Bundle of Nerves
December 5, 2011 3:09 PM   Subscribe

It has come to my attention I might suffer from some form of anxiety disorder...and looking back it's been for my whole life and I only have noticed it now...help me with an approach to this...I don't want to do everything at once because then I'll never know what helped me or made me worse.

Go back 25 years to my first love who cheated on me and dumped me...the overwhelming sense of doom was frightening, but looking back seemed appropriate. By doom I mean, heart palpitations, a feeling of total lack of control, and a feeling of just wanting to "get away" Moreover, when I was with other people I intensely wanted to be alone, but when alone the loneliness was sickening.

Fast forward to current day, and I've gotten almost as sickening a feeling when, for example, I think my car might have needed expensive repairs, when my daughter lost her cell phone, when my kids goof off instead of doing their homework, and most worrisome when I need to have serious talks with my wife that impact our relationship. The anticipatory anxiety I feel from the latter easily exceeds any sense of doom I have felt from anything else. And there's the rub...I can't deal with crap as little as needing to replace my daughter's cell phone without an overwhelming sense of doom/dread...how can I deal with my relationship? I need some help. Obviously, therapy, meds, are all on the table. But what should I do first?
posted by teg4rvn to Human Relations (8 answers total) 9 users marked this as a favorite
 
Note: IANA-anything except someone who has been in your position.

Anxiety is one of those annoying things that feeds and grows from your awareness of it. Learning how to recognize the feedback loop is the greatest key to stopping it. It sounds obvious, but the first thing you need is a balanced professional opinion from someone who is not you or someone in your family.

I personally would start with a psychiatrist (clinical) rather than a therapist/social worker. I think you need to deal with the immediate physiological aspects of anxiety - the fight-vs-flight triggering stuff - before you set up a talk therapy or CBT-type routine. I found it helpful to get a baseline of control before I could back up enough to talk about the big-picture historical stuff.

There will be many opinions on meds vs. not-meds forthcoming in this thread, I'm sure. I think meds are a fine idea if it is determined, after a thoughtful discussion of all factors, that they are necessary. But they are not always necessary. Lots of people do just fine on CBT; others find their anxiety so severe that a medication routine may be necessary, even if only for a certain period of time. Your mileage may vary.
posted by mykescipark at 3:23 PM on December 5, 2011 [1 favorite]


Acknowledge doom, dread and anxiety without accepting it as true. Your self-regulation system is set to a "High"setting, and it sends you messages you can't control. You're allowed to acknowledge them without believing them.

practice this over and over again.
posted by Ironmouth at 3:50 PM on December 5, 2011 [4 favorites]


If you have EAP through work, call them first. They'll make getting in with just about anyone else you need to see significantly easier. My EAP hooked me up with my therapist, my psychiatrist, and my partial hospitalization program. It's more likely they'll be really helpful if they're local to you, and not a big centralized thing like Optum.

If you are in the US, I can almost promise you that there's going to be a four to eight week wait to see a psychiatrist, assuming anyone will see you without a referral. There is a therapist in your community who has openings tomorrow, and about fifty who have openings within the next week. Therefore, if you can see a therapist without preauthorization from your insurance provider, see a therapist first - Google your city name and the word anxiety.

Oh, hang on, I see you have a couple's therapist (from earlier questions.) Ask them first, unless you have a truly excellent reason not to. Why? They know you, and they know the clinicians in your area. For instance, my general practitioner, my current therapist, and my soon-to-be DBT counselor have all, without prompting, given me the name of the "best" psychiatrist in my city for my situation (all of them gave the same name.) You can try your GP, too, but since you already have a therapy relationship in place, go to them first.

Once you have a therapist, you're in the system and they can give you names of the right kind of psychiatrist to see, and probably names of ones they've worked well with. This is important, because anxiety is one of the ones where you want your therapist to be able to talk to your psychiatrist.

Anyway, whenever you see whoever you see, or talk to whoever you talk to, you want to obtain:

1. A good therapist, who has current openings and takes your insurance, and deals with GAD, panic disorder, and/or social anxiety explicitly.
2. A good psychiatrist, who has current openings and takes your insurance, and deals with GAD, panic disorder, and/or social anxiety explicitly.

While you are waiting for these appointments to come together, please:

1. Write out a brief description of your relationship with your parents, your siblings, your wife, and any exes that are relevant. Whoever you see is going to ask you lots of questions about random specific stuff that happened with each of them. They're also going to want to know a lot more of your personal history (going back to childhood) than your couple's therapist probably did.
2. Print out a copy of every last one of the therapy/marriage/children/hiding money from your spouse at your father's request/etc. questions you've posted to MetaFilter, including your responses to people's questions. That one about what it takes to be a man is another good one to bring (I stopped at the first page - any personal growth stuff should be around just in case.)
3. Read up on Generalized Anxiety Disorder, Panic Disorder, Social Anxiety, and PTSD. Also read up on benzodiazepines.
4. Put together a really simple medical history. They're going to want to know if you've got asthma before putting you on anxiety medications (beta-blockers are one of the things they'll consider, and they're contraindicated for asthmatics.)

