Physical symptoms, panic attacks, and how to manage them
anonymous Asks ...
For about a week I have felt like I have a lump in my throat all the time and sometimes I am so stressed at work, I am a chef, I can feel my heart start pounding in my neck and I always wonder if I am going to have a heart attack. My friend is a nurse and she took a look at my throat with the light thingy and said there was nothing physically wrong that she could see and she said that stress caused lots of weird symptoms like this. How can I tell for sure if it is stress that is causing my problems? I am sure you can understand that it is hard to taste food properly when I feel like I cannot swallow right.
David Shannon Says ...
Sometimes it is difficult to sort out what is causing physical symptoms like those you describe. If you have specific concerns about that, I would suggest following up with your doctor. Having trouble swallowing could result from several things I can think of off the top of my head, such as stomach reflux, sinus drainage, or some physical condition that might take more testing than your nurse friend's visual exam could reveal. Having that talk with your doctor might be a good idea anyway, since they may suggest an anti-anxiety medication for you to try.
However, when you say "I can feel my heart start pounding in my neck and I always wonder if I am going to have a heart attack," that sounds very much like a panic attack. One overly simplistic but useful way to think about panic attacks is that they happen when you get very anxious about being very anxious. So there is a multiplying and escalating effect to your original worrying, and you may wonder what brought all this on. Panic attacks almost inevitably causes physical reactions. It is quite common to experience a pounding or racing heartbeat. It might also cause you to perspire more. It is pretty easy to get disoriented, lose concentration, suddenly need to sit down, or have to get up and pace.
When panic attacks are recurrent and you start to live in fear of having more of them, then you may have what is called panic disorder. You may go to great lengths to avoid situations and stressors that might cause another panic attack to happen. This can be debilitating, and interfere with many aspects of your life.
Treatment options include both medications and psychotherapy. Specifically, cognitive behavior therapy can help you identify, interrupt, and challenge the thought patterns that drive the escalating panic, and the resultant physical responses.
For a more comprehensive discussion about panic attacks and panic disorder, I recommend the Mayo Clinic's eleven part treatment of the subject: http://www.mayoclinic.com/health/panic-attacks/DS00338 .
There are things that you can do to help manage panic attacks, when they do occur. The first thing is to remember to breathe. That will allow you to start thinking rationally about the situation. If you have experienced them before, you can say to yourself, "Oh, I recognize these symptoms. I'm having a panic attack. I've had them before, and I've survived." It may take a period of at least 10 minutes for the physical symptoms to subside. You may have to just wait that out, as calmly as possible, knowing that they will diminish and end eventually. When this happens on your job as a chef, of course, it may be very difficult to take time out for that process to work. You may need to plan for ways to manage it that specifically fit with the demands of your work. For example, if you have other competent staff present, you could ask them to take over a particularly important task that requires close attention, and just cannot wait. If you are not able to structure temporary solutions like that, you may just have to tough it out. That makes managing the attacks more difficult, but you can keep reminding yourself to breathe. You can employ other relaxation techniques that you know or can learn, while you are going about your business. You can have the dialogue with yourself about recognizing what is happening and reassuring yourself that you can survive it. If you have developed a treatment plan with your doctor or mental health provider, you can recommit to following it, take comfort in the belief that it will work eventually, and have realistic hope that future attacks will be less frequent and less severe.
All of these interventions have a better chance of working, once you have sought medical and/or psychotherapeutic help. You'll have a much better idea of what is going on, and what you can do about it.