Panic Disorder vs. Anxiety: A Guide for Families

Is this panic disorder or anxiety panic disorder?

Hello Doctor,
My mother has become very anxious over the past few years due to my father's infidelity.
I have taken her to see a doctor.
Although my mother chose to forgive my father, and he apologized and promised to cut ties, she still knows that he hasn't completely severed those connections, which has led to her mental health issues.
She has always been a light sleeper, but this has worsened in recent years.
She often falls asleep around midnight but wakes up after 1-2 AM and cannot fall back asleep, remaining awake until dawn.
The doctor prescribed sleeping pills, which were initially effective, but after a while, they lost their efficacy.

Sometimes, she has sudden outbursts (possibly triggered by watching TV) where she cries out phrases like "I don't want this, I want to die," and engages in self-harm, such as hitting her head against the wall or biting her arms.
During these episodes, I can only comfort her, and they typically last about 10-20 minutes before she calms down on her own.
We consulted a psychiatrist who diagnosed her with panic disorder and bipolar disorder.
How can we resolve this?
Currently, she is taking medication prescribed by the psychiatrist.
Although her panic attacks have decreased recently, she experiences significant lethargy the next day after taking half a sleeping pill.
When I ask her if she sleeps better, she says she still wakes up after 1-2 hours.
She desperately wants to sleep but just can't.
Now, she tries to go to bed as soon as she feels sleepy, but often she remains unable to fall asleep.
This ongoing situation is deteriorating her mental health.
What could be the underlying issues, and could you please provide some guidance? Thank you.

Ya Zi, 30~39 year old female. Ask Date: 2017/07/12

Dr. Huang Weiqin reply Psychiatry

Hello, regarding your description of your mother's emotions and behaviors, it seems she may be experiencing depression combined with anxiety and autonomic nervous system dysregulation due to the stress from the infidelity incident.
The damage to mutual trust, self-confidence, and self-esteem caused by infidelity typically cannot be resolved in the short term.
It is recommended that family members accompany her to seek further medical treatment.
If appropriate medications can be adjusted and she receives psychological therapy and relaxation training, her condition usually improves and recovers.
Thank you for your inquiry.

Reply Date: 2017/07/12

More Info

Understanding panic disorder and anxiety can be quite challenging, especially when it affects a loved one. Your mother’s situation, as you've described, seems to involve a complex interplay of emotional distress stemming from family issues, particularly your father's infidelity, which has understandably led to increased anxiety and panic symptoms.

Panic disorder is characterized by recurrent and unexpected panic attacks—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. In contrast, generalized anxiety disorder (GAD) involves excessive worry about various aspects of life, which can lead to physical symptoms such as fatigue, irritability, muscle tension, and sleep disturbances.

Your mother's insomnia and the episodes of extreme distress, where she expresses thoughts of self-harm, suggest that she may be experiencing panic attacks or severe anxiety episodes. The fact that she has a history of shallow sleep and is now facing heightened anxiety due to family stressors complicates her condition. It’s important to recognize that these symptoms can be exacerbated by emotional turmoil, especially when it involves significant relationships.

The medications prescribed by her psychiatrist, including sleep aids, may provide temporary relief but can sometimes lead to dependency or diminished effectiveness over time. This is particularly true for benzodiazepines, which are often used for anxiety and sleep issues. If she feels lethargic or "out of it" the next day, it may indicate that the dosage or type of medication needs to be reassessed.

Here are some strategies that may help both your mother and your family navigate this difficult time:
1. Open Communication: Encourage open and honest discussions about feelings within the family. Sometimes, just knowing that others understand can provide comfort.

2. Therapeutic Support: It may be beneficial for your mother to engage in therapy, such as cognitive-behavioral therapy (CBT), which is effective for both panic disorder and anxiety. Therapy can help her develop coping strategies and address the underlying issues related to her anxiety.

3. Medication Review: Regular follow-ups with her psychiatrist are crucial. If the current medication is not effective, discussing alternatives or adjustments is essential. Sometimes, a combination of medications may be necessary to address both anxiety and depressive symptoms.

4. Lifestyle Modifications: Encourage healthy lifestyle choices, such as regular physical activity, a balanced diet, and good sleep hygiene practices. These can significantly impact mental health.

5. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or deep-breathing exercises can help reduce anxiety and promote relaxation. These techniques can be particularly useful during moments of panic.

6. Support Groups: Connecting with others who are experiencing similar challenges can provide a sense of community and understanding. Support groups can be a valuable resource for both your mother and your family.

7. Crisis Plan: Given the severity of her symptoms, it may be wise to develop a crisis plan. This could include identifying warning signs of a panic attack or severe distress, and having a plan in place for when these episodes occur, such as calling a trusted friend or family member.

8. Family Support: As a family member, your support is vital. Be patient and understanding, and try to avoid judgmental language. Encourage her to seek help when needed, and remind her that it’s okay to ask for support.

In conclusion, addressing your mother's panic disorder and anxiety requires a multifaceted approach that includes medical treatment, therapeutic support, lifestyle changes, and family involvement. It’s essential to work closely with her healthcare providers to ensure she receives the best care possible. Remember, recovery is a journey, and with the right support and interventions, improvement is achievable.

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