palpitations, tachycardia, shortness of breath, and severe gastrointestinal dis-
tress are all common. Panic can create the classic danger signs of stroke,
heart attack, pneumonia, and perhaps even dengue fever. Relatives rush
the panic-stricken to doctors, who order tests, take vital signs, and happily
announce that they are all negative.
“Well, Jane,” the doctor says as he looks through pages of print-
outs. “The tests show that you’re a perfectly healthy young
woman. I think the breathing problems and the dizziness are
caused by anxiety. What you have is panic disorder.”
“You mean all this is in my head?”
“No, not at all. You see, the anxiety is what’s causing you
to think ... ”
The doctor goes on, but Jane isn’t listening. She’s shocked
by the implications of what she thinks she heard: He thinks I’m
making it up.The initial diagnosis of panic disorder is usually made by ruling out
anything more dangerous. Panicky patients are more apt to react with sus-
picion than rejoicing. As they see it, the diagnostic process starts with serious
medical tests and ends with being taken less than seriously. They wonder
if the real reason the doctor is blaming their minds is that he can’t figure
out what’s wrong with their bodies. Many people with panic disorder pursue
a physical diagnosis as if it were the Holy Grail. They shop for doctors who
will speak the magic words: You’re really sick, but I can cure you.Unfor-
tunately, they find all too many.
For anyone with panic disorder, accepting the notion that their illness
is mental as well as physical requires a paradigm shift, a change in percep-
tion that is rarely achieved without painful soul-searching. Yet, the success
of the entire course of treatment depends upon this single insight. After
initial calming and ruling out physical demise, the next step is convincing
people with fear disorders that their suffering is caused by the physical cor-
relates of the fear response rather than fatal illness. For that, you need a
really good explanation. People like Jane must understand clearly how
short circuits in their heads lead to pains in their chests. A busy doctor
may have sketched out the process, but it will likely fall to you to elaborate.
And repeat. A couple of hundred times should do it.
74 ❧Explosions into Fear