Question:
The Many Causes of Panic Disorder(s) ? (Long)
Answer:
The conventional wisdom on panic disorder seems to be that it is a mental
problem that either results from hyperventilation, emotional distress or a
neurochemical imbalance, etc. According to this theory, all of the
physical symptoms patients feel are brought on by the flight or fight
response, not by underlying medical problems - so patients are discouraged
from seeking too many medical tests. The search for a cause can certainly
turn many PD patients into hypochondriacs - but I wonder sometimes if
we're not justified in our hypochondriasis.
First of all, there is a certain haughtiness in the position many (but not
all) doctors have, that if they don't know what's wrong with you, then
it's all in your head. Certainly there are many hypochondriacs in the
world (I may be among them! LOL), but many times it is the doctor who
makes the mistake, not the patient. I have seen and read about so many
examples of bad health care in person and in ASAP that I'd bet the
patients are right more often than not.
Most of the "general audience" info I see on PD - mass market books,
pamphlets, etc. - seems to back up the idea that our symptoms are totally
psychosomatic or due to a brain dysfunction. But over the last four and a
half years I've reading a lot of the research in medical journals on PD,
and it doesn't always jive with the conventional wisdom.
It's good to keep in mind that many doctors admit that the cause of PD is
unknown. Not only do we not know how it works, we don't know how the
medicines to treat it work - let alone how to fix the problem permanently.
The relapse rate for PD is very high, from what I've read.
The most popular new theory is that PD results from a chemical imbalance
of the mind, resulting perhaps from genetics; research into biochemicals
like CCK and sodium lactate seem to support it. Yet we should keep in mind
that blaming behavior problems on chemical imbalances and genes is a big
fad in the medical community at present. I don't doubt that genes and
imbalances can cause PD, including my own, but wonder if they're not
receiving too much attention. Moreover, our fears may be changing our
brain chemistry rather than the other way around - if you stop and think
aboutit, every thought we think has to be paralleled by a physical change
in the brain. I'm certainly not a doctor, but I've worked in academia
before, and have seen first hand how researchers in different disciplines
can rush to accept the latest trendy paradigm.
One of the problems with the whole "PD-is-a-brain-disorder" theory is that
there are many known causes for PD that aren't mental at all. The
following have been PROVEN beyond a doubt to be the culprit in panic
attacks in some people: 1. Thyroid dysfunction 2. Hypoglycemia (low blood
sugar) 3. Alcohol withdrawal (after a period of severe alcoholism) 4.
Mitral valve prolapse 5. Adrenal tumors. (There may be others I'm
forgetting)
There we already have at least 5 disorders which can cause PD, only one of
which (alcoholism) originates in the brain to any remote degree. Who is to
say that there are many, many other non-mental disorders that can cause it
too? To those five, we might someday also list a couple dozen other
conditions that are statistically more common in panic patients, like
asthma, migraines, phenylketonuria and inner ear dysfunction. I've seen so
many others listed in journal articles and books, but can't remember 'em
all. There are also a few other mental disorders like schizophrenia and
mania that can cause PD-like symptoms.
Think about it: there are probably hundreds of different physical
disorders that can cause the main symptoms of PD, like dizziness, tremors,
nervousness, etc. If you're of a personality type that's afraid of the
sort of embarrassment passing out in public might bring (which is
certainly not unreasonable), then all it would probably take to make you
have your first panic attack is to develop one of these conditions, which
may be difficult to detect. Separately, that sort of attitude and a
medical condition mimicing PD might be harmless, but when you put them
together, then BANG! You've suddenly got panic disorder, which takes on a
life of its own after that.
Around the turn of the century, people suffering from thyroid disorders
were assumed to be emotionally unstable or brain damaged because the cause
of their disease was unknown. Worst of all, many of them were labeled
hypochondriacs because of their complaints. I'd bet big money that one
day, many of us PD patients will learn that we were wrongly assumed to be
mentally ill, or hypochondriacal. I'd also bet big money that one day
researchers will find several dozen causes for our panic attacks, some
physical and some mental. But that day won't come until the medical
community stops focusing so narrowly on finding this neurological Holy
Grail. Many other potential causes should probably be given equal
consideration.
As one who has tapped out a few lengthy posts in my time, I'd
be a damned hypocrite if I didn't read them too!
I don't think I *really* agree with you, though. At least,
the way I feel about this is that the neurochemistry
paradigm *does* make more sense than anything else,
but I am, despite that, quite certain you are right
that a lot physiological causes are either unknown,
or known about, yet go undiagnosed.
Actually, pace our friend Bootcamp, my own money would
be on the inner/ear/balance/perceptual disturbance
syndrome as a very likely candidate indeed.
