Panic Attacks At Dusk..anything I Can Do?

[Deleted member 37605]

Getting a dog is a good idea if you love dogs and want the commitment and cost and time dedication. They ac...

Unfortunately I can't get a dog because the place I live in doesn't allow dogs.

I don't think Yoga-Deep Breathing etc really help with Panic Disorder. I have learned some deep breathing techniques, but when my anxiety gets triggered, there is really no stopping it.

 

[Gs172003]

Ok then I have questions..

Don't most people with PTSD have anxiety related symptoms throughout t...

Have you thought about seeing a trauma therapist?

 

[Gs172003]

Actually, everyone I know who has Panic Disorder are much worse off than I am with a lifetime of PTSD. I wo...

There are quite a few things I've never been able to do and it has nothing to do with my diagnosis. That seems like a very general statement to me.

 

[joeylittle]

Don't most people with PTSD have anxiety related symptoms throughout the day?

The sets of criteria for diagnosing PTSD are rather far-ranging. It's not a requirement of the disorder to have anxiety-related symptoms throughout the day.

According to the DSM-5 (which is the diagnostic manual for all psychiatric disorders), Acute Stress Disorder can be diagnosed up to one month following a traumatic incident; after that, if the trauma meets the criteria listed for PTSD, and if the individual exhibits enough of the other criteria (symptom sets) for PTSD, a diagnosis can be given. If the symptoms are better explained by another disorder, than one is given that other diagnosis.

What you are describing, to us non-doctors, sounds more like some kind of anxiety or panic disorder.

The good news is, you are putting yourself through a kind of exposure therapy, and it sounds like it's working. The kinds of setbacks you mention in your OP - that unexpected rush of adrenaline you had - is not uncommon. It's to be worked through, just as you have been working through it.

You can't be diagnosed with GAD until you've had consistent symptoms for 6 months - and even then, you don't sound to me like you meet the criteria; the anxiety does indeed have to be generalized (come from multiple sources). Panic Disorder has to occur unexpectedly, and your panic attacks seem to be on a timetable.

My personal armchair-diagnosis (backed up with zero medical degree)? - You're developing a phobia. Phobia is an actual disorder, and it's nothing to sneeze at. It's in one of five categories, and symptoms all group around the phobia. What you've attached to is the time of day that you experienced a severe fright - so your developing phobia is manifesting primarily at that time.

Phobias also cannot be diagnosed for 6 months. Why? Because it's really not unnatural to have the kind of extended trouble that you are having, after a terrifying experience. But if it persists longer than 6 months, it's 'settled' into a disorder.

The DSM is really just a big-ass book of codes; a way to organize symptoms. And without going to see someone who is trained in using it (psychiatrist or psychologist, some therapists are qualified to diagnose but not all), you won't really know.

My personal recommendation is to keep doing what you are doing - don't be daunted by the setback, it's just your mind holding onto some of the fear. If you are up for it, try and get into doing some other activities that support anxiety management - you're doing diet and exercise, which is great - you could look into guided meditation, you could see if you can take a mindfulness class...all this stuff helps.

And if it's still no better at the six month-mark, go in and see someone for another diagnosis. But, if you have been making headway doing the exposure therapy, then by all means - keep doing it! It's working, which means it's addressing the problem.

 

[Deleted member 37605]

Thanks Joey..that seems great!

 

[Deleted member 37605]

I noticed they all came following an intense exercise session.

Feelings of extreme disassociation . Feelings like I was losing control of my body. Completely terrifying.

I was determined to exercise to get better so I jogged and walked through a nearby park. The park has a path that ends adjacent to a busy street. There is a tall bridge on the street.

As I walked home, I crossed over the tall bridge. I was in the middle of a terrible panic attack, perhaps triggered by the exercise. I saw a little girl running towards me about 10 feet in front of her mother. Not sure how or why this happened but I got this terrible "flash thought" whereby I grabbed this little girl and I held her as I jumped over the bridge's short fence. For a few seconds it felt like I was losing control of my body and I was actually doing it.

