Panic disorder took hold of my life when I was fifteen years old. I was a happy, outgoing child, and had no major self-esteem issues, except for a wee bit of angst over my entirely normal teenage acne. Then, one day, while riding my bike home from a friend’s house, I had a dreadful attack of diarrhea, and I didn’t make it home on time. I felt utterly ashamed. Utterly, utterly shaken to the core. I don’t know why I took this incident so much to heart. I snuck into my house, rinsed my clothes, showered, and did the cleanup and laundry in secret. I never told anyone what happened.

I began to dread times when I needed to bike anywhere; in fact, I avoided biking or walking at all. I lived in El Paso, Texas, where the desert landscape offered no convenient bushes to duck behind, and I worried constantly that my bowels would revolt, that I would have no warning, and that I’d be humiliated in front of someone. Yikes! Coo blimey! I thought I’d flat die if that were to happen.

Soon, the anticipatory anxiety began to rule me. I could go places only if I knew there was a bathroom nearby. I experienced head tingling, hand sweating, faintness, and nausea if I was trapped in a bathroomless place. I felt my guts roil anytime I didn’t have a quick way out. I couldn’t sit in a classroom if the door was closed. I couldn’t wait in a drive-through line if there were cars hemming me in. I couldn’t take long drives unless I was the one driving. Traveling became a misery of dread before, panic during, and shame following. And I had been such a fun-loving girl; now I was a lonely girl trapped in her room. I kept journals, listened to the Beatles, and read everything I could get my hands on. I functioned well at school, and only a few girlfriends were aware that I was struggling.

I had no name for my problem. I couldn’t explain it to my parents, who thought I was strangely capricious because I wouldn’t go shopping or out to dinner unless outright forced to do so. I was living in hell. Really suffering intensely.

I remember climbing up the tree in my backyard and crying so loudly that the neighbors called the next day to ask my parents what was going on. My mother chastised me for embarrassing her. I felt like a freak.

Then, in my sophomore year of high school, I was taken with a lad I’d seen in a school play. I wanted to win his heart, so I stepped out of my shell a bit until I did. He was sweet, and he made himself available to me in “safe” places. We ditched school and broke into my locked house for a place to hang out. The phobias eased, but never abated completely. I fainted in the high school registration line in my junior year. I said it was the flu.

I had an incident of loss of bowel control probably once or twice a year—just often enough to keep me terrified. My parents finally had an upper and lower GI series done (highly traumatic for a young virgin; think anal probe), only to find no physical cause for the symptoms. My dad offered counseling at that point, and I said no. I was desperate for the help, but I couldn’t face the ten-minute drive to the doctor’s office.

There were no Oprah Winfrey–type shows to help me name my problem. Finally I heard the word agoraphobia somewhere, and I began reading up on the topic. I can’t tell you how profound my relief was knowing that other people were suffering like me, that I wasn’t totally alone, and that there was hope I could conquer it. I felt it was a dreadful character flaw, a weakness, an indulgence of my psyche somehow. I felt guilty and ashamed, but I was helped by the fact that typical sufferers were described as highly intelligent and creative people for the most part. At least I felt kind of smart!

Life went on, and I met my second boyfriend. I pulled myself together enough to go out and about with him a bit, always with difficulty, always taking baby steps. He was understanding and sweet, just like my first guy. He bedded me at seventeen and wedded me at eighteen. I wanted out of my parents’ house desperately, and he was my ticket. The idea of college terrified me, even though I was a straight-A student and was expected to go, as the people in my family were all educators.

So I married to escape college, and we moved to Louisiana. My mom had to choose my wedding dress, and she basically planned my whole wedding with me on the sidelines nodding “yes” or “no.” I had to be dragged out of bed on my wedding day, but I coped. I worked and went to college for a year as an art major. The panic attacks abated when I was in my normal daily routine, but came back full-tilt boogie when I had to travel for visits home. They completely disappeared during my first pregnancy, and it was a joyful release. I shopped!

