panic attacks now will manifest in a tense feeling and slight blurry vision and are now mostly uncontrollable, with fast thoughts racing around my head and feelings of detachment.’
Panic disorder means having several of these episodes a day – and they can last up to twenty minutes, and even longer attacks have been recorded. Imagine the fear just one panic attack can produce. Shaking, difficulty breathing, nausea, chest pain, fear of dying. The slump afterwards when the adrenaline leaves you. Then imagine how far you’d go out of your way to avoid another one. Just as I did in the car, people with panic disorder will often avoid a place where they’ve had an attack. This can limit your ‘safe’ places scarily fast. While it might feel like you’re doing the sensible thing in not ushering in an attack, you’re actually reinforcing the fear – giving it legitimacy. A person with panic disorder lives in fear of an attack, but will also have more general fears – meaning there is no real safe space for them at all.
Catherine has identified what brings on her attacks, and although everyone is different, I recognised a lot of my own triggers in what she said: ‘Feeling out of control or not feeling as if I know enough about something. For example: going into town without having a plan of how I will be getting home, being spontaneous about plans, or going into a university class/exam unprepared.
‘My second theme seems to be health related – I can get panic attacks related to doing things that could make my health worse, such as side effects of antibiotics or thinking I might be having allergic reactions to something. I also sometimes panic about the fear of passing out. If I’m very hungry, or I work out too hard, I can have a panic attack about the fear of passing out.’
While still having panic attacks, Catherine has done something I didn’t do at her age: seeking help early. She has signed up for CBT sessions and also uses coping strategies when she senses that she might be about to have an attack:
‘In the moment of panic my usual coping strategy is deep breathing, sipping water and mentally telling myself “there is no threat, everything is fine, and to be calm.” I may remove myself from the situation if my panic is incredibly bad but usually I make myself stay, ride it out and show myself that what I’m panicking about isn’t going to harm me. In terms of prevention I mostly use lifestyle – I get enough sleep, eat well, take vitamins, go for walks – generally just keep myself healthy and stress free. If I’m having an anxious time I can recognise when I’m pushing myself too far and when to take time to myself.’
Phobias
Almost everyone has a fear of something strange. The NHS estimates 10 million people in the UK have some kind of phobia.[28] My mum hates rats. For years, she wouldn’t even allow the word to be spoken in front of her. We had to say ‘big mice’. My mother is incredibly strong, smart and fearless. But I have seen her turn into a screeching mess when confronted with ‘big mice’. A country walk a few years ago turned into a farce when we spied one twenty metres ahead of us. ‘TELL IT TO GO AWAY!’ she yelled repeatedly as she clutched my arm. Unhelpfully, I laughed uncontrollably at this request. I am not a kind daughter. She can write her own book about this.
But phobias can be life-changing. My mother rarely comes into contact with rats. Other people are not so lucky with their fears – and it can be incredibly distressing when you sense danger – whether or not the danger is real.
Phobias usually fall into one of two categories – specific phobias and complex ones. My mother has a specific phobia. Animals are common, as are heights, blood, vomit and flying. If you have a fear of something specific you’ll normally go out of your way to avoid it. If your phobia is massive spiders and you don’t live in Australia you might not find this too restrictive but when it’s something you can’t always avoid, you can find your world shrinks. I developed a fear of flying aged eighteen. Having previously been fine on planes, I suddenly could not get on a flight. I was terrified. I missed fun family holidays, friends going on adventures, and work trips. I occasionally took dreary train trips and pretended it was a fun way to travel, but I felt absurd and immobilised. Just the thought of a plane journey would have me shaking, and I felt so restricted by it.
Complex phobias are even harder to overcome. This term usually refers to agoraphobia and social phobia. Agoraphobia is widely assumed to be a fear of wide open spaces (a desert? the surface of the moon?) but is more likely to mean anxiety about how to get out of somewhere without panicking or where help is not obvious. Anxious people are often looking for the literal or metaphorical emergency exit. This might mean you feel overwhelmed on the Tube, or in a busy supermarket. Again, this can mean a person with agoraphobia might limit the places they go to. In the worst case, this might mean becoming housebound – the only place a person might feel truly safe. Agoraphobia often comes on after a bad experience – being stuck in a lift, or after having had an accident. Professor Kevin Gournay, an expert in the condition, estimates around 1 per cent of the UK population is affected by severe agoraphobia.[29]
Maybe this sounds like claustrophobia to you – the difference is small, but important. Claustrophobia is the extreme fear of confined or closed off spaces. With agoraphobia, you have a fear of any place that might make an easy escape difficult, leading to a panic attack or extreme anxiety.
Social anxiety disorder
Social anxiety disorder is also called social phobia. Just as depression is not feeling a bit sad, social anxiety does not mean being a bit shy at the office Christmas party. It’s a crippling condition which can include fears of meeting new people, speaking in public, worrying you’ve embarrassed yourself in public, and having panic attacks in situations where you’re forced to interact with people. People with social anxiety experience a lower quality of life than those unaffected, an increase in alcohol and drug abuse and a risk of suicide. In the UK, about five in every hundred people are thought to have some degree of social anxiety and it affects women more than men.[30] Perhaps unsurprisingly, it tends to develop in a person’s teenage years and is unlikely to improve without help.
Ruchira told me that she’s had fears about how others perceive her for as long as she can remember. Although it was uncomfortable, it wasn’t until university that the anxiety element reared its head properly. ‘I would excuse myself from seminars and just hyperventilate in the toilets without being able to return without the same panic happening. This was what I would call the flare-up – before this my anxiety had hindered me in smaller ways such as nervousness in crowds, fear of being looked at, attending events – things I never realised were different or I didn’t have to feel.’
Ruchira explained that she never thought of herself as someone who would face such an issue – but then, who does? ‘I’m a really outgoing confident person. I had the best time going out and meeting new people [before] so the idea I had social anxiety baffled me. I think social anxiety comes in different forms for so many people, and mine was all about how I’m weighed up in career settings or by my looks. “Being taken seriously” was a big anxiety, as I’d built an assumption that my young-looking face meant I had to make up for it or counteract people’s thoughts before they got to know me.’
Eventually, her anxiety hit such high levels that she sought help, but it took a while. ‘This came at a time of me rarely leaving the house and hitting the lowest state first. CBT made me realise [that] much of this stemmed from a fear of dying or fainting in front of everyone who I imagined would judge me. This mixture of panic and social anxiety – which had grown unchecked for years – had become something that meant I couldn’t walk in crowds, get on the Tube, order food or anything without bursting into a panic attack. CBT really helped – along with a citalopram [SSRI] prescription.’
So you see – social anxiety – not just shyness at all.
