Coping with Unexplained Anxiety and Panic Attacks: Expert Advice Needed

How to cope with inexplicable stress and various forms of panic?

Hello Dr.
Huang,
I hesitated for a long time before deciding to ask for your advice.
Since around the end of October last year, after securing a stable job, I began to exhibit tendencies of health anxiety.
Whenever I experience any physical discomfort (mainly related to my eyes), I start to panic and fear the worst.
Despite repeatedly visiting doctors and confirming that there are no issues, the panic returns shortly after.
At its worst, I visited an ophthalmologist three to four times a month.
Fortunately, after May of this year, I experienced some relief.
However, just when I thought I was in the clear, my health anxiety shifted to a fear of car accidents.
I installed a dashcam, yet I still find myself worrying about potential sudden incidents.
Consequently, aside from necessary commuting, I began to avoid riding my bike.
In mid-August, while out shopping alone on a hot summer day, I encountered a woman wearing shorts, which momentarily led my thoughts astray.
Almost simultaneously, I felt an overwhelming sense of guilt and fear, even though I had done nothing wrong.
After quickly leaving that environment, the fear and guilt stemming from my thoughts continued to linger in my mind, making me anxious about becoming a person others would despise.
I have a girlfriend whom I have been dating for over a year; she is wonderful, and I love her deeply.
However, I fear that my troubling thoughts might let her down.
A month after that incident, I noticed an incredible change: I began to feel afraid in crowded environments and fearful of unfamiliar women, especially those who are attractive or dressed more revealingly.
My heart would race with the same fear and guilt, leaving me unable to cope.
My usual work environment consists mostly of men, but whenever women are present, I feel uncomfortable and even experience dizziness and chest tightness, which is very distressing, as I have never experienced this before.
I have always had a bit of a perfectionist streak (even my family has suggested I might have obsessive-compulsive tendencies), making it difficult for me to relax and keeping my mind in a constant state of tension.
I realize that the series of issues I've faced since last October may stem from having excessively high expectations of myself, but I don't know how to resolve this.
The fear of people that began in August is something I have never encountered before.
When discussing this with my family, they said that having fleeting thoughts is normal and not to dwell on them.
Friends have suggested that I need to adjust my mindset.
I understand all of this, but I find it hard to implement.
I am genuinely afraid that this will lead to more serious problems.
I hope you can provide some professional advice to help me through this difficult time.
I apologize for the lengthy message, and thank you for your patience in reading it.

HYAX, 20~29 year old female. Ask Date: 2019/09/18

Dr. Huang Xiaoxian reply Psychiatry

Dear HYAX,
Thank you for your question.
From your description, it seems that you originally had a bit of a perfectionist personality and experienced job-seeking pressure before October.
However, after securing a job, instead of feeling relieved, you began to worry about your health, potential accidents, and feelings of guilt, which are clearly affecting your daily life.
Clinically, many anxiety symptoms often emerge after a stressor, and even after the stressor is removed, the symptoms may not improve.
I recommend that you seek an evaluation at a mental health clinic to receive appropriate treatment to alleviate your symptoms.
Wishing you all the best.

Reply Date: 2019/09/18

More Info

Coping with unexplained anxiety and panic attacks can be a challenging journey, especially when these feelings seem to arise without a clear cause. Based on your description, it appears that you have been experiencing a range of anxiety symptoms, including health anxiety, panic attacks, and social anxiety, particularly in relation to interactions with women. It’s important to understand that these feelings are not uncommon, and many people experience similar challenges.

Firstly, it’s crucial to recognize that anxiety can manifest in various ways, and your symptoms may be linked to a combination of factors, including stress, perfectionism, and perhaps underlying fears or insecurities. The fact that you have a stable job and are experiencing these symptoms may indicate that the pressure of maintaining that stability is contributing to your anxiety. Perfectionism, as you mentioned, can create an internal environment where you are constantly striving for an unattainable standard, leading to increased stress and anxiety.

Regarding your health anxiety, it’s common for individuals to become hyper-aware of bodily sensations, especially after experiencing panic attacks. This heightened awareness can lead to a cycle of fear and anxiety, where any minor physical symptom is interpreted as a sign of a serious problem. It’s good that you have sought medical advice and have been reassured that there are no underlying health issues. However, it may be beneficial to focus on strategies that can help you manage these feelings more effectively.

Here are some strategies that may help you cope with your anxiety and panic attacks:
1. Cognitive Behavioral Therapy (CBT): This is a highly effective treatment for anxiety disorders. CBT helps you identify and challenge negative thought patterns and beliefs that contribute to your anxiety. A therapist can guide you through this process, helping you to develop healthier coping mechanisms.

2. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety symptoms. These techniques encourage you to focus on the present moment and can help calm your mind and body.

3. Gradual Exposure: If you find yourself avoiding certain situations (like riding a motorcycle or being in crowded places), gradual exposure can help. Start by exposing yourself to these situations in a controlled and manageable way, gradually increasing your exposure as you become more comfortable.

4. Journaling: Writing down your thoughts and feelings can provide an outlet for your anxiety. It can help you process your emotions and identify triggers for your anxiety.

5. Physical Activity: Regular exercise is a powerful tool for managing anxiety. It can help reduce stress, improve mood, and promote overall well-being.

6. Limit Stimulants: Reducing caffeine and sugar intake can help minimize anxiety symptoms, as these substances can exacerbate feelings of nervousness and panic.

7. Seek Professional Help: If your symptoms persist or worsen, consider reaching out to a mental health professional. They can provide a comprehensive assessment and develop a tailored treatment plan that may include therapy and/or medication.

8. Support System: Lean on your friends and family for support. Sharing your experiences with trusted individuals can help alleviate feelings of isolation and provide a sense of community.

It’s important to remember that recovery from anxiety is a process that takes time. Be patient with yourself and recognize that it’s okay to seek help. You are not alone in this journey, and with the right strategies and support, you can learn to manage your anxiety effectively. If you find that your symptoms are significantly impacting your daily life, do not hesitate to consult a mental health professional for further guidance.

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