Four days after my daughter’s birth, I went hobbling through the mall close to my house—my first post-birth outing. Thank God the babe was at home with my mom. I felt the old familiar rumble, ran for the bathroom, and didn’t make it. As I was crying and cleaning myself up in the mall restroom, a kind woman said, “Honey, you just hold your head up and walk outta here. There’s no reason for you to be ashamed.” I think she’ll never know what that kindness meant to me.

Years passed, and I explored medications with my doctor. I tried Xanax, but needed too much of it and feared addiction. I tried BuSpar, which didn’t seem to help, Paxil, which destroyed my libido (and I like my libido, thank you!), and finally got a respite from it all with Tranxene.

I was marginally functional while home tending babies. I moved back to my hometown and stayed home until my second child was three. I braved college again, but had a brush with a near-divorce in the midst of my last year. I was seeing a counselor during the marriage crisis, and she told me that I was amazingly functional, considering my history of panic attacks, and that she found my spirit inspirational. She was a godsend.

I think I finally knew I could overcome my panic disorder when I began to trust my medication. I could control the scariest symptom, the diarrhea attacks, with Kaopectate or Lomotil. But I couldn’t live while constantly taking Kaopectate every day, so I’d step out on normal days and only medicate if I knew I had to shop or travel or whatnot. The respites I enjoyed during pregnancy and nursing made me fundamentally believe, in a visceral way, that the problem was not a character flaw or an unconscious choice, but rather physical. At the time, I thought it was hormone related, and now I know more about issues related to serotonin reuptake.

(Many people with anxiety disorders don’t have enough of the neurotransmitter serotonin. Medications for these disorders often block the reabsorption of serotonin into the brain’s neurons in an attempt to correct this problem. Such drugs are called selective serotonin-reuptake inhibitors [SSRIs], and they keep the serotonin in use for as long as possible to make up for the fact that there’s not enough of it circulating in the body.)

But those respites gave me a glimpse of how fun “normalcy” can be. And I wanted more of it. Life is so good.

I take nothing for granted. I still struggle now and again, and I’ve had mini-relapses, but nothing long term. Even when I relapse for a while, I know I can “come back.” I know I’m okay.

My real release happened when I broke out of the anticipatory “thinking-dreading” cycle. I think that happened to some extent when I moved away from home and had the freedom to decide for myself what I was comfortable or uncomfortable attempting. I no longer had the extreme pressure from my family to truckle to what others wanted or needed me to do.

That was step one. The medications were step two. And finally forgiving myself and releasing myself from the blame and guilt set me free. Now if I fail, oh well, I can try again. I don’t experience these things as cataclysmic anymore.

So it was medication that helped me; but even more it was a release of guilt, and an allowance for failure. I knew I could be happy, and I knew it was worth the discomfort of pushing my own envelope to get there. I now am a quite spirited public speaker. But writing is a skill I developed in my solitude, and I wouldn’t trade my years alone, in retrospect. Okay, I lied. Maybe I would, but I can’t, so I just want to enjoy the rest of this life!

To make a long story short, I have worked in education ever since college, finally got divorced after twenty-one years, have two happy, cool kids, and at forty, I’m a happy and functional human. I take 25 milligrams of Celexa daily, and I keep a stash of Xanax in my purse, but rarely need it. I can do just about anything. I travel, I love, I socialize, I work, and I exercise. I still avoid bus trips, but I am going to work on that. I prefer to be the driver on long trips, but I can deal with someone else driving. I no longer experience paralyzing, cyclical anticipatory anxiety. That was the torture that held my mind, and being free of it is my biggest joy.

I love being alive on the planet. I love who I am. I take the joy and sorrow as it is vouchsafed me, and I know it all stems from the same source.

