Anxiety is a psychological state that can have different causes and origins. I’d like to discuss one potential cause of anxiety symptoms and panic attacks with an example from my personal experience.
For the most part, I haven’t been prone to anxiety during my life, but several years ago I had some full-blown panic attacks related to an investment that appeared to be going south. Along with several friends and family members, I’d acquired a real estate asset with short-term financing; in order to get permanent long-term financing, the asset would have to meet certain performance criteria. If it didn’t, we wouldn’t qualify for the new loan and we might lose our entire investment when the short-term loan came due. I was the member of our team primarily responsible for dealing with the bank.
As a clinical psychologist, I’ve led a fairly sheltered professional life; with little experience of the business world, this real estate investment took me far outside my comfort zone, introducing me to range of new and anxiety-producing experiences. The asset seemed to be performing well; it looked as if we were going to meet our performance criteria. Just as we were preparing to submit our new loan application with the deadline approaching, everything suddenly changed. One Friday afternoon as I was getting ready to go away for the weekend, a report came in showing we’d fallen far short of our goals.
As we were driving to our weekend destination, I felt almost unbearably agitated. (Fortunately, I was the passenger or we might not have gotten there alive!) These were my anxiety symtoms: My heart was beating faster than usual and my palms were sweaty; my chest felt tight and I found it hard to breathe. I felt jittery. My thoughts were racing as I spun out disaster scenarios — we’d lose our investment, I’d lose my home, I’d go bankrupt, etc. I couldn’t concentrate or keep up with normal conversation. Most of all, I had a feeling of impending doom.
That night, I kept drifting off to sleep only to awaken abruptly, drenched in sweat, my heart racing, body trembling, short of breath, in a state of pure panic with the sense that I was falling into a bottomless pit. These panic attacks continued throughout the night and I slept fitfully, for five to ten minutes at a time. Although I never articulated it this way to myself at the time, in retrospect, it’s clear I felt as if I were going to die.
(Long story made short: the anxiety continued for weeks but I never again had panic attacks. The asset recovered. We secured our long-term loan.)
The stress of this real estate investment process, so unfamiliar and outside the scope of my usual experience, beyond my capacity to cope with it, made me feel as if I were going to disintegrate. I mean that quite literally — fall into pieces and cease to exist. The anxiety symptoms developed because I felt a very real threat to my existence; in psychoanalytic terms, you might think of it as a form of signal anxiety about impending danger. As I became exhausted and sleepy, my rational, reality-based mind grew weaker and weaker; whenever I drifted off to sleep and relinquished conscious control, that feeling of disintegration intensified, leading to the panic attacks that woke me up.
I believe that the terror of disintegration lies behind many anxiety symptoms and panic attacks; depending on how cohesive our sense of self, the degree of psychological pressure needed to produce them will vary.
Finding Your Own Way:
Think about the most emotionally difficult and psychologically stressful experiences of your life. They’ll most likely involve some kind of profound and unexpected change or loss like the death of a loved one or a traumatic accident. For some of us, even moving to a new city or a job change can set off panic attacks. Did you have similar anxiety symptoms? Can you relate to my terror about disintegration?
One of my clients with a very fragile sense of self had panic attacks during a long and difficult childbirth, experienced as a literal threat to her life. If you’ve given birth to a child, did your experience in any way resemble hers?
For any of you who have suffered from PTSD, this post should resonate. Exposure to emotionally overwhelming experiences can make you feel terrified that you’ll disintegrate under the psychological pressure. The more fragile your sense of self, the less it will take to stir up these feelings and anxiety symptoms. For some people, the threat of any kind of intense emotion can set of panic attacks.
I’ll have more to say about the link between internal states of catastrophe and anxiety symptoms in another post.
I read this article w/ keen interest as a serial cyclical panic/anxiety attack sufferer. Your choice of words truly resonated with me as I’ve struggled to describe this sensation countless times to my spouse, family, friends, psychs, therapists, etc. Incidently, your choice of words/phraseology, e.g.: feeling like you are falling into pieces, disintegration, impending doom, & ultimately feeling like you are going to die, are some of the exact same words I’ve used when trying to explain what it’s like to experience a panic attack. Towards the end of your article you mention a correlation between PTSD and panic attacks. My question is can on-going severe panic attacks in and of themselves be a cause for PTSD? What about long term major depressive episodes?
