Psych Central

Panic Disorder or Psychosis?

By Kristina Randle, Ph.D., LCSW

I am worried about developing psychosis or something similar. Hello! I am a 34 year old female who has been diagnosed with and dealing with panic disorder with some agoraphobia for just over a year now. I have managed this disorder by doing kundalini yoga, and also by learning to talk myself through a panic attack before the symptoms get worse. I was doing quite well, until last month. I am writing about this panic attack because I am so afraid of developing a psychotic illness. I am afraid that I might have a psychotic break during a panic attack.

I was sitting in class, when I started to develop a particularly strong panic attack that included the typical symptoms of lightheadedness, feeling faint, weak legs, depersonalization, pounding heart, etc. This panic attack was particularly strong for two reasons. One of them was that my sense of hearing became particularly heightened during the attack. Everything felt much too loud, and it made it even harder to concentrate.

Since that attack, I feel like my mind and body have not fully recovered. I have become particularly scared. I remember laying in bed the night after the attack with the feeling that I didn’t feel safe anywhere because I was really nervous. It made me feel discouraged.

I also feel very achy since that attack, and had a burning sensation around the chest area, and a feeling like I wanted to cry a lot, but the tears were not coming. I have been checked by a cardiologist to find out my physical heart is just fine. My sense of hearing still feels heightened, and sometimes life is too loud.
My depersonalization feels worse than it did before. I sometimes feel so out of my body. I have a fear of waking up one morning, and not knowing who I am anymore, or not recognizing the people and circumstances of my life. Due to my depersonalization, I went through a brief period after this panic attack where I ruminated over existential questions like what it means to be a human, and about existence, as well as the universe. The worst part of this was the rumination and fixation. It became very heavy because these are questions that none of us may ever know. I have been able to find some peace with this.

I have some other thoughts that scare me, and I am not sure if they should be taken more seriously. Several months ago, I was taking to my Mother. It needs to be noted that my Mother is a critical person of me in general. I had this thought enter my head: what if she would do me harm. I felt it was irrational, but having the thought was upsetting. It is even more upsetting that I know this is paranoia. I am wondering if this could become schizophrenia. Since the more recent panic attack, when my nerves feel frazzled, I feel afraid of people that I never felt afraid of before. It isn’t so much that they would do me harm, but my nerves feel so on edge that being around them makes me feel too overwhelmed. I feel a lot more drained by people, and don’t have the energy to deal with them. This fear of people makes me worry a lot about developing schizophrenia.

Finally, I get a thought that I also feel is irrational, but it developed along side of my existential questions. I sometimes wonder if everyone is in on something. I feel this is irrational, and I wouldn’t be able to tell you what they are in on, but again this thought feels upsetting.

Based on what I have written here, I am wondering if all of this falls under the heading of panic disorder still, or could I be developing something more serious? I feel so afraid that I will lose contact with reality. I am afraid of losing control all the time, and that I will say things to people that I have no control over. I may start taking medication, but I worry that the side effects could make things worse. I am going back and forth on that. Thank you for your time.

A. It is not uncommon for individuals with panic disorder to fear that they may be “going crazy” or losing control. These are common fears. You mentioned at the end of your letter that you are afraid of losing control and losing contact with reality. These fears are consistent with the symptoms of panic disorder.

You discussed the specific possibility of developing psychosis or schizophrenia based on two specific irrational thoughts: what if your mother would harm you and wondering whether others are “on something.”

You describe being upset about your thoughts. I am not certain if this is because the presence of new irrational thoughts is fueling your fear of a developing psychosis or schizophrenia, or if you are concerned because you believe them to be true.

What is the subtle but key distinction? Whether you can determine the difference between reality and non-reality. My question to you would be: Do you believe that your irrational thoughts are true?

If you believe that your mother might actually harm you and there is no basis for this belief (i.e. she never threatened to harm you, she’s never harmed anyone, there’s no reason to believe that she may harm you, and so forth), this would be considered a paranoid ideation or a delusion.

If you believed that people around you were “on something” and because of this belief you no longer associated with them, despite evidence to the contrary, then I would be concerned about the possible development of a psychosis-based disorder.

Having irrational thoughts does not necessarily indicate psychosis or schizophrenia. The real concern is if you believe that your thoughts are true despite there being no proof, no evidence to support your beliefs or in the face of evidence to the contrary. By definition, a delusion is an erroneous belief held even when there is evidence to the contrary. Delusions and paranoia are characteristics of psychotic-based disorders.

You are correct to be concerned about these symptoms. Unfortunately, I cannot definitively answer your question unless I am able to interview you in person. I believe you should be evaluated by a mental health professional. He or she can determine if your symptoms are related to panic disorder or they are indicative of a possible psychotic disorder.

It is also important to note that you wrote a very logical and well-prepared letter. This shows that you are thinking clearly. Thought disorganization is a sign of schizophrenia and other psychotic-based disorders. There’s no evidence in this letter of that particular symptom. Also encouraging is the fact that you are very self-aware of your symptoms. Self-awareness is often an essential ingredient in the successful treatment of mental health disorders.

One final thought, you mentioned that you have utilized a specific form of yoga to help decrease your panic symptoms. It is very good that you are utilizing yoga to decrease your symptoms. I would encourage you to continue yoga classes but I would also recommend medication and psychotherapy. Medication and counseling, in addition to yoga, could be a very efficient way to cure the symptoms that are degrading your life.

If you choose to explore medication as a form of treatment, it is recommended that you see a psychiatrist. Primary care physicians can and do prescribe their patients psychotropic medications. Many are very good and highly qualified but a psychiatrist has years of additional training in the field of mental health treatments and disorders.

Psychology Today has a listing of mental health professionals. By typing in your ZIP code, you may be able to find one in your community.

Without treatment, your symptoms may become worse. With treatment, the quality of your life can be significantly improved. Do not let fear and anxiety continue to degrade your life. I hope that you will consider professional mental health treatment. It can benefit you but only if you are willing to try. Thank you for your question.

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Last reviewed: By John M. Grohol, Psy.D. on 4 May 2010

APA Reference
Randle, K. (2010). Panic Disorder or Psychosis?. Psych Central. Retrieved on April 19, 2014, from http://psychcentral.com/ask-the-therapist/2010/05/04/panic-disorder-or-psychosis/

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