Is it a Panic Attack or PTSD?

Operation: I.V is a 501(c)3 non-profit founded in 2012 that helps combat veterans heal from both PTSD as well as traumatic brain injuries. Its founder, Roxann Abrams, is a Gold Star Mother who lost her son SFC Randy Abrams in 2009. Randy took his own life after experiencing a PTSD flashback from his service in Iraq. Randy had undiagnosed PTSD- a common occurrence among combat veterans either due to mistakes made by the medical field or simply the individual’s failure to report such grave symptoms.

As a result of her son’s death, Abrams founded Operation: I.V. so that combat veterans who served in either Iraq or Afghanistan have a place to receive treatment through a specialized “VIP”, or “Veteran Intervention Plan” program. “VIP” offers ten different rehabilitation programs, including hyperbolic oxygen therapy, service dogs, and anxiety reduction therapy. Additionally, veterans may also partake in programs such as job retraining, business mentoring, and educational assistance. Again, while there is no cure for PTSD, the programs provided by Operation: I.V. can drastically improve a veteran’s mental health and overall outlook on life.

Due to her personal experiences with PTSD, Abrams can be considered as a non-certified expert on PTSD. I guess you could say that I am too—I, Abigail, have written almost one hundred articles on the subject to date. But recently, Abrams and I shared a rather interesting conversation over the phone: how is anxiety different from PTSD?

Of course, anxiousness can be a symptom of Post-Traumatic Stress Disorder, but yet panic attacks are considered to be their own branch of mental disorders. Except, no one knows much more than that about panic attacks—their causes are still unknown to the medical community. Some argue that there is a biological root in people who suffer from panic attacks. Others believe that panic attacks are all psychological.

Recently, Abrams and I shared this precise discussion. I argued that panic attacks have triggers, as I occasionally have the great pleasure of experiencing sometimes gripping attacks that seem to come out of nowhere. Well, I shouldn’t say that. Normally, my panic is triggered by something—a feeling, a visual, a sound. Normally this description confuses psychiatrists, until I tell them that I have a fear of vomiting. “Emetophobia,” I believe it’s called. Now, it is certainly one of the more embarrassing things to be “afraid” of, but I have a good reason!

When I was three months old, I was diagnosed with hydrocephalus, a brain condition where cerebrospinal fluid does not properly drain from the inside of the skull, thus causing intense pressure to build inside the head. In fact, hydrocephalus is an acquired traumatic brain injury (TBI), and almost 300,000 veterans return from the battlefield with such a physical disorder.

One of the main symptoms of this disorder is projectile vomiting as a result from the intense, pulsating headaches that do not let up for days to weeks. When I was little, every time I threw up, hours later, I was in emergency brain surgery, always faced with the possibility of not making it out alive, or with the possibility that this disorder would kill me (yes, hydrocephalus can be fatal!). So, not to be overly-dramatic, but I subconsciously associate vomiting with brain surgery and death. It also doesn’t help that I haven’t thrown up since I was a baby during those hospital stays. So…sixteen years? (Take that, Jerry Seinfeld!) In fact, I have no conscious memory of ever throwing up.

So, needless to say, whenever I get the slightest inkling of nausea, or have someone else near me throw up, such an instance can quickly send my nerves into a tailspin. It is something I really have no control over, unfortunately. Sure, I have been prescribed some anti-anxiety medications, but fortunately I only take them when I am in the midst of an attack. Most times, I will only take two doses of my prescription pills a year, so you could say my angst is more in control than it could be. In fact, I only take my medication whenever I simply cannot talk myself down from the ledge, either by focusing on my breathing, or diverting my attention to something else so my brain does not obsessively focus on vomiting (which, ironically, causes some people to vomit… yay me!).