I’ll have to think about those questions, Tracey. Right off the bat, I’d say that yes, recurring panic attacks could lead to PTSD with all its avoidance behaviors, trying not to do anything that would trigger another attack. I’m very sorry you’ve have serial attacks; from my own experience, I hope never to have one again. One of the worst experiences in my life.
I too had panic attacks that led to Agoraphobia that lasted many years. Your description of fear of disintegration is exactly how I felt and struggled to describe to therapists. When I finally received a diagnosis I was very relieved to know that it wasn’t just me. That this was an actual ‘condition’. This was the worst and best thing that happened to me. I found myself through a series of excellent therapists and a lot of walking through terror. I found out how strong I am.
suffering for the last three years, feels like as though i am crippled and plagued by whatever this is that people keep saying to me (anxiety attacks, depression). my question is if it was this than why doesnt it stop like it just came on, i have always been a person who was busy active on the go, just normal, yes with worries, the normal stuff, but 3 years ago i was out shopping when suddenly i felt so uncomfortable, i was pale yellow scared heart palpitations sweaty dry throat, cold shivering exhausted i thought i was going to die and i was scared. since then i have been crippled with these symptoms unable to do the normal things i used to enjoy and do, i have been fighting to carry on as normal as i can drag my body to, but each sec, min day has been unbearable, cannot even stand properly feel dizzy legs breaking so much pressure on the body sick,headaches with constant worrying crying, and the question of what is wrong with me why doesnt it go away why wont it stop make it stop make me norma please, i would walk on fire or drink a horrible medicine or take up a challenge if only i could get better, be normal like i used to be but i dont think i ever will be, i’m scared, i hate living like this i am a messs please someone help me please.
This sounds truly agonizing. The truth is that no one can help you in the way you’re asking; there is no “answer”. It sounds to me as if your defenses were (just barely) functioning normally until a few years ago, and then something happened — an internal or external stress — that pushed you over the edge. It could’ve been something small, barely noticeable, but suddenly you could no longer defend against these horrible anxieties. You will probably need to get professional help; in the meantime, it might be useful to learn some meditation techniques that focus on breathing.
Anxiety attacks started when I found out that I was married to a child molester and no one would listen to me. My first thought was heart attack. A visit to my doctor was a relief after he explained anxiety attacks and how to stay calm until it subsides. He told me to divert my attention when I feel an attack coming on; it took a lot of will power, but it worked. Thirty-two yrs later, for various reasons, I’m still getting anxiety attacks.
I never before heard the phrase “disintegration anxiety.” Very apt, and it stirs up a memory. Years ago, whenever I woke up in the morning, I felt as if I were a school of fish. Biologically, that’s not so far off the mark, since we’re a bunch of cells and systems in close communication. It didn’t scare me; I simply felt that part of my routine in the morning was to let myself re-cohere.
After some years of that, I found myself starting my mornings imagining myself as one large fish, sliding from sleep to wakefulness. These days, I just wake up. But I always wondered about that fish period; it was never unpleasant, but it was a sort of disintegration and obviously I couldn’t go around like that all day.
That’s really interesting. It’s curious that the experience stirred no anxiety … sounds scary to me. From my experience, fish imagery sometimes relates to pre-birth material, or fantasies of being back inside, in that water environment.
You may be interested to read from this book, which contains some of Kohut’s ideas about the self and disintegration anxiety. Very helpful. Get yourself to a decent analytic therapist if you experience these kinds of symptoms – they are the most commonly seen problems:
http://books.google.co.uk/books?id=D1oH6W1eD20C&pg=PA32&lpg=PA32&dq=disintegration+anxiety&source=bl&ots=5xp2JXFiQL&sig=VxPGs9b-6WYatDQnwOZ4SFI_et8&hl=en&ei=0JzfTvLfEY6JhQe17qGQBQ&sa=X&oi=book_result&ct=result&resnum=10&sqi=2&ved=0CF8Q6AEwCQ#v=onepage&q=disintegration%20anxiety&f=false
I read a lot of Kohut in my analytic training — he has many valuable things to say about the self, shame and narcissism, although I often find his language difficult to penetrate. I don’t think he’s useful for the lay reader. And I agree with your advice about what to do if you’re experiencing these symptoms.