The good news is, there are a LOT of really effective treatments for most anxiety disorders - I read somewhere that up to 75% see significant improvement in just a few months of CBT. The not-so-good news is there's a few complications in your background (which is why I say you should look up PTSD.) It might turn out you're having panic attacks because of something harder to root out than regular old "no idea where this came from" anxiety.

Do not freak out if things don't work right away, you don't click with the first therapist, etc. MeMail if you want to hear about my adventures in the mental health services, as a consumer.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 3:53 PM on December 5, 2011


In keeping with what Ironmouth said, I'll share one thing they taught in the partial program that I find helpful when I'm still not all the way over into total panic. That is, I can feel it coming, or I know I'm heading into a situation that's likely to trigger it, but I'm still doing OK.

Basically, the idea is that your fear reactions are totally normal and functioning properly - they exist for really good biological reasons, to protect you. The trouble is that they're being set off when they shouldn't, possibly because of something bad that happened that you can't forget: in any case, it's your thoughts that are the problem, and they're what need to be addressed.

For example, if you went camping in the woods, and heard rustling, and then a bear came charging after you and you had to run for your life (or freeze, or whatever you did to survive that situation,) that would make sense. It saved your life - it was necessary and important and good for you.

But then, the next time you're in the woods, you hear rustling, and you don't wait for the bear to show up - having been there and done that, you jump right to the running for your life. You've been trained to assume that a bad thing is coming, and are responding as though it was there. It doesn't matter to your body, once the training takes over, that the rustling was just the wind, or your friend, or whatever - it's in "oh crud bear" mode, end of story. You feel like an idiot once you're five miles away, but rationality isn't doing you any good by then - the decision was made way back when the leaves were rustling.

So what you have to do is to ask yourself, when the rustling starts, or maybe even just as you're wandering in the forest right when you first get there, is: do I actually see a bear, or is it just rustling still? The idea is to interrupt things before you're reacting to the phantom bear, to get yourself to actively assess whether there's real danger or not, so that the automatic process doesn't get a chance to kick in. This is also part of why you're going to hear a bajillion things about mindfulness (not my favorite subject) if you end up in DBT, by the way.

(And yes, I do wander through potentially anxiety-provoking situations asking myself whether there are any bears or not, now.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:13 PM on December 5, 2011 [1 favorite]


Also, and not to raise your anxiety any more - if you have not had a decent physical with bloodwork in a while, you might want to do that just to make sure nothing's off just far enough to possibly be causing your anxiety to get weirder than 'normal' for you. (It's possible, indeed, that it has been boosted to a high level due to a series of super-stressful life events and/or patterns of thinking, but there are sometimes very straight-up physiologic reasons for anxiety to be out of whack as well).

You might also want to take a look at how much/often/easily you typically sleep, eat, and/or exercise, if you haven't already, and whether any of those things might benefit from you modifying them.

You are correct that doing a ton of stuff at once can be difficult, and doesn't often tell you exactly what is at the root of a problem, but there are certainly things that you could elect to change one a time that may be good for you anyway, even if no single change by itself appears to instantly alleviate your anxiety stuff.
posted by bitterkitten at 4:18 PM on December 5, 2011


Put some real work into finding the best, most trustworthy, most reputable psychiatrist you can find. Go to more than one. Get referrals from smart people. Spend some money and time on the search. Don't go for the one who takes your insurance and has an opening - go for the best one you can find.
posted by facetious at 7:34 PM on December 5, 2011


This totally happens to me. Then I do the thing, and it's never as awful as I thought.

Therapy can help, medications may help. You might try buying the Mind over Mood workbook and doing the exercises in the chapters that are appropriate for you.

Even if it doesn't make you feel better, it will give you some concrete goals to work on with a therapist in the future.
posted by elizeh at 8:15 PM on December 5, 2011


First I can tell you what I did wrong: I muddled along without help, sometimes using books, for Way Too Dang Long, thinking that I could think myself out of it.

Next, I'll tell you what I did right: I went to my GP and said I thought I had an anxiety problem, and could they refer me to somebody. They did, and it took some muddling - he offered me a prescription, but it wasn't the one I wanted, so I held off filling it (forever). He recommended a therapist that I Really Didn't Like, but I went back and talked more with the psychiatrist, and he helped me find my long-term therapist. She helped tremendously.
posted by ldthomps at 12:10 PM on December 6, 2011


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