I was terrified. I felt soooo guilty over this incident. I couldn't sleep at night. I kept picturing myself doing it over and over again. I felt so horrible that I donated money to Sick Kids hospital.

This even "re-traumatized me". I started to get nervous about having other panic attacks and something similar could happen. So yes, this may be panic disorder, where fear of panic attacks is the main problem.

 

[Muted]

My therapist has talked about body sensations and how those can trigger anxiety. The shortness of breathe from exercising can trigger panic attacks, because they often both feel like you can't breathe.

 

[Muted]

I completely understand that rippling affect of how one reaction from trauma causes more trauma etc.... that's the story of my life up to this point. I think trauma left unattended leaves people vulnerable to more trauma. The more we can deal with past and current trauma, we protect ourselves from the vulnerability and likelihood of being re victimized. Those are my thoughts anyway.

 

[Lionheart]

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

A typical panic attack versus typical anxiety attack is quite different mainly due to the duration of time each one lasts. An anxiety attack can actually go on for days, weeks or months while a panic attack lasts 30 minutes at the most. An anxiety attack can be classified as a deep sense of worry or tension build-up over time.

A panic attack is an actual episode that happens for a short period of time for no apparent reason.

For these reasons, I tend to agree with @joeylittle that you may be developing a phobia or that you may have an anxiety disorder.

I have had both types of attacks and for me, there is a big difference between an anxiety attack and a panic attack.

At any rate they both need appropriate treatment and I hope you get the help you need.

 

[Powder]

Don't most people with PTSD have anxiety related symptoms throughout the day? or does it ONLY come from reminders of the incident? From what I read people with PTSD are generally hyper-vigilant throughout the day and anxiety and Panic disorders are very common with PTSD and very intense.

Great questions here. Triggers are so complex that there is no way I can answer about how they work, but to just give you an open and shut official answer, I'll do my best, but I'm sure others can add to this as well, maybe @joeylittle.

I think it would take more than my expertise to answer such questions, as their is the official, clear-cut answer, but those don't always help or make much sense. You will read online that only reminders or "triggers" from the traumas can get his level of response for PTSD. Even if you don't know it at the time, the trigger is very similar in some ways as a strong reminder to the brain and body of the trauma, through the senses.

So, not just there all the time, but trauma-related, waiting to surface at any reminder of the trauma. But, it may "feel" like it's there all the time due to avoidance, intrusive thoughts, and that dynamic. So, I doubt you would be able to find the 'line in the sand' without long-term clinical observation and help seeing if the triggers cluster around a trauma or just seem to, and in the reverse. You really cannot self-diagnose for several reasons.

With Panic Disorder, unlike PTSD, symptoms appear under stress immediately. Body sensations are the most common trigger. The body becomes sensitized and feelings that others find well-tolerated are not, such as heart beating faster, bug bites or itching, pain, etc. Not so with PTSD, unless that was part of the trauma. Even then, it won't always do it. Triggers are complex. I don't intend to be able to explain them and how they work any time soon.

Insomnia is common with anxiety disorders. The most common form of insomnia is waking up early and feeling too worked up to go back to sleep. Most people think insomnia is only not being able to fall asleep, but it often shows up in the middle of the night or in the early hours.

So from what you are saying, I don't see anything to confirm a PTSD diagnosis at all, No original trauma as defined in the DSM category A. No clustering of symptoms in the criteria for Dx, nor anxiety related to triggers of the trauma.

I do see Panic Disorder and GAN.

I am not qualified to make that call. Just observing from your words. So get that 2nd opinion. I'm sorry this is happening to you. I know the last thing you want is to have to work hard on finding the cause, when someone told you PTSD.

 

[Deleted member 37605]

Great questions here. Triggers are so complex that there is no way I can answer about how they work, but to...

No it's ok, I just want answers really. Even if I don't like the answers.