I am forty years old and have two teenage kids. I grew up in El Paso, Texas, married at eighteen, moved to Louisiana, and then moved back to El Paso. I was an art major for my first stint in college, and took my degree in elementary education on my second go-round. I taught in the public schools in El Paso for five years, and after moving to Trinidad, Colorado, in 1997 I worked at the local junior college as a staff developer, curriculum specialist, and tutor coordinator.

I am a voracious reader, and love to travel, dance, sing, and paint. I am newly remarried and my kids are about to be up and out, so I am thinking about what that means. I love people and life, and am looking forward to the second half of mine. You may contact me at Lori.Downs@tsjc.cccoes.edu.

Commentary
By Dr. Paul Foxman

Lori’s anxiety developed as a result of a traumatic experience, and therefore her condition could be considered a form of post-traumatic stress disorder (PTSD). The trauma—an attack of diarrhea—resulted in a messy bowel accident at the self-conscious age of fifteen. Lori’s shame, secrecy, and fear of a recurrence resulted in a pattern of anticipatory anxiety and agoraphobia. As is often the case with avoidance, this coping style led to severe life restriction.

An effective treatment approach for this combination of agoraphobia and PTSD involves three components: education, changes in thinking, and desensitization to the dreaded situations. The educational goal is to understand the link between the traumatic event and anxiety symptoms, including attempts to prevent it from happening again. For example, Lori would learn that her worrying and avoiding were actually attempts to protect herself from anxiety, but it came at the price of life restriction and chronic anxiety.

The cognitive aspect of treatment consists of replacing “what if” worries with new, rational thinking. For example, while Lori behaved as if she would die if she had another attack, in reality her worst scenario would be inconvenient, but not life-threatening. Diarrhea is usually a private experience, not a public display, and Lori’s fears of its happening “in front of someone” were disproportionate.

Finally, it is essential to face feared situations in order to master them. For this component of treatment, a technique called floating through, pioneered by Dr. Claire Weekes in her books on agoraphobia (see the Bibliography), is helpful. The floating-through technique consists of four steps:

*            Facing—not avoiding or running away from feared situations

*            Accepting—having an attitude of acceptance towards anxiety rather than one of rejecting or fighting against it

*            Floating—relaxed breathing through the anxious feelings

*         Letting time pass—trusting that the anxiety episode will subside

The effectiveness of this approach rests on developing skill at relaxing, which you can master with practice. The best way to do this is to practice relaxing in a safe and comfortable environment, when you are not feeling anxious. Use recorded relaxation instructions, or simply take a few minutes several times a day to experience deep relaxation. With practice, you will be able simply to think relax, take a deep breath or two, and physically relax. Your breathing will become fuller and slower, your muscles will soften, and your mind will calm down. Once you have practiced the relaxation skill, you will find it more effective in the middle of an anxiety episode.

Professional help from an experienced anxiety specialist using these steps could accelerate the anxiety recovery process. Medication can also be helpful in controlling anxiety symptoms and providing a sense of “normalcy,” as Lori puts it. However, medication alone is usually insufficient for agoraphobia and PTSD because it does not educate the sufferer or address the thinking patterns that underlie these conditions. Besides its treatment limitations, additional problems with medication include frustration often encountered in the process of finding the right drug and the right dosage. For many anxiety sufferers, this process can be discouraging and can result in giving up on medication. Furthermore, unpleasant side effects, such as the loss of sexual drive that Lori found unacceptable, can be a barrier to using medication. Generally speaking, medication makes sense for controlling anxiety symptoms while the person learns and practices the steps outlined above.

Learning to relax is an especially important step when gastrointestinal (GI) symptoms are involved. Proper functioning of the GI system requires relaxation because digestion and elimination are disrupted by tension, stress, and worry. Think of relaxation as a skill that you can practice daily through meditation, quiet reflection, relaxing stretches or yoga, use of a relaxation audiotape, listening to soothing music, enjoyable reading, and other methods. Experiment with relaxation approaches and discover what works for you. As with any new skill, practice is necessary for mastery.