ABSTRACT
In human evolution, anxiety in its many manifestations – fears, worries, panics and obsessions – began as a normal and essentially adaptive human response. Anxiety and classically, the fight or flight response, allows a person to perceive, identify, and respond to a range of conditions of danger. This initial perception of danger is biologically based, signaling the individual to prepare for battle or to retreat. In so doing, a complex array of hormonal and behavioral responses are set into motion. There is ample support for cross-species parallels to both the organism’s response to danger and the underlying brain mechanisms; we are hard-wired to both experience and importantly, to deal with anxiety. However, we need not be confronted with danger that threatens our very survival in order to experience significant anxiety; signal
Linda, a 52-year-old white woman, presented to her local hospital emergency department saying “I’m dying.” Indeed, she was in significant distress, complaining of heart palpitations, dizziness, clammy hands and a pervasive feeling of dread. She further stated that “this keeps happening now.” When her medical tests all came back negative, the emergency department social worker was called to talk with her. By this time, the physical symptoms had subsided but Linda expressed her fears that she really was having a heart attack but that the “doctors didn’t know it,” that she was “going crazy,” and that this would “just keep happening.” In an effort to obtain a medical and family history, the social worker asked Linda if she had ever felt this way before or had she any family member who seemed to feel this way. Linda responded that she’d “had a spell” in college, when she’d first left home which later subsided, and that she had been “really, really nervous” for a time after the birth of her first child. She also stated that her mother used to get “so worried about the kids’ safety,” that “she’d always insisted on picking us up at school herself, even when we were older and it was embarrassing.” As they talked, the social worker learned that Linda’s only child had very recently left for college and she was now alone because her husband had left her the previous spring. She further described herself as “a very competent person” and could not understand how she could fall apart this way. She said she’d had two previous episodes in the last several months wherein she “felt I was dying.” Upon further questioning, she revealed that she’d received a second notice of foreclosure in the mail, immediately prior to the onset of the symptoms that led to her coming to the emergency department. Linda was suffering with anxiety and struggling to make sense of its debilitating symptoms and her decreased functioning while worrying that “it would happen again.”
