So much for all those years of therapy paying off.

Today something stressful happened to me, and I had a huge panic attack. For once, the thing that set me off would have even upset a normal person. I actually had a reason to feel distressed. Of course, I didn't just feel distressed. I had a huge fucking panic attack.

I totally freaked out. I couldn't breathe, my heart was trying to beat itself out of my chest, my blood pressure rocketed to the moon and my head felt like it would explode. And while I was going through all of this, I had to try and fix the problem that had caused this panic attack in the first place. Which meant dealing with people.

As you know, even when I'm at my best, I don't deal with people all that well. I really tried to not let my panic attack affect my communication with the people I needed to talk to to fix the problem, but I'm afraid I wasn't completely successful. I ended up yelling at someone over the phone and sent some emails that maybe weren't completely polite.

Fortunately, the situation was resolved very quickly. And I really appreciate how helpful and competent the people were who fixed things. Even though to me, every moment that I was waiting for things to be resolved felt like hours.

After the problem was corrected, and I had checked over the emails that I had sent and determined that although they were a bit abrupt, they weren't all that bad, I was still in really bad shape.

I went out back and spent time with my critters, which can usually calm me down. It helped, but nothing was going to stop my body from the physiological over-reaction it was engaged in.

For several hours after everything was resolved, my heart was still pounding, my blood pressure was still spiking, I was still having trouble breathing and I had the most intense stress headache. I was also crying uncontrollably. Not huge wracking sobs or anything like that, just tears dripping from my eyes and the occasional sad gasp.

And in case you've never understood why women love their cats so much. As I was laying on my bed crying, several of my cats came and rubbed up against me or curled up next to me. One even licked the tears from my face.

I know that though the thing that happened did deserve an emotional response, it did not deserve this extreme anxiety reaction. I knew that even as I was panicking. But did it help? No.

This is my life. Even when I know that my reactions are far beyond what they should be, that doesn't change what is going on. Knowing that you are over-reacting and not being able to stop it, just makes things even worse.

This is why I am a recluse. I am incapable of dealing with the everyday stresses that normal people encounter in their every day lives.

I thought that limiting my interaction with the outside world by creating an online identity or two that only dealt with the rest of the world through cyberspace would protect me from these kinds of stresses. It does limit them, but apparently, it cannot completely prevent them.

A Lie And A Dream

My husband lied to me on Wednesday. It was a lie of omission, but it was a very important omission and a nasty little lie. He did it to manipulate me into doing something that he knew I would not want to do if I knew the truth.

I feel so betrayed. 

He's lied to me before about little things. Mainly things to protect his own feelings. (He obviously doesn't feel the same way about lies that I do.) And I've let him get away with it. Because they were little things, and I could tell he was lying, and I thought he could tell that I knew he was lying. I guess maybe he couldn't. And so he thought that lying to me this time wouldn't be a big deal.

He was wrong.

I was FURIOUS. So furious that I could barely speak. My body was shaking and my throat was so tight, I could barely breath. My eyes burned and watered and didn't want to focus properly. My heart beat so hard that every pulse hurt. My mind might have been able to rationalize what he had done, but my body knew that I had been betrayed and responded with a massive panic attack. It took hours for my physical symptoms to calm down.

I'd trusted him. I'd trusted him more than I have ever trusted anyone else in my life. I thought that he would always look out for me, the way that I look out for him. I used to feel so safe and protected with him.

Not anymore.

Lately, I haven't been feeling safe and protected at all. In fact, I've been feeling sort of neglected. And I told him so several weeks ago. I told him that I felt that he had given up on me. That because my problems hadn't magically gone away simply because I was now in a loving relationship, that he had simply given up on even trying to help me when I was in one of my funks. He apologized and insisted that he hadn't given up, that he simply didn't know what to do to help me.

I don't expect him to “help” me. At least not in terms of healing me. But he used to give me lots of emotional support and attention when things were bad, and even though that didn't heal me, it did make me feel better. Now, I feel like he just says the words he thinks he should say, but he doesn't really mean them. He's just going through the motions. It doesn't feel real, and it leaves me feeling even more hopeless.