I have been reading and speaking to my psychologist. Apparently any event that can be considered to be possibly life threatening can trigger PTSD or at least ASD. Catching a burglar in the act could be considered a real danger. It is kind of just a myth that it needs to be rape or surviving a gunshot wound or some trauma of that intensity.

That being said, I am very thankful that my symptoms have abated greatly the past two weeks. Today was particularly good. Most of the light headed feeling is gone. A few disturbing thoughts at various times in the day but it has decreased a lot too. I was able to go out in the early evening and I was fine, not even light headed.

Every day I think to myself what I could have done differently. I could have refused a ground floor apartment. I could have installed bars or gotten a big dog. If I have GAD, then I would think to myself I was going to get hit with this anxiety BS sooner or later. But if it was ASD I can't help but think it was avoidable.

If my symptoms have improved greatly in just 1 month, that's a good sign I don't have PTSD right?

 

[joeylittle]

I have been reading and speaking to my psychologist. Apparently any event that can be considered to be possibly life threatening can trigger PTSD or at least ASD. Catching a burglar in the act could be considered a real danger. It is kind of just a myth that it needs to be rape or surviving a gunshot wound or some trauma of that intensity.

Nice to hear it's a myth. Your psych should get in touch with the DSM committee straightaway. (But really, I'm guessing that they did not explain it fully).

So, here's the actual language:

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

• Direct exposure.
• Witnessing, in person.
• Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
• Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

So just focusing on the first sentence -

• death
• threatened death
• actual serious injury
• threatened serious injury
• actual sexual violence
• threatened sexual violence

Your encounter with the prowler could have been perceived by you as threatened injury or violence. That is the way in which you are correct. Whether or not you have all the other symptom clusters then becomes relevant.

But if it was ASD I can't help but think it was avoidable.

It wasn't ASD, because it continued past one month. That's very straightforward.
It can't be GAD yet, because it hasn't been 6 months yet.
It all sounds very typical of a phobia, and if you think that phobia isn't acceptable because it doesn't reflect the seriousness of the fear you've been going through...well, phobias are really f*cking serious. But hopefully, you won't even make it to the 6 month diagnostic mark there either, because you are doing so well with your own handling of the experience.

That being said, I am very thankful that my symptoms have abated greatly the past two weeks. Today was particularly good. Most of the light headed feeling is gone. A few disturbing thoughts at various times in the day but it has decreased a lot too. I was able to go out in the early evening and I was fine, not even light headed.

This is the point. This part, here. The part where exposing yourself to similarities in the situation is alleviating your symptoms. Whether it's PTSD or a phobia, this is one of the recognized, legit ways to treat it.

I'm going to go back to the 'myth' for a moment. What all the criteria A elements have in common is actually intensity. This doesn't mean that your experience wasn't intense - but PTSD does not develop from a very large fright. If this were true, haunted houses would be kicking out cases of PTSD every year. You need to believe you are in imminent danger of extreme harm (violence or sexual assault) or death, or be exposed to same by witnessing it directly occurring to someone else, or repeatedly as part of your job.

The intensity relates to how the traumatic memory 'marks' the brain - though that is still very much a research project for lots of science-people.

If my symptoms have improved greatly in just 1 month, that's a good sign I don't have PTSD right?

That, and the fact that you are seeming to lack the entire scope of symptoms that are required to be diagnosed with PTSD. This article here: Post-Traumatic Stress Disorder, will give you a full overview - but I would caution against trying to 'fill' each criteria.

If your therapist is actually a licensed psychologist or psychiatrist, they are sucking at their job right now, in my opinion. If they are a more standard therapist, they are probably not qualify to assess you for any psych. condition.

To ask bluntly, were you ever the victim of a sexual or physical assault? Do any of the criteria apply to another part of your life? because extremely stressful events can trigger delayed-onset PTSD. You are coping very well with your symptoms (and I really do congratulate you on that), so I'm inclined to think that what you are experiencing is related to the prowler. But, it's always worth asking.