation with disease and impending death.


The Vicious Circle
of Phobia

As we have seen above, the crises of panic in phobic patients is provoked by abnormal connections in the ancient part of our brain, the limbic system. When the "emergency alarm" sounds off, the patient starts to feel all the primitive, animal sensations of impending fight or flight, and immediately the brain is flooded by images of catastrophe and failure. The limbic brain reacts to this situation once more by increasing the fear symptoms to even higher levels. Respiration becomes altered, thus leading to significant chemical changes in the blood. Endocrine glands pump hormones, such as adrenaline, into the blood, reinforcing the metabolic changes and again unleashing new crises.

When this level is reached, symptoms become to look very frightening. The patient gets confirmation that the initial symptoms were really indications of a very serious problem. A feeling of great danger ensues on the patient's imagination. Again, the limbic system, commanded by the conscious sensations at the level of the cortex, reacts in the only way it knows: by detonating new panic, new fright and flight.

In this way a vicious circle is formed, holding the phobic patient in its unending grip...


Introduction / Origins / Phobias and Panic / Symptoms / A vicious circle / Treatment / References / About the author

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