Ask Dr. Ding

Dear Dr. Ding:

I have a question for you. I have death anxiety and I have it in a big, bad way. So my question to you is like what is the line of like normal worry and worry that should be medicated? You probably can’t really say by just knowing me online, but part of me thinks that everyone must worry about getting older and dying or being alone etc,
but there are times that I am freaking out over it. And I’m like 35…what’s up with that???

I definitely don’t like thinking about aging nor do I like the thought of
losing my husband to some horrible disease or something but they both tie into the
death fear. My two absolute crippling anxieties are 1) time running out (which
I see differently to aging) and 2) the lights just going out. Just typing
these two things has tears in my eyes. I’ve had a few full blown anxiety
attacks over it, but mostly will just have tear fest or unable to sleep or
butterflies in my stomach/shakes. I have tried believing in religion,
reincarnation (I would love to be able to believe this!), spirits, ghosts,
white light etc. I’ve tried reading about near death experiences. I do
believe in spirituality and believe that soul stuff can linger on, but I don’t
believe that that happens with everyone and worst yet would be the the “sixth
sense” theory….one of my full blown anxiety attacks. I went to see this
movie and the creepy kid and the ghosts didn’t freak me out. What freaked me
out was the husband was dead and he didn’t know it and couldn’t communicate
with his wife and was like all confused and shit. I swear to goodness I could
barely get out of the theatre and sat outside hyperventilating and rocking
back and forth like a lunatic. But mostly I obsess about the lights just
going out and ceasing to exist. Is that like totally narcissistic or what?

Anyway now you got the juicy heart of it. Advice?

Sign me Faithless In Fredonia

Dear Faithless:

Death anxiety is not narcissistic in a pathological sense. Some theorists posit that it’s in fact a fundamental part of being human. Here’s the juicy heart of my response to your question, Faithless: trauma, either around or during birth or in early childhood, prior to your prefrontal cortex fully developing. It may have been something major, it may have been something minor, but it’s probably there if you look for it. The question is, do you want to go looking?

Anxiety is a huge pain in the ass, and ranks just behind depression in terms of prevalence, and long-term untreated anxiety can be associated with early onset of generalized inflammation throughout the body, which, as we all know, is bad mojo. You can take some heart in knowing that primarily it’s smart people who get troubled the most by anxiety; you have to have a certain amount of omelet frying in the old brain pan in order to fire up a full-blown panic attack.

You may want to ask whoever was your primary caregiver in infancy or early childhood if they can recall anything specific happening to you of a traumatic nature. And remember: what’s traumatic to us as adults (witnessing a grisly accident) tends to be quite different from what was traumatic to us as newbie human beings (being left alone for too long). Also, what might be troubling to one person may not be troubling to another, due to inherent differences in temperament and personality, life experiences, and so on. So don’t dismiss information you get that might at first glance seem inconsequential,

Generalmente, my philosophy as a shrink is: if it ain’t broke, don’t go mucking around trying to fix it. However, even if your anxiety is pretty manageable in that it doesn’t mess up your life functioning it may still be sufficiently distressing that you decide to seek treatment. And, by the way, meds tend to only address the symptoms, and are best used in conjunction with another form of treatment so as to get maximum benefit. If you know of a qualified psychotherapist with a specialization in either anxiety disorders or trauma, treatment could go one of two ways.

1) You learn various cognitive and behavioral coping strategies to deal with your symptoms as well as their triggers, generally termed Cognitive-Behavioral Therapy. Very effective.

2) You uncover heretofore unremembered traumatic event(s) and reprocess same using techniques such as Eye Movement Desensitization and Reprocessing (EMDR), or hypnosis within the context of insight-oriented psychotherapy, or psychoanalytically-oriented psychotherapy. Also very effective.

You seem to have an excellent grasp of the kinds of thoughts, beliefs, and situations that are likely to trigger a panic. That’s great: you would probably be an excellent candidate for some form of insight-oriented psychotherapy, ala #2. However, your panics may begin to show signs of what in clinical circles is termed “kindling” where episodes become closer together, more intense, and of longer duration. This type of presentation oftentimes responds better to option #1, due to needing some immediate control over the symptoms.

In the meantime, you may find it helpful to ask yourself the following questions:

1. Am I holding my life expectations to an unreasonably high standard? Putting too much achievement pressure on myself?
2. What unpleasant emotions or thoughts am I avoiding? Why? Can this be remedied?
3. What types of coping skills do I have already that might help me address my anxiety? [Relaxation, meditation, yoga, tai chi are all excellent choices]

One of the main interventions besides changing how we talk to ourselves is re-learning how to breathe. As infants, we breathe very deeply and smoothly, but as we age we tend to lose this rhythm. Deep, restful diaphragmatic breathing can be easily relearned, but must be practiced actively at least 3x per day so that it becomes reflexive. The idea behind this is that it’s pretty much impossible to have a panic attack while utilizing this kind of breathing, and that by over-practicing this kind of behavior, it kicks in automatically at the first onset of panic symptoms.

Behavioral Xanax! What could be better? It’s free, it’s non-addictive, and makes you look all Zen and shit.

P.S. Don’t worry about your lack of spiritual faith, Faithless. We’re all here to remember our true nature, to discover the real, authentic core self (not the ego). Luckily for all of us here on AskDrDing, there are many, many juicy, heart-filled ways to get there.