And now, he has betrayed me. 

This is only the second time that we've really fought in the eight years that we've been together.  My husband is generally a good man and usually there is no need to fight. If we disagree about something, we simply talk it out.  If it looks like it's going to be a real problem, I usually just give in.  I don't like fighting.  It triggers my anxiety attacks.   But this time, I was not going to just give in.  It wasn't a simple disagreement.  He used a lie of omission to MANIPULATE me. He KNOWS how I feel about manipulation.  And he did it anyway.  To get something that HE wanted, without any regard to my feelings.

I feel so alone.

Last night I had a dream that Foxfire, I and some older man were part of a military excursion in a middle eastern country. The man was in a big truck, Foxfire was driving a truck and horse trailer and I followed behind them on a little motor scooter. As we were leaving the place we'd spent the night before, I told them that I needed to fill up my scooter because I was on empty. But they didn't hear me, and they didn't stop.

I rolled my scooter over to a makeshift little booth that had a gas pump and started to fill it up. Then I realized that my purse with my id and money were all in the truck with Foxfire. I apologized to the woman running the booth, and told her that I didn't have any money, that my companions had taken everything I had and left me behind with nothing. She kindly allowed me to finish filling up my scooter, saying that surely they would come back for me, and I could pay her then.

I waited and waited, and they never came back for me. However, a group of Australian men and women showed up and they paid for my gas and hung around with me, waiting for my people to return. When night came and still no one had come back for me, they allowed me to bunk with them in the large crowded room that they and a number of middle easterners were sharing for the night. As I lay on the floor, one of the men in the group, curled up next to me and held me, comforting me. I had been feeling horribly alone and deserted by my husband, and this complete stranger made me feel safe and secure.

And then, of course, the middle eastern army attacked the building, looking for the Americans who had been there earlier. All the middle easterners that had been sharing the room with us ran out a window and were mostly killed. The Australians and I hid under the bunks. The man who was holding me protecting me with his body.

The next morning, we looked out the window and saw that the little booth where the woman had been so kind to me had been completely destroyed. Probably because she had helped the enemy American. I felt horribly guilty that her business had been ruined because of me.

And then I woke up.

Not exactly a subtle dream. My sense of self has been taken from me. I feel empty, abandoned and alone and must depend upon the kindness of strangers for my well-being. However, anyone who helps me is put in danger and/or destroyed.

Midnight Panic Attack

I woke in the middle of the night last night having a panic attack so bad that I was literally shaking. I crawled out of bed and downed a valium as quickly as I could, then crawled back into bed and lay there hoping the valium would kick in soon.

I don't know why my anxiety attacks are so much worse lately. My mother-in-law was recently diagnosed with breast cancer, but it didn't seem to affect me that much. At least not consciously. I was more worried about providing emotional support for my husband than I was about my mother-in-law's illness. It sounds heartless to not be worried about someone with cancer. But I grew up knowing that both of my parents and my brother had terminal diseases. (Turns out my brother's wasn't terminal after all, he's still alive and kicking, but one of my cousins did die from the same thing.) I think my parents' long term illnesses and eventual deaths wore out all the circuits in my brain that are programmed to worry about parental illness. Or maybe somewhere deep deep inside I am worried, but it's just not making it to the surface of my thoughts. Who knows.

Or maybe the anxiety is simply about my husband. He is emotionally torn up about his mother's illness. He is also stressed about being emotionally torn up. I've tried to tell him that it's normal to be upset, but he keeps beating himself up about over-reacting. Personally, I think that he's handling it extremely well, but it's what he thinks that matters. I just try to be there for him. Which means I'm back to hiding how badly I feel so as not to put any more stress on him.

Someday I'd like to run around screaming at everybody, telling them in graphic detail exactly how miserable I am. I suppose this blog is my more subtle way of doing that. I may not be telling the people in my life, but I am telling someone. Even if they are complete strangers.

