"It only hurts when I exist"

August 21, 2012 9:21 AM

Is this a symptom of a panic attack? Is there a medical term for it?

I have mild PTSD and anxiety disorder. I also have obsessional, upsetting thoughts. When I get very anxious, and I happen to be in public, I become so self-conscious about my thoughts and my various defects that I have a terrible need to hide. I want to stop being in front of other people for a few minutes, even though I know very well that nothing is wrong with me and nothing looks wrong with me. I want to tear my skin off and crawl out of my body until I can calm down. This has happened in privately stressful times since I was 11 years old. I am on medication now, but it only does so much.

Please understand I'm speaking figuratively. I do not have any urges to harm myself or anyone else. I never actually go and hide, because I am usually at work when this happens. (If I am at home I can go lie down and listen to white noise for ten minutes, which helps.) I never discuss my obsessional thoughts or take them seriously; they are simply disturbing to me personally ("Imp of the Mind" type).

What I'd like to know is what exactly this sensation is. Is this a panic attack? It doesn't come with heart attack type symptoms or shortness of breath. (I have had that happen, but it was years ago and felt very different.) I have a therapist and he's great, but he didn't really answer this question when I saw him last. Possibly there's not a clear answer.

posted by anonymous to Health & Fitness (12 answers total)

That is a very common physical manifestation of anxiety, Anon. Anxiety is a spectrum - it can range from mild to full-blown panic. Yours sounds like it's somewhere in the middle of the spectrum - extremely unpleasant, but not full-on debilitating. While you don't mention what medication you're on, and while IANAD, this is EXACTLY the kind of thing for which short-acting benzodiazepines are prescribed all the time. You might want to ask your GP if it would be possible for you to try them (assuming, that is, your GP agrees, and that you do not have preexisting issues with addiction).
posted by julthumbscrew at 9:25 AM on August 21, 2012 [1 favorite]

It sounds like Social Anxiety Disorder to me. I would suggest talking to an internist,psychiatrist or GP about this-there are definitely drugs which can help. Good luck, anon,it must be like a very stressful condition for you.
posted by Isadorady at 9:30 AM on August 21, 2012

Different people have very different experiences of panic. For some people the physical symptoms are what is really frightening (i.e., the heart and breathing symptoms you describe above). For others, it's the mental/cognitive experience that feels really scary. Usually that's associated with feeling like things "aren't real" or that you sort of cease to exist-derealization or depersonalization in psychiatric terms. There can also be fear associated with feeling like your thoughts are out of your control, that you are "going crazy."

It sounds like you are a person who is prone to your mind and body running on the anxious side, and with the PTSD diagnosis, I wonder about particular fears about feeling out of control and if that has a role here. The focus on what others are seeing in you could also suggest some social anxiety like Isadorady suggested. All kinds of anxiety, from worry, to panic to social anxiety, can have episodes like this where your anxiety spikes all of a sudden.

Speaking to a good psychiatrist and a good therapist who specialize in working with anxiety disorders would be really useful in parsing that all out and giving you some tools to allow you to control the intensity of the anxiety you experience. Cognitive Behavioral Therapy is one therapeutic approach that is particulalry well supported for anxiety.

I know that this feels really scary, but I have lots of hope for you that it can get better.
posted by goggie at 10:10 AM on August 21, 2012

Yeah, that's your anxiety flaring up. You could be living in my head, anonymous, that was one of the first manifestations of my anxiety disease, and mine started early in childhood too.

It's fairly common within the context of anxiety-spectrum symptoms, so while I know it freaks you out, don't let it freak you out too much. You know what I mean - this is not some sort of heretofore undiscovered brand of super concentrated crazy, this is a known thing and people know how to deal with it, so you can learn too. I don't know if that will help you, but sort of.. logic-ing my way out of the traps my anxiety sets for me is useful, sometimes. Mindfulness with bigger words. "I am feeling x because of y and therefore my [brain] causes [polysyllabic name of symptom] and that's all this is." The world is not ending. You are not broken. The big stupid anxiety monster is just goin' all Godzilla on your lobes.

