From Christine A.
Padesky, PhDDear Julia,
It was a good idea to consult with your client’s physician first to see
if there might be a medical cause of the fainting. Unfortunately, what
the physician told you is not consistent with what I’ve been told by
physicians over the years. As the Freedom From Fear website (www.FreedomFromFear.org)
states:
Panic will not make you faint; While you faint for a variety of reasons
that may have nothing to do with panic attacks, (heat, exhaustion,
dehydration, poor nutrition, etc.) panic WILL NOT make you faint. When
you faint your blood pressure must go down, when you're having a panic
attack your blood pressure is going sagely up, not down.
(reference:
www.freedomfromfear.org/aanx_factsheet.asp?id=10)
There are several issues raised by your client's experience:
First, people often say they "fainted" when they felt faint and
"needed to sit down." It is necessary to interview carefully to find out
if the person actually lost consciousness as occurs in actual fainting.
People do often feel faint when hyperventilating or having a panic
attack. While feelings of lightheadedness can be so intense they are
labeled "fainting," the person does not lose consciousness during a
panic attack which is part of panic disorder.
Fainting can occur under a variety of situations that can co-occur
with panic attacks such as hunger, viral infection, allergy, vertigo
from an inner ear disorder, anemia, sinusitis, heat exhaustion, poor
eating habits, low blood sugar, salt depletion, standing up quickly,
pressure on the vasovagal nerve (e.g., in pregnancy), etc. If fainting
is verified, interview to find out if any of these were present when the
client fainted. As I may have mentioned in my workshop, one man had been
thoroughly tested by a neurologist who ruled out any physical cause for
his fainting. Later tests found a small tumor in his brain that was
pressing on a nerve and was missed in earlier tests.
As a third point, panic attacks can occur within any anxiety disorder
not just panic disorder. It is important to interview and find out what
thoughts and images were going through the person's mind in the middle
of the panic attack. With panic disorder you get beliefs such as "I'm
having a heart attack." "If I faint, I will stop breathing and die." In
social anxiety you get thoughts during panic such as "if others see how
anxious I am, they will think I am a mental case." In blood phobia you
get thoughts such as "if I see blood I will faint" (which may be true
for the reasons in the next paragraph).
If the panic attack is a symptom of severe anxiety when the person
has a blood phobia, they would indeed be likely to faint. In blood
phobia there is a rapid DROP in blood pressure which leads to fainting.
Over time, a person can become so anxious when the anticipate seeing
blood or an injury that they become anxious to the point of panic and
simultaneously have the drop in blood pressure associated with blood
phobia. This would not be diagnosed as panic disorder (and so you would
not use hyperventilation as part of treatment) but instead as a blood
phobia. Interestingly, the treatment for blood phobia involves teaching
the client to raise their blood pressure in the presence of blood or
injury through various muscle tightening exercises.
Thus, you need to be a bit of a detective when the client reports
fainting during a panic attack. It is important to question with
compassionate curiosity (expressing concern for your client) because the
client can otherwise think you doubt their veracity.
Please let me know what you learn from your client.
(Christine A. Padesky, PhD)
