of faintness and being separate from the body. Changes in blood flow and
pressure may also affect the delicatevestibular system, the mechanisms in
the inner ear and the brain that tell you which end is up.
Muscular tension, especially in the neck, can pull the body off balance
and further impair blood flow to the brain. Vision may dim at the edges,
leading people to think they’re blacking out. Actual fainting is almost
nonexistent, except in the case of blood phobia.
CARDIAC IRREGULARITIES. The heart and lungs have to speed up to get
all the fuel-laden blood where it needs to go. Imagine stomping on the gas
pedal of your car. If everything is in tune, the change in acceleration will
be smooth. If anything is even slightly out of adjustment, there will be
bumps and bubbles. Unless you’re in superb physical condition, the rapid
shift of heart rate and blood volume will be quite noticeable. As the heart
beats out erratic rhythms, the muscles in the chest and diaphragm are pulled
tight as drums, which creates the percussive effect known as palpitation.
GASTROINTESTINAL DISTRESS. There’s no way to put this delicately. When
the digestive tract shuts down rapidly, it tries to dump whatever it’s carrying
from whichever end is closest. Socialization and well-developed sphincters
usually prevent indignity, but not without considerable discomfort. People in
panic can generate prodigious amounts of gas. They sometimes think they’ll
throw up or foul their pants, but they almost never do.
Panic Attacks Are Real
There is no question that panic attacks are real, rather than imaginary.
Misfiring of the sympathetic nervous system causes actual physical changes
that feel terrible, but are not terribly dangerous. The dire implications are
the imaginary part.People with panic disorder must understand that,
regardless of how badly they feel, they are not going to die, faint, throw up,
go crazy, foul their pants, or otherwise make fools of themselves.Despite
the internal pyrotechnics, panic attacks are almost invisible to the naked
eye. You see people having them every day, and never notice.
To help people with any fear disorder, you must both acknowledge
that their symptoms are realand reassure them that the danger is all in
their heads. This must be done with almost preternatural sensitivity.
Explosions into Fear ❧ 77