Waking Up Is Hard To Do

This post was copied from an old blog that I no longer keep up. It was originally published on November 5, 2008.

I woke up this morning with a nasty headache. I still have it. But at least I didn't have a panic attack when I woke up. Eight out of ten mornings(or thereabouts), as soon as I realize that I am actually awake, my heart starts pounding and my mind races, and I become terrified because I will actually have to get up and face another day. I'm not exaggerating. I'm really scared to wake up. I'd much rather just stay asleep(permanently). Some people are afraid to go to sleep because they have nightmares. Well, for most of my life, I suppose, my day to day existence was a nightmare. My life isn't that bad now. My external situation is actually pretty good. My husband loves me. My kitties love me. I have lots of books to read. But the wiring in my brain still thinks that being awake means being in emotional pain. So almost every time I wake up, I panic. It doesn't last long, a few minutes maybe, then I calm down. Unfortunately, this mornings headache isn't going away. I suppose I should take something for it...
Practicality... bleh...


Update 3/31/11: I still wake up with panic attacks. I now refer to them as my UMPA's (Usual Morning Panic Attack). Though I think the frequency may be down to seven out of ten mornings. It might not be much, but it's an improvement.

What exactly do anxiety, depression and non-24 CRSD do to me?

It has come to my attention that most people really don't know that much about clinical depression and have even less understanding of what an anxiety disorder is. So I'm going to try and explain a little about what these psychological illnesses do to me not just emotionally, but physically. I did earn a bachelor's degree in psychology when I was in college, but that was over twenty years ago. And frankly, the very basic knowledge that you get from a BS in psychology isn't that useful. So everything I am going to talk about in this post is based on my own personal experience and many, many years of therapy. However, I did use google and wikipedia occasionally to make sure that I was using terminology correctly, and in doing so discovered some new and useful terms to use to describe and define my problems.

My main problem is anxiety. The depression seems to be more of a side effect of the anxiety, though that may be an incorrect assumption on my part. So what exactly is an anxiety disorder? There are actually several different kinds of anxiety disorders that may occur separately or in combination. I not only suffer from Generalized Anxiety Disorder (GAD) which is basically just chronic worry and stress (and which seems to me to be the foundation for most of my other anxiety disorders), but also from Panic Disorder, Enochlophobia, Agoraphobia and some type of Social Anxiety Disorder(anthropophobia or possibly Post Traumatic Stress Disorder). I also suffer from a sleeping disorder that may or may not be related to my anxiety and/or depression.

Panic Disorder seems to be just a more extreme form of GAD. Basically, it means having continuing or recurring physiological fear responses(fight or flight responses) when there is no reason to be afraid. Or when there is reason, having an extreme response when only a mild response is called for. In my case, among other things, it means that I have panic attacks even when there is nothing to be afraid of, and when something stressful actually does happen, these panic attacks can become so severe as to be completely incapacitating. So what exactly happens to me during a panic attack?

When most people think of panic attacks, they imagine the movie version where the person screams and flails about and/or hides in a closet curled up in the fetal position. Well, some panic attacks are like that. And I have experienced that kind, but not very often. In reality, like most things psychological, panic attacks can vary in extremity from mild to full blown. Most of my attacks vary from mild to somewhat intense. A very mild panic attack can simply involve an elevated heart rate and quick shallow breathing. I may not even be consciously aware of one of these mild attacks until Foxfire asks me what's wrong. Somewhat intense panic attacks might include a pounding heart, difficulty breathing, headache, the feeling that your skin is jumping/twitching(possibly caused by spiking blood pressure and/or hyper-firing nerve endings), involuntary muscle twitches, nausea, cold or hot sweats, racing thoughts, difficulty thinking, blurred vision and/or diminishment of physical co-ordination. A full blown panic attack means complete loss of emotional and physical control, and in one case, loss of memory for the event.

