ADAVIC Information Sheets
Information for carers
Each week Christie looked forward to delivering the community newspaper
to the houses in her area. The money was good too - at least to a
5 year old.
There was one downside. Across the street from her house behind a
high chain link fence was a vicious dog, which would snarl, drool
and throw itself against the fence whenever she went onto the property.
The look in the dog's eyes told her everything she needed to know
about its intentions. Christie was, naturally, more than a bit frightened.
She was not aware of it, but a self-preservation part of her brain
was increasing the adrenalin flow and causing various other changes
to her body as it prepared to meet the danger through 'flight or fight'
response mechanism. Whether she would actually fight or run would
be a decision made by a higher thinking part of the brain should the
threat become real. All Christie knew of this preparation was that
she felt tense and uncomfortable as the brain kept telling her, "Beware,
tread carefully, possible danger ahead. Better yet, let's get out
of here."
On the third Thursday of a month Christie approached the house with
the newspaper and, as usual, she felt her scalp crawling and her breathing
rate increase. As she was telling herself nothing could happen, she
realized nothing did happen. The dog was not at the fence; it was
coming around the side of the house. It was outside the fence and
looking even more vicious than it had when behind the wires. A fraction
of a second after she saw the dog her brain was preparing her body
for imminent battle. Nerve messages were being sent throughout her
body and huge quantities of chemicals were released into her bloodstream.
Almost immediately the brain made the decision to run. But to where?
The only possible place was a large open storm drain pipe. Without
really realizing what she was doing, Christie crawled faster than
she ever knew she could, deeper into the pipe. Just as her feet cleared
the outer edge of the pipe, her head bumped into a grate blocking
her way. She could go no further. She was fortunate the pipe was just
large enough to accommodate her body but she could not even turn her
head to see what was happening. Right behind her were snarls and scraping
noises. She could feel the warm air of the beast's breathe on her
bare ankles as well as the splatter of saliva.
Not being able to see what was going on and with nowhere to go her
panic level passed right through "terrified" and she 'freaked out'.
She was screaming, kicking and shaking so badly it took her sometime
to realize the dog was quiet and the snarling had been replaced by
the gentle voice of her mother telling her it was all right to come
out. It is safe now.
When Christie backed out of the pipe she found herself wrapped in
the protective arms of her mother. Next to the reassuring hugs, Christie
just wanted to go home where she could 'be real safe.' With the danger
past, Chrisitie's body returned to its normal condition.
It makes sense that the body would have such a protective mechanism
to respond to emergencies. Virtually all animals have a similar system,
which operates in the same way.
So what has this got to do with anxiety, panic attacks and agoraphobia?
Anxiety is a heightened alertness as though responding to a possible
dangerous situation; ie. stay alert, look out, be ready. Most people
with high anxiety feel uptight and ill at ease. But be ready for what?
These people don't know; the body is preparing for an emergency but
there is no received condition that should be making it do so.
A panic attack is a massive feeling of terror that strikes suddenly,
and rapidly increases to the state in which Christie found herself.
The problem is, the body is responding as though it were in extreme
danger when there is none. Without a real danger to fight or run from,
the person is very alert to the changes going on in his/her body.
As there is no physical way to use the 'emergency condition' chemicals
produced, the body continues to react to them making the person feel
worse, which causes more chemicals to be produced, and so on. In short,
the emergency system is kicking in without a cause. Why? 80% of people
with panic disorder appear to have inherited the trait but it still
seems there must be a trigger before the disorder appears. It is not
the person's fault they develop the disorder, any more than if they
had developed diabetes.
Agoraphobia can be difficult to understand. Let's try this. If, every
time Christie went outside, the vicious dog was there waiting for
her, it would be very easy to understand why she developed a fear
of going outside. However, in the case of the agoraphobic, there is
no discernible danger but the person finds it very difficult, if not
impossible to do various things which may range all the way from leaving
a certain room, to driving, to entering a mall, etc. Sounds weird?
It seems to be and even more so to the person who has it and used
to do all these things with no problem. The reason some 'can't' leave
a certain area or go to certain places is partly due to a fear of
developing panic attacks and becoming debilitated in those places.
In my own case it was not like that. When I tried to go out the door
I felt I was pushing against an invisible force which was trying to
push me back in. Weird!
Actually, this does make sense if we look at it from evolutionary
point of view. A mouse which goes out onto a bare plain during the
day is not very likely to go unnoticed by predators. This is bad news
for the mouse and mice generally don't do it. Why? Instinct. Some
part of its brain is reacting to instinct to ensure the mouse is not
going to put itself into such obvious danger. The mouse 'can't.' Something
is preventing it. Now, with humans, the same thing is possibly occurring
except, as above, it is occurring without cause - some parts of the
brain are sending out a false alarm signal.
