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Causes of Panic Disorder: Separation Anxiety

by Dr. Blumberg on August 6, 2010

Living Panic-Free
Living panic-free is not a simple matter. Panic disorder is a complex condition.  The causes are multi-factorial.  Psychological, biological and interpersonal factors often combine over time building up to that first panic attack “Out of the Blue.” Panic episodes often wax and wane on their own, even without intervention. Oftentimes, just when you think you beat panic for good, another wave of panic can strike unexpectedly.

Stop Recurring Panic Episodes
For example, six months ago, Judy*, a 35-year old school teacher, had successfully completed panicLINK®.  She had mastered the 6-step takeCONTROL training method and believed she had eliminated panic from her life for good.  I tried to prepare Judy for the inevitability of relapses and the return of panic into her life.

We rehearsed Rebound Readiness skills so that she could use the return of symptoms as a further opportunity to practice symptom normalization. It is so easy to let your guard down and think you are done with panic.

Suddenly, a new wave of dizziness, shortness of breath, weakness, rubbery legs, and heart pounding can hit you from behind.  You can find yourself rapidly drawn right back into that vicious cycle that you worked so hard to break.

Judy had an ideal panic-free summer, relaxing with family and friends and enjoying family life. She especially enjoyed organizing an enriching activity schedule for her 6-year old daughter, who was preparing to enter the first grade.

Back to School Signs and Recurring Panic Attacks
 Before she knew it, August had arrived. “Back to School” signs were cropping up everywhere.  All of a sudden, out of nowhere, Judy started to feel a wave of lightheadedness, weakness and rubbery legs. But this time, the feelings were more intense and a new symptom of numbness spread down her arms and over her lips and face. The terrifying thought, “What if I am having a stroke, and I will never see my daughter start school?” flashed across her mind. When her medical Doctor reassured her that the numbness was probably just stress-related, it just did not make any sense to her. Her summer had seemingly been so stress-free!

Stressful Life Events and Panic Onset
Two core stressors have been well-documented in the scientific literature as triggers for panic attacks. I continue to observe these same core triggers in my own panic practice with well over 5000 patients covering three decades.  Barlow and Cerney (1988) in their classic work “Psychological Treatment of Panic” review research, which shows that the two precipitating events for the onset of panic attacks include:

  1. Marital and family conflict
  2. Death/separation and sickness of significant others

Wayne Katon,  in his 1988 book “Panic Disorder in Medical Settings” also indicates “Significant separation events as frequent precipitants for panic disorder.”

But, somehow, Judy did not make the link between the sudden surge of numbness in her body and the “Back to School” signs. She did not connect the fleeting image of her 6-year old daughter leaving home for her first day as a first grader with the waves of weakness rippling through her body.

Why didn’t Judy see the link between separation anxiety and the onset of panic symptoms?

There is a four-factor pre-panic profile that predisposes panic-prone individuals to the development of “Out of the Blue” panic attacks.

Your Four Factor Pre-Panic Profile

  1. Your Interpersonal Style (How do you relate to others?)
  2. Your Cognitive Style ( Your thinking style)
  3. Your Core Stressors ( The Type of stressful events that upset you most)
  4. Your Emotional Management Style (how do you manage your emotions?)

You must know yourself in all four areas to see the link to living panic-free.

*References to real persons, places and events are made in a fictional context, and are not intended  in any way to be libelous, defamatory or in any way factual.


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