Giovanna Spantigati

Those who have experienced both kinds of disorders are usually able to distinguish them. In fact, though you can somewhat reduce and control the anticipatory anxiety by leaving the feared situation or seeking assurance from someone you trust, when the panic attack begins you cannot stop it. The panic reaction is like "all or nothing" since it goes beyond all control when the mechanism is triggered. If anticipatory anxiety reaches its highest levels of intensity, it can be disabling and cause more discomfort than critical episodes. In these cases, panic attacks may stay in the background, almost obscured by anticipatory anxiety, and their presence should be investigated thoroughly, since the patient may neglect the description.

Invariably, at this stage, there is search for reassurance, sometimes in compulsive and superstitious ways. The patient undergoes several physical and instrumental tests; performs many tests, including electrocardiograms, X-rays, electroencephalograms, computed tomography, magnetic resonance imaging, which are usually negative and its reassuring effect is only transitional. When new panic attacks arrive, here comes again the need for new investigations. Fears are reinforced by the fact that the cause is not found and there is no diagnosis for symptoms that, despite their intensity, are usually minimized by doctors reports. The large number and variability of these symptoms lead to different diagnostic formulations, influenced by the doctor's background, therefore, according to the doctor, it can be called cardiac neurosis, hyperventilation syndrome, labyrinthitis, hypochondriasis, hysteria, depression, anxiety syndrome of spastic colon. Patients go from one doctor to another and are often accompanied to the emergency services, usually labeled as neurotic, hysterical, with pathophobic, and so on.

In most cases, crisis continue and there is the tendency to link the attacks to specific situations and places. If the patient avoids to stay alone, to leave home or to use public transport, the panic attacks become less frequent and more tolerable. There is agoraphobia when the limitations imposed by the disorder interfere with leading activities in everyday life. More than two-thirds of patients with panic disorder who go to the psychiatrist have agoraphobic problems. In fact, patients develop a "fear of fear" and avoiding special places and situations they can control the upcoming new panic attacks. Some people become completely unable to leave home or may go out only with a reassuring person they trusts. How to recognize a DAP.A DAP is characterized by a precise period of intense fear or discomfort, during which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: 1. palpitations, tachycardia, 2.sweating; 3. fine or great tremors,, 4. shortness of breath or choking; 5. feeling of choking; 6. pain or discomfort in the chest; 7. nausea or abdominal distress 8. feeling dizzy, unsteady, lightheaded or faint 9. feelings of unreality or being detached from oneself, 10. Fear of losing control or going crazy; 11. fear of dying; 12. paresthesias (numbness or tingling sensations); 13. chills or hot flashes. (Dr. Salvatore Di Salvo) The end. I suggest you to look at the website - though in Italian - where you will find plenty of information and online publications. http://www.depressione-ansia.it

Giovanna Spantigati