[ Note that a person with agoraphobia need not have panic attacks
and vice versa.]
Understanding the basis of panic attacks and agoraphobia is crucial
to being an effective caregiver. I hope the above has been of some
help with this.
SYMPTOMS - CAUSES
- Heart Pounding - Heart speeding up to move blood and oxygen faster.
- Breathing faster - Obtaining more oxygen for the muscles
- Chest pain - Muscles tightening.
- Rubbery legs - Blood supply building up in the legs/decreased oxygen to the brain
- Feeling of Dissociation - Less blood going to the brain and/or some think a trance state is almost reached.
- Bright lights are disturbing - Pupils have opened for more acute vision
- Walls are bending inwards - An effect of the pupils opening wide
- Sweating - The body is harder to hold onto in a fight
- Numbness in hands - Due to the diversion of blood to the muscles
- Tingling in mouth - A result of hyperventilating
- Choking sensation - Due to muscle tension
- Shaking - Due to muscle tension
- Not noticing pain - During an emergency the body does not need to be hampered by pain.
Many people who develop anxiety disorders are creative, intelligent, caring and conscientious almost to their own detriment. They may also be insecure and have hidden the insecurity for years. With severe anxiety they are no longer in control of even their own bodies. It is not unusual for them to need a safe place and a safe person in whom they can put complete trust. It may not be unlike a parent/child relationship. This could be the environment in which you are working. Recognize this is the case. You and the person are working towards a return to the situation before the disorder appeared. Actually, you are working towards a better situation so that the anxiety will not return. In doing so many couples find they have grown closer together.
General
- Try to understand the disorder. You do not have to be an expert.
- Even if you cannot comprehend the disorder, be supportive and do not say things such as, "It is all in your head." "You can get over it if you try." The person already knows it is all in his head. Don't rub it in.
- Appreciate the mental pain and frustration the person is going through.
- Assure the person he/she is not insane. He/She isn't.
- Recognize the energy required just to get through the day. The emergency chemical, adrenalin, uses up a great deal of energy.
- Recognize that each person will recover in time. Some do it more rapidly than others. The speed of recovery is not a reflection on the person.
- Try to keep social contacts open. It is very easy for these outside contacts to disappear.
- First discuss with the person the extent of your role. You will not be giving up your job or social contacts for them. You will not be available on a 24 hour basis. If they need 24 hour contact, try outside agencies as a source of phone contact, etc.
- On outings, allow the person to proceed at his/her own pace. Don't try to push. Let the person know they are in control and can say, "stop" any time they wish.
- Don't make surprise changes. If you and the person are going to the store, go to the store. Don't make side trips. If in a store, don't just disappear for a second. This can be traumatic.
- Recognize you are the person's safe person. The person whom they rely upon. Once you have established the bounds, don't let them down. They have probably been severely let down many times before during their lives.
- Recognize that at times you may be in a parent/child relationship. The person again has to build up confidences and learn to trust.
- Recognize the person is under a great deal of stress and may be snappy at times. You don't have to be a doormat. Just don't have too thin a skin. The fact they have an anxiety disorder does not give them the right to be rude to you, or treat you as dirt.
- Recognize that people with this disorder need to be in control as much as they can. As a result they can become very controlling and manipulative.
- Because you happen to be handy you may find you are the target of much of their anger and frustration. Don't get into fights over it but don't take it. Leave the room for a while if necessary.
- Recognize these people have lost their self-confidence. Try to build it up.
- Allow the person to talk openly with you about his disorder. Don't negate what he says. Just listening and understanding is important.
- Do not attempt to play the role of professional counsellor or psychiatrist. Professionals have their job to do and you have yours.
- Recognize there is a fear of taking new medications. There a number of ways you can help.
- Do not let the person become so attached to you they are like glue. It is a balancing act.
- As the person becomes more confident and can do more, make sure you are letting him/her have the freedom they have regained.
- Make certain medical professionals know the person has an anxiety disorder. You could have a few suggestions to give them, such as no adrenalin in the dental freezing, and so on.
- Be prepared to go with them to medical appointments and, if necessary, hold their hand during procedures. The fact they you are there is probably all that will be required.
- Find other sources of information for caregivers. This introduction page is just that -- an introduction.
This information was provided by Ken Strong. Ken lives in Victoria, B.C. Canada. His internet site for carers has won numerous mental health awards. http://www.pacificcoast.net/~kstrong/