Thank you for replying. Yes, for the lay reader perhaps to technical, I was just thinking a lot easier to understand than Kleinian splitting to preserve the good object and therefore resulting in emptyness and then the anxiety! I think there really is a need for “translating” these complex concepts into a format that non-clinicians can make use of.
I think there’s a need to translate all of these concepts into everyday language for both non-clinicians and clinicians alike. Many professionals attain a level of fluency with psychological jargon and can discuss the concepts with great ease and have little understanding about what it means in actual experience. The Kleinian “good object” vs. “bad object” is a good example.
Hello,
Thanks for this post. Yes, I’ve experienced disintegration anxiety. In fact, I’ve been dealing with it on a chronic basis with varying levels of intensity for almost 4 years now. It is, literally, a living hell.
For me, it feels very much like you and others have described: namely, the feeling that you are being inexorably sucked into a black hole of psychological torment and insanity of indescribable horror. But I have experience an additional feature and I’d love to hear if others do, too. I can only describe it as an all-consuming sense of despair and hopelessness. And what’s strange is that there doesn’t seem to be any content to these feelings, so it feels like the worst despair you can imaging, but you have NO idea why.
Kohut’s description is frightening because he feels that one much do whatever they can to fend off this experience. But really, what can one do? If you happen to have the strength of self and a foundational core of being that’s strong enough, it seems that you can recover and keep the horror at bay. Short of that, he seems to say that you’re out of luck.
I’ve been in psychodynamic psychotherapy for almost 4 years, and I regret to say that it’s resulted in much of an improvement. I’m not a incapacitated as much as I was 4 years ago, but I often wonder if it’s because I’ve almost gotten used to it. My therapist has a theory about the cause of my problems, but the problem is that, in comparison to the magnitude of these symptoms, nothing he says seems like it could remotely result in this level of pain.
Sorry for the rambling post, but it’s rare to find someone who’s had this experience.
Thanks again,
Moose
No need to apologize. My guess is that the despair and sense of hopelessness have to do with the extent of the internal damage, how pervasive it feels, and how impossible it seems to do anything that will help. In my own experience, and in that of my clients, I’d say the way out is through a long-term relationship with someone (your therapist) who can bear to go into the darkness with you. I have more to say about this issue in my later post on attachment theory and the healing psychotherapy relationship.
Thanks Joseph for this insightful post.
“The more fragile your sense of self, the less it will take to stir up these feelings and anxiety symptoms.” This line especially resonates with me. In the last week or so, realizing that I am not most probably not going to have my job soon and will have to look for a new one, has given me quite strong anxiety, especially when I wake up in the morning. It is a clear sense of my self being destroyed, falling apart, dissociating, because my self is not strong enough to handle the intense anxiety.
At the same time, more awareness of my basic psychological inclinations and potentials (which comes as a result of therapy), both in love and work, gives me some sense of a strong, stable self, although this feeling is not strong enough to keep me from feeling like I’m falling apart.
Interestingly, I get this impulse that before this happens, I should destroy myself. It is not an impulse that makes me act, and I’ve experienced it at other times over the years, and have brought it up with my therapist too. But I haven’t been able to understand the dynamics of this impulse to kill myself before I die because of my self falling apart.
I wonder if you have any thoughts on this?
I’m not sure I could shed any light on that dynamic without knowing more. Could it be a way of trying to kill off the damaged, fragmenting “you”, as if that were a viable solution, but not the whole “you” (as unrealistic as that sounds)? Could it be a way to gain control of the experience, so that you don’t feel helpless in the face of it?
Thanks. I partly relate to the first hypothesis you have although I find it difficult to imagine what would be left of me if I kill the damaged part of myself. Yesterday I came across Edvard Munch’s painting ‘Scream’ and realized how well it represents this fear of total disintegration. Hopefully the therapy sessions will help me understand and contain the anxiety more.
For anyone who experiences this type of crippling anxiety, or depression for that matter, with no discernible cause, please have your thyroid checked before you pursue any other type of treatment, especially if you are 40 or over. Hypothyroidism causes depression, and hyperthyroidism causes anxiety. Be sure to have a complete thyroid panel, and insist on getting a copy of the results. For whatever reason, many general practitioners do not have a good understanding of the thyroid. If the numbers come back normal, they will tell you it is fine. However, your thyroid functioning may be in the process of changing. Ask them to compare the numbers to your previous blood work. Endocrinologists are much more adept at reading and analyzing the information, and one visit might well result in the resolution of all of these problems. Several of us in our family have been diagnosed with either hypo- or hyperthyroidism, and are well and happy today because our levels were regulated. My brother’s friend was suicidal for months before they figured out in the psychiatric hospital that his thyroid was not functioning properly.
