Is It Hyperventilation, Panic Disorder, or Autonomic Dysfunction?

Q: Is It Hyperventilation, Panic Disorder, or Autonomic Dysfunction?

Hello： Hyperventilation, panic disorder, and autonomic nervous system dysregulation actually belong to the same group of syndromes, indicating similar symptoms, and the treatment methods are also similar. <br>Essentially, they are all part of the anxiety spectrum disorders. <br>I

Is this hyperventilation, panic disorder, or autonomic nervous system dysregulation?

Hello Doctor: Recently, I have been experiencing intermittent feelings of breathlessness at irregular times throughout the day.
Sometimes, I suddenly feel like my breathing becomes short (as if I can’t get enough air), and these episodes occur without any apparent reason, even when I am not feeling anxious or stressed.
During these episodes of sudden shortness of breath, my blood pressure also spikes temporarily (I have hypertension, but it is well-controlled with medication, usually around 107, which my doctor has noted is somewhat low).
Occasionally, my lips feel tingly, and I sometimes experience weakness in my limbs.
I have consulted various specialists at major hospitals and undergone numerous tests: the pulmonologist found no issues, the cardiologist conducted several tests that were all normal, and an echocardiogram revealed only mild mitral valve prolapse (with slight regurgitation).
I also had a 24-hour Holter monitor that recorded around 3000 instances of arrhythmia (premature ventricular contractions).
The gastroenterologist performed an endoscopy and found ulcers and gastroesophageal reflux, for which I followed a four-month course of medication and have mostly recovered.
I have seen numerous specialists (too many to count) and spent a lot of time, money, and energy consulting all the necessary fields (the only one I haven’t seen is psychiatry).
Once, I felt so unwell that I went to the emergency department of a major hospital, where they conducted many tests, and the emergency physician said everything was normal, as did the outpatient doctors.
However, I still cannot find a clear reason for these sudden episodes of discomfort.
It seems that the doctors at the major hospital can only prescribe medication, yet I still experience these intermittent discomforts.
Could this be panic disorder? Or is it autonomic nervous system dysfunction? (Because during these episodes, I do not feel like I am encountering any stressful or anxious situations, yet they still occur inexplicably.) Should I consider seeing a psychiatrist? Thank you for your response.

Niming, 30~39 year old female. Ask Date: 2016/10/26

Dr. Liang Sunyuan reply Psychiatry

Hello: Hyperventilation, panic disorder, and autonomic nervous system dysregulation actually belong to the same group of syndromes, indicating similar symptoms, and the treatment methods are also similar.
Essentially, they are all part of the anxiety spectrum disorders.
If you can maintain regular treatment, most individuals can achieve significant improvement.
Since you have undergone so many tests and treatments without improvement, I recommend that you consult a psychosomatic medicine specialist for an in-person evaluation by a physician.
Wishing you all the best.

Reply Date: 2016/10/26

More Info

The symptoms you are experiencing—such as shortness of breath, feelings of tightness in the chest, sudden episodes of breathlessness, and associated sensations like tingling in the lips and weakness in the limbs—can indeed be perplexing and distressing. Given your extensive medical history and the numerous tests you've undergone, it seems you are seeking clarity on whether these symptoms are indicative of panic disorder, hyperventilation, or autonomic dysfunction.

Understanding Your Symptoms
1. Panic Disorder: This is characterized by recurrent, unexpected panic attacks, which are sudden periods of intense fear or discomfort that peak within minutes. Symptoms can include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes. Importantly, panic attacks can occur without any identifiable trigger, which aligns with your experience of feeling breathless without any apparent anxiety or stress.

2. Hyperventilation: This occurs when you breathe very quickly or deeply, often due to anxiety or panic. It can lead to a decrease in carbon dioxide levels in the blood, causing symptoms like lightheadedness, tingling in the extremities, and a sense of breathlessness. While hyperventilation is often associated with anxiety, it can also occur in other contexts, such as during physical exertion or even at rest in some individuals.

3. Autonomic Dysfunction: This refers to a disorder of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, and breathing. Symptoms can include fluctuations in blood pressure, heart rate irregularities, and episodes of dizziness or fainting. Given your history of high blood pressure and the episodes of weakness and breathlessness, this could be a contributing factor.

Next Steps
Given that you have already consulted various specialists and undergone extensive testing without a definitive diagnosis, it may be beneficial to explore the possibility of a psychological component, such as panic disorder or anxiety-related issues. Here are some recommendations:
1. Consult a Mental Health Professional: Since you have not yet seen a psychiatrist or psychologist, this could be a crucial next step. A mental health professional can help assess whether your symptoms are related to anxiety or panic disorder and can provide appropriate therapeutic interventions, such as cognitive-behavioral therapy (CBT) or medication if necessary.

2. Monitor Your Symptoms: Keeping a detailed diary of your symptoms, including when they occur, their duration, and any potential triggers, can provide valuable information for your healthcare provider. This can help in identifying patterns that may not be immediately apparent.

3. Consider Stress Management Techniques: Techniques such as mindfulness, meditation, and controlled breathing exercises can help manage anxiety and may alleviate some of your symptoms. Engaging in regular physical activity can also improve overall well-being and reduce anxiety.

4. Follow Up on Autonomic Testing: If you suspect autonomic dysfunction, you might want to discuss with your healthcare provider the possibility of specialized tests, such as tilt table testing or autonomic reflex testing, to evaluate how your autonomic nervous system is functioning.

Conclusion
In summary, while your symptoms could potentially be linked to panic disorder, hyperventilation, or autonomic dysfunction, a thorough evaluation by a mental health professional is warranted. They can help you navigate these symptoms and provide strategies for managing them effectively. Remember, it’s important to address both the physical and psychological aspects of your health to achieve a comprehensive understanding and treatment plan.

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