While I did not mention my emetophobia with Abrams during our phone call, she told me that I was not necessarily suffering from panic attacks, but undiagnosed PTSD. Which, actually, makes a lot of sense. The Mayo Clinic defines PTSD as having three main categories of symptoms: “re-experiencing symptoms,” “avoidance symptoms,” and “hyperarousal symptoms”. These categories can be simplified to describe symptoms of flashbacks and nightmares, feeling of guilt and depression, and insomnia, respectively.

I would definitely call a total of 12 emergency brain surgeries (and an almost equal proportion of near-death experiences due to surgical complications) traumatic events! And if it took a simple thing as vomiting to initiate those traumatic events, it is no wonder why I’m hooking myself up to an IV drip mixed with Clonazepam.

Okay, that is certainly a bit of an exaggeration, and indeed, anxiety and PTSD are no laughing matter. Especially since Abrams told me that attacks caused by PTSD are caused by “triggers,” and are not just random bouts of anxiety like panic attacks. In my case, I can see her point, because unless I am present with the sight or sound or threat of vomiting, it does not enter my frame of consciousness, and thus does not give me any anxiety. I must be presented with some sort of trigger, like suddenly feeling nauseous, in order for my feelings of anxiety to kick into action.

Hopefully, this discussion helped others who might be suffering from PTSD or panic attacks. For me, it was important to finally learn the difference between the two, since ultimately, I am not treating the underlying problem for my anxiety—PTSD. Instead, I am just nurturing a major symptom of the disorder with the help of psychiatric medication. Unfortunately, many veterans in recent years who suffer from PTSD have proven that psychiatric medication can only bring temporary relief. In fact, many veterans are accidentally overdosing and dying due to their incessant need for psychiatric medication and its waning effects overtime without an increase in dosage. Luckily for me, since I only take my Clonazepam on a need-basis, I have still only been prescribed the lowest dosage (.25mg), despite the fact that I have technically been using the medication for over eight years. My psychiatrist said that as long as I do not use the medicine every day, I will not build up a tolerance to it, and therefore will not need an increase in dosage just to feel its calming effects.

Unfortunately, this is not a reliable solution for veterans, since every day is “need-based,” and so they are more likely to build a tolerance to their medication in a short period of time. PTSD currently has no known cure, so it is important that veterans (and civilians like myself) continue to receive proper and carefully-monitored care. For civilians like myself, that can include talk-therapy (still have to get on that), and psychiatric medication. Or perhaps in my case, just to finally end this psychological charade, I should just vomit already and get on with my life.

But for the one in five veterans who suffer from PTSD, what are they supposed to do? Traditionally, they should follow the same treatment plan as me, with talk-therapy and possibly psychiatric medication, but veterans are strongly discouraged from seeking medical attention by ways of the VA. Reports released by CBS News in 2013 revealed that medical professionals associated with the VA prescribed 259% more narcotics than in 2002, and that individualized therapy had fallen by the wayside. A medical practitioner associated with the VA anonymously admitted to CBS News in a TV interview that “it is easier to write a prescription for narcotics and to just move along and get to the next patient” so that more veterans would be “treated”. This news outbreak, coupled with the 2014 VA scandal, hopefully cause ailing veterans to consult non-associated medical facilities to rehabilitate their physical and mental health.

It is my greatest hope to one day be rid of my own PTSD, but since hydrocephalus, too, has no actual cure, I do not know if I will ever see such a day. I currently have one of the “most successful” treatment options available for those who have hydrocephalus, which is something called a shunt. But those who work at the Hydrocephalus Association say that shunts have “the highest failure rate out of any surgically-implanted device,” with an estimated failure rate of over 50%. And while I have had tremendous success for the past sixteen years with my current shunt, I know that any day, I can be placed right back into the hospital, clinging to life once more. For this reason, it has become my mission to not only spread awareness of hydrocephalus, but also the devastating effects of PTSD as well. From my own personal experiences, it would be one of my life’s greatest reliefs to not walk around and see myself as a “ticking time bomb,” but to many of those who suffer from PTSD, I am sure they feel the exact same way. Hopefully, there will be a surefire cure for us all soon.