Dr. Burgo, please encourage your colleagues to make sure their patients are tested by an endocrinologist to rule out thyroid issues. That said, psychotherapy can do wonders for people with anxiety and depression. Thanks for a great post on an important topic!
It’s always good to rule out medical conditions before undertaking therapy for this kind of anxiety. Thanks for contributing your perspective. On the other hand, these days you have to be careful about consulting physicians because they’re so accustomed now to writing a prescription for any kind of psychological issue.
I agree. I’m a huge proponent of psychotherapy. If there is a psychological basis for the anxiety, you definitely want to take care of it in therapy. On the other hand, if the anxiety is related to a thyroid issue, no amount of psychotherapy is going to fix it. That’s why it may be worth a visit to an endocrinologist first, because they have such a better understanding about thyroid functioning.
I can’t believe that there is actually a name for the type of anxiety I’ve been experiencing lately. I am an adult survivor of child abuse which included physical beatings, watching animals being tortured and killed, sexual abuse by father, brother, family physician, uncles. The sexual abuse was both overt and covert. Emotional/psychological abuse as well in terms of threats, both parents ignoring me. No stimulation other than figuring out how to survive. My mother was jealous of me because of the attention my father showed me. My parents, although well educated professionals, were alcoholics and sadistic. I really don’t know how I survived my childhood. But I did. However, I’ve never experienced an intimate relationship and have only been attracted to abusers and users. I am 58 years old and am currently in my third or fourth round of therapy for these issues. I suffer from psychosomatic illnesses, obesity, had an addiction to cigarettes, and shoplifting, and used drugs recreationally. I’ve stopped smoking and stealing, but could never stop binging. Now, when I want to binge I just sit down, take some deep breaths and literally white knuckle through the feelings that arise. And the exact words I used to my therapist about the experience were that I felt as if I would disintegrate. Like when Captain Kirk in Star Trek would teleport himself or get “beamed down” and you would see there bodies disintegrate into just atoms spinning and floating. The thing that helps me is that because I mustered up the courage to actually sit through them, they now are happening much less and I know that I am probably getting down to some original pain that I must have experienced as an infant- preverbally, and this is also why I feel it happens- I am actually experiences what a helpless little infant must have felt being ignored by a maniac or worse perhaps hit?, sexually abused? But trying to stay with oneself through this experience is, in my opinion, of ut most importance because it starts to heal the infant within. It proves to that infant within that you will not abandon as you were before. I can’t imagine anything more absolutely terrifying than to be helpless and not have someone there. I think, for me, that is the disintegration.
Yes, for me, too. I think it takes a lot of courage to wade into those feelings, but as you say, it’s the only way genuine growth can occur.
