Responses to Readers
Dennis B. Kottler, MD
Westlake Village, CA
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"Responses to Readers" does not attempt to answer all questions submitted, however, reader input will serve as the basis for further educational material to be presented here. (Please see also: Frequently Asked Questions About Mental Disorders).
The following responses appear in chronological order with the most recent questions/comments addressed first:
*** Question: Now that I've gained fairly good control over my panic attacks, how do I deal with the constant fear of having another one and the hyper-vigilance this has created?
*** Answer: The answer lies in the question. The first challenge has apparently been met, developing an effective set of tools to deal with panic when and if it occurs. Based on this fact, one should view panic as not all that much to be dreaded anymore. In fact, if a panic attack were to occur it would most likely be of rather "weak" severity and would serve as an excellent opportunity to practice the anti-panic techniques and thus reinforce the perception of control over this problem. Perception is key here.
"Reframing" one's view of panic disorder in this fashion should eventually eliminate the anticipation and hypervigilance.
BTW, this process seems to work well for other disorders, even somatic disorders. For e.g., a patient reports that about three times a year a herniated lumbar disc acts up causing severe pain and difficulty walking, even getting off the couch. This responds to anti-inflammatory meds, is self-limiting, and gradually clears in about 3-5 days. The patient has become reconciled to this problem and now "greets" the affliction with much less dread. Although still unwelcome, it is not nearly as frightening as it was the first time it occurred.
*** Question: What is the difference between "manic-depressive disorder" and "bipolar disorder?"
*** Answer: There is no difference. "Bipolar disorder" is just a more recent term for the same condition. In the past we did not recognize that in fact there is a "spectrum" of bipolar disorders from the "classic" pattern of severe mood swings to less severe forms.
***Question: How do you tell the difference between "social phobia" and just plain shyness?
***Answer: Excessive "shyness" may indeed indicate a problem with social phobia. If the shyness is causing impairment in work (school) or social functioning it needs further investigation. Also, when the shyness is accompanied by recurring thoughts of "people wil think I am silly or stupid" if I speak, this is a further indication the problem may be social phobia. A professional assessment is necessary if there is a suspicion that social phobia is the problem. Fortunately there are very effective treatments now available, involving cognitive-behavioral therapy and/or medication.
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