One of the stranger symptoms I occasionally suffer is a sort of aphasia. Having trouble speaking during a panic attack is not that unusual. But more frequently, I have trouble understanding speech. In other words, even though I can hear the words perfectly, my brain simply doesn't comprehend them. Sort of like listening to a foreign language, except that the language is English. The more anxious I am, the harder it is for me to understand what is being said. This type of problem is almost always a constant condition associated with a brain injury of some sort, either a trauma or an illness. As far as I know, it is not generally associated with psychological problems. Nevertheless, I sometimes experience it.

So how often do I have one of these panic attacks? Well... almost every morning when I first wake up, I have a panic attack. I refer to it as my Usual Morning Panic Attack (UMPA). (Since my sleep schedule is very erratic due to my sleep disorder, "morning" refers to whatever time I happen to wake up, whether it's 6AM or 6PM.) Sometimes my UMPA is fairly mild and lasts as little as 30 seconds. Other mornings, it can last 30 minutes or more. Very rarely, I don't have an UMPA at all. Those are very good days. Most times, I can still get out of bed even while I am having a panic attack and have done so fairly often. If I hug Foxfire during this time, he can feel my heart racing/pounding. It worried him the first few times it happened, but now he seems to be used to it. Occasionally, my UMPA is bad enough that I can't get out of bed for hours. And even when I make it out of bed, all I can do is lay on the couch and read or watch TV. Reading is usually the most effective way for me to deal with panic attacks, but occasionally, the attack is such that I can't concentrate well enough to read or my vision is too blurry.

Of course, I don't just have panic attacks in the morning. I also have them during the day. Sometimes, they are brought on by a stressful situation, but other times they seem to occur for no reason whatsoever. Like my UMPA, these attacks can vary greatly in duration and intensity. Sometimes, it feels like an attack will wax and wane over several days without ever completely fading away. Those are the days when I just don't leave the house, and frequently, I won't even pick up the phone. These extended panic attacks usually coincide with a depressive episode of at least moderate intensity. Strangely enough, I can still chat online even when I'm beyond the point of being able to talk on the phone. Possibly because you can take longer to respond to people online, or possibly because reading text and typing uses different parts of the brain than talking and listening. I don't know. But sometimes even chatting online is more than I can manage, and all I can do is lay on the couch and wait for it to end. Even when I am asleep, I am not safe from having a panic attack. Sometimes I'll wake up with my heart racing and the sheets will be soaked with sweat.

The most severe panic attack I ever had occurred when I tried to go watch a friend's band perform at a night club. It was very, very crowded. People were literally pressed up against one another. I don't do well in even moderate crowds, so I just kept getting more and more nervous. I should have left, but I didn't. I wanted to stay and watch my friend perform. But eventually, I broke and had a full blown panic attack. I don't remember what I did. There is a completely blank space in my memory. I remember getting more and more stressed out and the next thing I knew, I was standing with about five feet of space all around me and people were staring at me. The friend that had brought me with her to the club came over and led me outside. She didn't ask what the problem was and I didn't ask what I had done, but we never went out together again.

Even though I had suffered from the fear of crowds before that panic attack, that experience has made me even more worried about being in public situations. I had thought that my fear of crowds was agoraphobia, but when I googled agoraphobia, every medical definition that I found described it as being a fear of having a panic attack in a public situation where help was unavailable or from which you couldn't easily escape. But I had been afraid of crowds long before I had that panic attack, and although I did worry about being able to escape, I wasn't afraid of having a panic attack, I was afraid of the crowd itself, of being hurt by the people surrounding me. So I googled “fear of crowds”, and the best term that I could find to describe my fear of crowds was enochlophobia. It's not exactly the most reputable reference, but I couldn't find anything better. The Wikipedia definition of agoraphobia did include a description that seemed more closely related to my fear of the crowd itself rather than just fear of having a panic attack in public. It described ”a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control.” My fear of crowds could well be caused by my inability to predict or control what the people around me are doing. Strangely enough, it seems that there may also be a link between my enochlophobia and my inability to determine spatial orientation once my feet leave the ground. Those with weak vestibular function rely more on visual or tactile signals for spatial orientation and may become disoriented when visual cues are overwhelming, such as in crowds.