Talk to your therapist about this, as there are ways to minimize it both with medication and talk therapy. Cognitive-behavioral is great for that sort of thing. Lifestyle, too - just like any other anxiety symptom this one can be triggered by stress.

Feel free to shoot me a memail or email if you want to talk/vent sometime. Knowing this stuff happens to other people was helpful for me - ya don't want to wish it on anybody, and yet it is immensely relieving to know that you are not alone.
posted by cmyk at 10:14 AM on August 21, 2012 [1 favorite]

Since it only happens in public, it sounds to me like it's probably a manifestation of agoraphobia. Which is normal (i.e. you're not a freak) in the sense that it's often associated with PTSD and panic disorder. But definitely something to talk about with your therapist.
posted by ErikaB at 10:20 AM on August 21, 2012

I have OCD and this definitely happens to me, for what it's worth.
posted by ariadne's threadspinner at 12:36 PM on August 21, 2012

To me it sounds like you're experiencing an intense emotion of shame, which Charles Darwin believed to be one of the hardwired emotions all humans experience. In my opinion it's as fundamental as fear, anger, or disgust, and in most descriptions I've seen, a hallmark feature of shame is the desire to cover up or hide. Article from Psychology Today.
posted by Dixon Ticonderoga at 12:47 PM on August 21, 2012 [1 favorite]

I have retreated to a bathroom when anxious or upset since I learned how to use a toilet (mostly because the door locks, but it IS the best place to withstand a long seige).

To me it's the "flight" in fight or flight. Just like prey, we're hiding until the threat goes away.
posted by Lyn Never at 1:40 PM on August 21, 2012

this is super-similar to the panic attacks I used to experience - especially the urge to be out-of-sight for just a few goddamned seconds, please. i worked in a huge cube farm, in a huge office building. the place I eventually found to take a 10 minute break was an unattended basement utilities area. drugs+therapy have done a lot for me.
posted by j_curiouser at 2:10 PM on August 21, 2012

Sounds like social anxiety induced panic attack to me. It's going to be ok; your therapist should teach you some techniques for dealing with this stuff. As you start to get control of your anxiety, you'll start to be able to deal with this better. This is a really common phenomenon that you are describing. The exposed feeling tha you're talking about is managable, I promise.

You're going to be ok. Best of luck.
posted by windykites at 3:29 PM on August 21, 2012

I've found that the panic attacks I have in company/public manifest differently to those I have alone. Wanting to run and hide is a big feature because I really really don't want to have a panic attack in front of my friends. But tamping that down and trying to over-rule it leads to the wanting to rip my skin off or scream wildly or whatever. So I generally just make some excuse (usually in an awkward weird way but nobody really cares) and then hide for a while somewhere.

And if I try a bit of mindfulness I will usually notice that yes, actually, my breathing and heart rate are through the roof - I am just so caught up in my mind that I don't realise it. Hell, most of the time I rock back and forth and do this compulsive hand thing, and don't realise it either.

But yes, panic attack, according to my therapist - it meets the criteria thanks to the overwhelming sense of doom.

(I had a panic attack at a friend's house on the weekend - nobody realised but were still solicitous since I was obviously upset. I listened to some music and tried to do a bit of yoga while they were off doing something else. It isn't a true fix since I was off kilter the rest of the night, but it's something).
posted by geek anachronism at 6:46 PM on August 21, 2012

I carry a washcloth in my bag, because a cold wet washcloth on my face¹ really helps with an anxiety attack. I carry a short-acting benzodiazepine, and in an anxiety/panic attack, put it under my tongue for fastest relief².

It sounds like you're not letting the anxiety attacks keep you from living your life, which is not easy. I've always had a lot of anxiety & social phobias, and have muddled through. You're not alone; good luck.

¹ Cold water on the face triggers the mammalian dive reflex.

² A therapist recommended it; seems to work, and causes no harm.
posted by theora55 at 8:33 PM on August 21, 2012