Fear disorders improve with medication, psychotherapy, and a little
help from friends and family, but as with the calming sequence described
in the last chapter, the improvements are sequential. One must be
achieved before the next is even possible.
The first step is understanding the disorders.
Panic Disorder
According to the fourth revision of the Diagnostic and Statistical Manualof
the American Psychiatric Association (DSM-IV)*, panic disorder consists of:
- Recurrent unexpected panic attacks
- At least one of the attacks has been followed by one month
(or more) of one (or more) of the following:
a. persistent concern about having additional attacks
b. worry about the implications of the attack or its
consequences (e.g., losing control, having a heart
attack, “going crazy”)
c. a significant change in behavior related to the attacks
A panic attack is the quintessential explosion into fear. If you’ve never
had one, it will be difficult to conceive of anything so intense. I always
think of Carol Burnett’s futile attempt to explain childbirth to men: “Imag-
ine taking your lower lip and pulling it over your head.”
Some things are simply beyond understanding unless you’ve experi-
enced them yourself. Suffice to say that a full-blown panic attack is far beyond
anything most people would interpret as fear; it feels like certain annihilation.
Let’s look at Jane again, whom you’ll remember from her attack at
the mall and the incipient explosion in her kitchen:
Jane had her first panic attack shortly after her son was born. She
awoke from troubled dreams to discover that a strange disease had
paralyzed her chest. The muscles were so tight that she could not
draw a breath. She was certain she was going to suffocate. In the
darkness, she reached out for her husband, hoping to touch him
one last time before she died.66 ❧Explosions into Fear