I agree with all of you. I read it all carefully and your description of the feelings having an attack are exactly how I feel. I am convinced that every person has some kind of anxiety or mental disorder. I think that it is a shelter mechanism. But if it is too much of concerning and worrying, it is not normal anymore. Many anxieties, I believe, are not coming alone. My ones come with a social anxiety (not comfortable with people, groups, feeling watched, stared at….) from my mother, a low self-confidence which kind of developed into an inferiority complex which is not very helpful during having an anxiety attack . My mother was very controlling, strict, harsh and always more concerned about what the neighbor’s think. She was sneaking in my room when I was a teen, throw out my stuff, moving and throwing out belongings and being a control freak in every situation. Talking for me, talking over me or not letting me explain my situation when she thought I have been “not a good girl”. I was always helpless. I was always wrong. I was always not good enough. I was not allowed to get angry or to raise my voice when I felt misunderstood and treated wrong. Who is angry and yelling is usually wrong. And in anyway, you should behave like a lady, not raise your voice or be aggressive. In school I got bullied. I was already a shy grey mouse when I entered it. The boys did everything harmful with all what your imagination as to offer, right up to the house door. My mother did not believe me until that day she actually saw what was happening. Well, this is years ago now. Like many other people with that kind of history, and there are many, I run into work and kept my self busy. I wanted to prove her (I know that now from analyzing why I feel worthless having not a job) that I am a good girl. Long time ago I must have resigned and done everything she wanted me to do, just to get a bit of love and affection. In anyway, my work covered up the pain I had inside, since I was a small child. It suppressed it. I was not thinking about it. Then I met my husband around a year ago. He now triggers some of my anxiety attacks bringing up all these suppressed emotions and stupid behavior teachings of my mother. But he also helps me to fight them. He had the same problem, actually worse. I did not know that there was a name for it or even a condition. I forgot that I had this kind of attacks with my mother when I was young. But during the years of independence and work it did not came back once. I was just normally depressed, head dead and ignored my emotions. Drinking, smoking and surrounding my self with superficial people. Yesterday, I had an attack. It happened that I could not sleep. I went up and set at the computer for a while. As we are very freshly pregnant I watched some videos and gathered some information. Everything was fine with my hubby, he was sleeping when I got up. Then, switching off the computer left me blind. So with my earphones still in, I waited until my eyes adapted to the dark, went to the loo and outside for a minute, when he appeared behind me just after two seconds I was standing there. Still the same song was playing, so all of that was not longer than 3 minutes I guess. He was in rage and asked me where the hell I was and that he could not find me. It was 2.30 in the morning. I said (finally tired but rationally and confused) what happened and thought he was sleeping. I could not understand why he was angry. So he went more angry and said that he does not believe me. He thought I was sneaking around the house in the dark. Hiding. In the end. It was just bad timing! But he made such a big deal out of it. I could not handle it. I told him what happened, he did not believe me. The whole thing was stupid in my eyes and I felt helpless. I was angry that he ruined my night and upset me again. This made it impossible to empathize more with his feelings. And this feeling of being not able to explain my situation always makes me shake, cry and totally irrational. I read your blog about empathizing. And because he made me angry and attacked me, I put up my walls which made it impossible to empathize with him. In anyway. Giving me the fault for his feelings and rage, I then started doubting everything. Why me, what is happening, why is it happening, I have done nothing wrong. He is not respecting me, so he must not really love me. It is like a spiral. The thought, even totally irrational, is dragging me down. Sometimes I am so upset, that it is impossible to talk anymore. Not one word comes out! It is eating me from inside. I am just sitting there and try to figure out how to explain my self better, sobbing, feeling sorry for my self. And that is it. I am thinking of me. Should I think of him? Yes. So I tried again. I asked him about it. He reacted stubborn and aggressive again. I did not know what else to do. I had bad panic attacks with him because of this feeling that he is not interested in what I say, he does not love me, we are splitting, I lose him over a little misunderstanding. After a few days he is usually calming down and we can talk normally. But all this leaves a huge damage in me, which makes me more distanced, which makes him feeling worse…. But he says that this is coming from my low self-confidence. All is my fault. I do not think that this is true, because I was totally fine that day. The end of the story is, that he needed some more reinsurance because HE was the one who was suffering low self-confidence and anxiety. But instead of telling me that, he was angry, made me angry and then expected me to see through that. I did not, and again, that made him even angrier and giving me the blame. I think sometimes I cannot win, which makes me depressed. I see all strange bad things in my behavior and as I never was good enough for my mother now it seems, that I am not good enough for him anymore – which breaks my heart – literally. It is a pain. It is hell. My bones are heavy too, I am feeling dizzy and the strangest thoughts come. If you ever read about the male and female part of narcissm, you know what I am going through. It is a fight sometimes. But we are getting better. We know about each others disorders which is a huge advantage. It is great to see that other people have the same experiences and I would be interested in other people’s triggers. My one is helplessness. Just like your one I think. Some higher person or real estate agent is threatening your existence. You are helpless. It is overwhelming. It is good if you can sleep over it a night or two. But he does not give me that time. Even knowing that I am easily emotionally confused. He has ADHS and got a prescription for dexamphetamine. They are good. I take 1/2 one every day too, to make me able to express my feelings and emotions. It works well. I can think clear, not doubting myself, not thinking that I am too stupid for doing something or whatever. It is great. I simply feel normal. And that is all I want. But in the night the effect of them is gone. Receiving critics, attacks, mean arguments and sarcasm on my feelings when he is expecting me to empathize with him…… I am getting in this spiral of thoughts, anxiety and fear. It is irrational, not helpful at all, but in that moment all the body makes it not possible to stop it. I tried with controlling the mind, calm down, breathing. But then the next wave of pain in the body and tears. It is really – unbearable. I might get this thyroid gland checked in anyway, as I felt like this already when I was just able to walk (probably because of my mother punishing me for not acting as she wanted me to….) Thank you for your patience of reading all that and I apologize for any writing mistakes, as English is not my first language. Please, if anybody has any experience with dextroamphetamines I appreciate any comment or other help how to not get anxious and scared like a little mouse, anytime some unexpected and unknowing confrontation comes up. I wish all of you just the best and can just recommend that you dig in your childhood.