Anyway, now, whenever I start feeling stressed in public, I'll try to leave whatever situation I'm in before it gets too bad. Therefore, I have to be careful about getting into situations where I can't just leave whenever I want to, and that rather limits my social life. I recently went on an overnight camping trip, and even though it was just for one night with just my husband and one close friend, I was seriously worried that I might have an intense panic attack during the trip and wouldn't have anywhere to go where I could panic in private. So apparently, I do suffer from agoraphobia as well as enochlophobia.

Fortunately, I do not constantly have panic attacks during most days. And as long as I can avoid anything that stresses me, the attacks I do have are generally mild and short. Unfortunately, it's not just crowds that stress me. All sorts of things can and do cause me stress, but one of the most common stressors I have to face is simply interacting with individual people. Some people cause me more stress than others, and there are the few that very rarely cause me any stress. (I am very lucky to have Foxfire who generally makes me feel less anxious when I am around him. Though even he will occasionally cause me stress.) But being around most people for any length of time almost invariably brings on a panic attack of some sort.

This fear of interacting with others would most likely be called a Social Anxiety Disorder. However, like the definition of agoraphobia, the description of Social Anxiety Disorder doesn't exactly fit my experiences. I do worry about what others think of me, possibly overly much, but mainly I worry about what others will do to me. Whenever I'm with most people, I have an underlying fear that they will attack me, either verbally or physically. I'm fairly sure that this fear developed because of actual events during my childhood. I was repeatedly attacked both verbally(by other students) and physically(by a family member) throughout elementary school and into junior high. (Those experiences could also be the source for my fear of crowds. Students on an elementary school playground could be considered a crowd.) The best term that I could find for this fear is anthropophobia, which literally means fear of people. But it's definitions focus on extreme shyness or fear of blushing, rather than fear of being attacked. I suppose, my problem could be a form of Post Traumatic Stress Disorder, but I hesitate to compare my experiences in elementary school to being in a war. Though Wikipedia does include being bullied during childhood as a source for PTSD. However, in my case, it wasn't the bullies who hurt me, it was all the normal kids who picked on me. The bad boys actually protected me from the others once or twice.

But whatever it's called, this inability to interact normally with others (combined with my other problems) has made it impossible for me to hold down a regular job. I spent most of my twenties and early thirties trying to find a career where I could fit in. Most of the time, I didn't last two weeks before the physiological symptoms of my anxiety and depression became so overwhelming that I simply couldn't go to work anymore. I did manage to last a bit longer at some jobs. (I think the longest was about two and a half months. I was editing training manuals and didn't have to interact with anyone but my supervisor and I didn't even interact with her that much.) But at almost every job, there eventually came a time when I was simply too physically ill to continue.

There were two jobs where I did not become too ill to show up, the first was a bookstore and the second a martial arts studio. However, I was fired from both places because of the disruptions caused by one or another of the symptoms of my anxiety or depression. I actually liked both of those jobs and it was devastating to be fired from them when I believed that I had finally found a place to belong. But apparently, my behavior was just too abnormal to be tolerated. Both managers cited financial reasons for "letting me go", but I know that it was really because of manifestations of my psychological problems. Those failures, especially the second one, left some pretty deep psychological scars. Now, I'm afraid to find a job that I actually like because I “know” that I will just end up hurt when they fire me because I don't really fit in. I don't want to suffer that kind of rejection again.

Perhaps there is some sort of work-at-home job that I could do, but now, even thinking about applying for a job makes me sick to my stomach. The more seriously I think about it or talk about it, the more severe the physiological symptoms become. Just recently, simply chatting online about the possibility of trying to get a job caused me to develop diarrhea and to have difficulty performing physical activities that I could previously do relatively easily.

