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Section 11
I.B.S. & Steps in Using a 'Letter to My Support'

Question 11 | Answer Booklet | Table of Contents

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In the last section, we discussed three characteristics of childhood agoraphobia, which are development in childhood and adolescence; separation anxiety; and early exposure.

One of the most common anxiety states is, as you know, panic disorder. This disorder is characterized by sudden attacks of anxiety which include dizziness, chest pain, and shortness of breath. 

In this section, we will discuss three aspects of panic disorder, namely typical manifestations; irritable bowel syndrome; and loss of significant person.

Three Aspects of Panic Disorder

♦ Aspect #1 - Typical Manifestations
The first characteristic we will discuss is typical manifestations. Most commonly, panic disorder is suffered by young adults in their twenties, more often female. These clients usually have a history of separation anxiety and a family member with a history of anxiety, panic, or phobic disorders. 

These clients begin to develop sudden attacks of distress, usually during a long period of stress.  During these attacks, clients usually experience chest pain, blurred vision, and hyperventilation.  Scared of these symptoms, many clients run to a hospital or doctor, only to find that there is no specific thing wrong with them. 

Jenny, 29 year old client of mine, began having panic attacks when she was in her early twenties. Jenny stated, "My panics began at a time when life was very busy but also very good. I had gotten a promotion with a sizable increase in pay and was on top of the world because I was finally doing what I had always wanted to do and knew I could do it very well. I was drinking more coffee to keep me functioning at my highest level, and probably got up to six or eight cups a day. All in all, it was a great time in every way and my family knew how pleased I was." 

It was here that Jenny’s panic attacks began.  She stated, "The first attack occurred when I was sitting in the audience at my son’s kindergarten "graduation" ceremony.  Suddenly, I felt hot and as though I  couldn’t breath.  My fingers started to feel numb and tingly and things seemed unreal."  As you can see, although Jenny was in a relatively happy state of life, the stress at her new job and many other factors contributed to the initiation of her panic attacks.

♦ Aspect #2 - Irritable Bowel Syndrome
The second aspect is the connection between panic disorder and irritable bowel syndrome. IBS is described as a functional bowel disease with chronic or recurrent gastrointestinal symptoms that are not explained by structural abnormalities, infection, or metabolic changes. This syndrome is the most common digestive disorder in medical practice, affecting 22 million Americans. 

This syndrome can be triggered by anxiety, stress, and tension. Just like panic disorder, IBS first appears in late adolescence or early adulthood and is found more commonly in women than in men. It has been speculated that some IBS clients could in fact be panic disorder clients. In 1986, five clients who suffered from IBS and panic disorder were treated pharmacologically for their panic. After their treatment, the IBS as well as the panic disorder dissipated. 

The researchers extrapolated that the gastrointestinal symptoms may have been manifestations of panic disorder, rather than merely aggravated by the anxiety. Evan was a 22 year old client of a colleague of mine who had suffered from IBS early on in his adult life. Evan’s daily morning routine consisted of abdominal cramping and diarrhea which was becoming more and more frequent. These attacks were also starting to happen at other times of the day. 

During these periods, he felt extremely anxious, became weak, unsteady on his feet, and thought that he would faint.  Evan’s father was also prone to episodes of chest pain, hyperventilation, and shortness of breath which seemed to have no physical cause. Finally, Evan was referred for psychiatric consultation and was diagnosed with panic disorder. After anti-panic medication was administered, both his emotional and physical symptoms slowly deteriorated.

♦ Aspect #3 - Loss of a Significant Person
In addition to typical manifestations and irritable bowel syndrome, the third aspect of panic disorder is the loss of a significant person. Many times, clients prone to panic disorder are dependent on a certain person or persons who act as a psychological anchor. If somehow this person is taken out of the client’s lives, this could send the client into a panic. This could occur in several ways:  death, a move, or even a breakup.

Many clients do not initially reveal their loss in their client history, so often these issues go unresolved. Clients also do not recognize their need for emotional support and view themselves as independent people. Beth had broken up with a boyfriend with whom she had had a relationship for three years. After their separation, Beth began to have feelings of dizziness and chest pains. However, she did not link her breakup to her sudden attacks. Beth stated, "I just seem to have this urgent need to have someone to turn to for help." 

For the last three years, Beth had had her boyfriend to rely on. Once he was removed from her life, she felt adrift and refused to see herself as a dependent person, and consequently refused to make any other attachments.

♦ Technique:  Letter to my Support
To help Beth find that foundation she so needed, I asked her to compile a "Letter to my Support".  I asked her to think of someone else in her life, perhaps someone she knew before her relationship, that she could turn to when she felt anxious. Beth chose her friend Lizzy. I then asked Beth to write a letter to Lizzy, explaining what was going on in her life and asking her for help. 

Beth wrote, "Dear Lizzy.  I know I haven’t been as attentive a friend as I should have been, but at this point in my life, I really need someone to hold my hand. Scott and I just recently called it quits and I’ve been lost ever since. I’m not asking for a commitment from you, just the reassurance that, if I need to, you’ll help me through whatever it is I’m going through." Beth gave her letter to Lizzy, and since then, Lizzy has been a remarkable support for Beth.

In this section, we discussed three aspects of panic disorder, namely typical manifestations; irritable bowel syndrome; and loss of significant person.

In the next section, we will examine three steps to help clients overcome their anxiety over travel. These three steps are Motivation; Pleasurable Tie-Ins; and lessening anticipatory anxiety.

- Greist, J. H., M.D., Jefferson, J. W., M.D., & Marks, I. M. (2005). Anxiety and Its Treatment. Washington, DC: American Psychiatric Press.
- Santucci, L., & Ehrenreich-May, J. (jun 2013). A Randomized Controlled Trial of the Child Anxiety Multi-Day Program (CAMP) for Separation Anxiety Disorder. Child Psychiatry & Human Development, 44(3), 439-451. doi:10.1007/s10578-012-0338-6.

QUESTION 11
What are three aspects of panic disorder? To select and enter your answer go to Answer Booklet.

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