I Survived a Panic Attack and All I Got Was General Anxiety

I've come to learn that no one outside of myself can fix me, and perhaps there is no psychological endpoint at which I will arrive and be totally repaired. The aspiration to be completely OK with the fact that I exist, or some other iteration of a perfectly whole human being, has only led me to self-delusion and further anxiety. This self-delusion occurs most profoundly in the times when I feel good, and wishfully make the assumption that I will never feel anxious again. My own perfectionism and the expectation that one must arrive at "perfection" or "wholeness" have probably caused me more anxiety than anything else. Perhaps true wholeness (if such a thing exists) is not when all is fixed within, but when there's an acceptance of one's broken parts.

All that being said, I believe that I may have recently achieved the anxiety disorder American dream. I finally found a great therapist who specializes in panic attacks and general anxiety, and takes my insurance.

This week, my new therapist and I did some detective work and stumbled upon something that in 15 years of panic attacks I had never discovered before. In looking closely at the three panic attacks I experienced the week prior, we found a commonality in each of them. All three—one in bed, one on the internet, and one in her office—had begun with a minor physical sensation in my body: a shift in how I was feeling. These minor shifts led directly into the physical symptoms of a panic attack: suffocating and choking sensations, tightness in the chest, racing heart, dizziness, and feelings of unreality. I always assumed that the physical symptoms of my panic attacks were preceded by a thought—usually one of the "I'm dying," "I'm not OK," or "I'm fucked" variety. I hadn't realized that it was the other way around.

What happened last week was that I had a cold. It wasn't a massive cold, just a minor sniffle. One night I was lying down, making a playlist, when I suddenly noticed that I couldn't breathe out of my nose very well. Immediately, my heart rate sped up, my breathing felt more shallow, and the room began to spin. I remember thinking my usual panic thoughts, Oh no, oh my god, something's wrong, I'm dying. In that moment, I completely ignored the fact that I had a cold, which was most likely the cause of my breathing obstruction. That's hypochondria 101. But my therapist pointed out that there was not even a second between the sensation of the stuffed nose and my physical response. There was no time for a thought. It was only after my body responded the way it did that my mind jumped in and attempted to explain those symptoms.

The order of this sequence is subtle but profound. If there is no time between a stuffed nose and a physical terror response, then it's the response that must be addressed and not just the thoughts. What's more, my therapist said she believes this involuntary reflex of entering an erroneous fight-or-flight mode indicates some type of trauma. I can continue to work on reframing my thoughts through cognitive behavioral therapy. But there might be a way to disconnect that erroneous fight-or-flight reaction before it even occurs.

When the therapist said "trauma," I cringed. I feel like the word "trauma" has become very trendy lately. I don't want my subconscious to be a form of clickbait. But the way my therapist described the role of trauma in linking my panic attacks to shifts in my physical body undeniably made sense to me. In a way, it reframed the history of my panic attacks as I've known them.

I've always had high levels of anxiety, dating back to hypochondria, nightmares, and fear of non-existent catastrophes as a child. But I always thought that my first panic attack occurred much later, around the time I had an abortion in my early 20s. The abortion was scarier than I thought it was going to be, and I remember being surprised by the way I felt after. I was not expecting to feel such nausea or dizziness. Since I hadn't anticipated these feelings, I assumed that something had gone very wrong. I thought I was dying. At the time, it didn't register as a panic attack, but as an adverse physical reaction to what had just occurred. But a few weeks later, I had the same exact physical sensations, and it's what I remember as my first panic attack.

Yet in talking to the therapist, I realized that my body has been having panic responses long before the abortion. I remembered jumping into a cold lake as a kid, and despite knowing how to swim, hyperventilating from the change in temperature. Immediately I knew I was dying. I remembered accidentally inhaling a little soda down the wrong pipe—not enough to cut off my breathing entirely, just enough to tickle my lungs. But my body went into panic mode, and I knew for sure that was the end.

I'm not sure exactly what this new phase of my psychological journey, entitled "trauma work," is going to entail. This week, I was asked to simply pay attention to what precedes my symptoms of panic. I now see that I experience it everywhere! Mild heartburn, minor fatigue, a mouth numbed by the dentist each led my body to react as if something was very, very wrong. This new realization is making it easier for me to then redirect my brain when it says, "I'm dying." Now I have a response. I can tell it, "Dude, your traumatized body is overreacting. This isn't death. It's heartburn."

I'm also not sure where this next phase of getting better will take me. The state of "better" is perhaps an illusive one—impermanent, nebulous—and not a final destination, in my experience. It seems the more I see my relationship to panic disorder as a journey, the better I do. It's helpful for me to try on different modalities as a series of experiments, rather than aiming for a final state of absolute OK-ness. Does absolute OK-ness exist for anyone? If I had my choice, I wouldn't have to continue growing. I would just chill out and be lazy for a while. But I've never been a chill person. And I guess sometimes our path chooses us.

So Sad Today: Personal Essays will be released March 15 from Grand Central Publishing. Pre-order it here.

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