In addition to the other physical manifestations of my anxiety and depression, I also have a continuing problem with insomnia. Or at least I thought I did. When I read through the insomnia page on wikipedia, I discovered that what I suffer from, though frequently mis-diagnosed as insomnia, is actually a Circadian Rhythm Sleep Disorder-free running type, more commonly referred to as non-24, short for non-24-hour sleep wake syndrome. I had no idea that there was a specific name and diagnosis for what I suffer with. Apparently neither did any of my doctors and therapists since none of them ever mentioned it even though the way that I've been describing it for years is almost the exact same way that it is described in Wikipedia, though with slightly less technical verbiage. Basically, my body's internal systems act as if a day is about 26 hours long. Thus my sleep/wake cycle does not sync up with the normal 24 hour day. It is apparently extremely rare, less than 0.05% of the population has it and most of those who do have it are blind. From what I can tell from skimming through a medical journal article about CRSD's, there are fewer than 100 documented cases of sighted people who suffer from non-24. Though I can't help but think that there are more people out there like me who simply haven't been accurately diagnosed with it. Unfortunately, although I now have a more accurate term for defining my sleep problems, I still don't have a way to fix them. (Though it does explain why the normal insomnia treatments have never really worked for me.) There have been so few cases of sighted non-24 patients that treatment is still very much in the experimental stages and nothing has proven truly effective. However the little data that exists does suggest that this sleep problem is strongly linked to psychiatric problems. Whether it causes them or is an effect of them is unclear. But regardless of it's cause, it's effect is that it is very difficult for me to function normally in society because of my dis-synchronization with the temporal norm.

As for my depression, it's manifestations are less physical and more emotional. It can and does cause headaches, body aches, fatigue and lethargy, but I feel it's effects most strongly in terms of my emotions/thought processes. Like my panic attacks, my depressive episodes can vary in degree and duration. Unlike my panic attacks, my depressive episodes are frequently severe, though they rarely reach the very worst level. My depressive episodes also tend to occur less frequently than my panic attacks, but to last longer. Though it is possible that I simply don't consciously notice mild depressive episodes if they don't last for very long. During a mild depressive episode, I feel tired and simply lack the initiative to actually get up and do anything, even things that I normally enjoy/want to do. During a moderate episode, I feel that nothing I can ever do will really affect anything so why bother doing any thing at all. Physically, it can feel like my body is weighted down by heavier than usual gravity. It is literally hard for me to move. I might also experience headaches and/or body aches. During a severe episode, not only are the headaches, body aches and lethargy even worse, I also feel utterly helpless and hopeless. I cannot believe that my life will ever be better than it is right then, and it seems that the best way to escape the emotional pain (the physical pain doesn't really matter at this point) is simply to end my helpless, hopeless, miserable existence. No matter how hard I try to think about more positive things, my mind keeps coming back to how difficult living is and how easy it would be to die. At it's very worst, I have to literally fight the compulsion to kill myself.

I don't know how to describe that compulsion adequately. It is very different from simply thinking about killing yourself. It is not abstract in the least, it is a very real struggle against an emotional imperative. The closest I can come is to compare it to the struggle not to breathe when you have been underwater a long time. You know you have to wait until you reach the surface, but your body just wants to take that breath in, no matter that you are still surrounded by water. If you stay under water long enough, you eventually give in to that desire to breathe and you drown. You can't help it, the physiological imperative overcomes your knowledge that you will drown. Fighting the compulsion to suicide is like fighting not to breathe under water. I have to continually convince myself that sooner or later I will reach the surface, and if I can just hold on till then, I can survive. And yes, I am afraid that someday that emotional imperative will overcome my knowledge that I will die.

I do not mean for this post to be a cry for help. I have plenty of help from my husband and my therapist. I just want my friends to understand a little better what exactly I go through day to day. I also find that writing things out helps me to organize my thoughts a little better for my own benefit. I certainly discovered several useful things while writing this post. Not only the stuff that I found online about agoraphobia and non-24, but also stuff that I worked out a better understanding of for myself through the process of trying to describe it to someone else. And maybe, just maybe, reading this post will help someone else understand either their self or a loved one just a little bit better than they did before.