Given the level of distress you feel, I wonder whether you have considered psychotherapy. It sounds as if both you and your husband might benefit from it.
It also sounds to me like your husband was terrified when he couldn’t find you; on some level, he probably felt abandoned by you. Instead of feeling small, helpless and frightened, he took refuge in the very “big” feelings of anger and blame — in other words, those reactions were defensive.
I am curious then about what you say here. What do you do when you actually DO disintegrate? In therapy. You go into therapy for anxiety. High levels of anxiety. And in the process of therapy you actually split into several parts of yourself. Before therapy you have no notion of ever dissociating. And then in therapy you are told that is what you do. And you do. Dissociate. All the time in sessions. You come to recognize it. The first time it is worse than anything you have ever experienced. With a little time you come to recognize it, the nausea, the dizziness, and you learn to get up and walk around, go to the window to breathe. The therapist gives you children’s toys to calm you. You stare at them, not understanding. You are not told what is happening but you assume you looked like you needed a doll?… It is upsetting because you never dissociated before therapy. Or at least you never noticed it. And does this help the anxiety? No, not quite. It makes it worse. Because it is terrifying to lose control in that way. In fact, the fear of disintegrating was real. It actually happened. And it was forseeable. Before it happenend you spoke of feeling yourself separating into the layers of yourself. And found this frightening. Then you spoke of breaking into a million pieces of yourself, each with jagged cutting edges, too sharp to pick up. You didn’t know why you were feeling like this. And then it happened. The multiple self. Something you NEVER thought was there. Voices, though not real voices, but extreme inner arguments. The whole lot. And yet you went into therapy for anxiety?! No big deal really. Well yes a big deal because it is horrible. But the shattered self is terrifying. Dissociation is terrifying. When you first started doing it you realized that you had actually discovered what lies BEYOND fear. There are no words for this experience. And all of it seemingly provoked by therapy? Just talking? Could you tell me if this is a normal experience in therapy? Because we speak often of the dangerous side effects of medication. And I have taken none, ever, my fear of medication being stronger than my fear of anything else. Though I have obviously been offered the full panoply of drugs. All of it. But no one ever speaks of the side effects of therapy. Is what happened supposed to happen? Or is it a iatrogenic effect of therapy. Something that shouldn’t have happened and got out of control? And what do you do to then get better? If you have any insight into this it would be greatly appreciated. Thank you.
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I just found this article after Googling “I feel like I’m disintegrating.” I am relieved to see that others have felt this but it doesn’t take away my PTSD, homelessness (but for the kindness of a family member – temporarily) and enormous grieving. My story is very long and complicated and I’d like to write about it more but I’m too tired. I’m writing this because I feel helpless and defeated. I’ve been in therapy for over 4 years and I’m still “frozen.” That’s it. Just putting this out there as I don’t have the energy to do anything else.
Really enjoying your blog! Very helpful in challenging my own coping/defence mechanisms I just wanted to point out that in the case of the panic attacks in childbirth, a long and difficult labour *is* literally a threat to the woman’s life. So I actually don’t think someone would have to be very fragile to experience fear. Though you’re right that panic attacks in labour are not comin AFAIK
Hi- I know this post is 5 years old but I stumbled on it and wanted to comment!
Please check out everything written by Claire Weekes. Also her audio- all online, free. She was a GENIUS. Also, Paul David’s book : At Last A Life. Also, google : “Nothing Works Anxiety “ for a brilliant essay about all of this written by an anonymous author.
Loosen
Float
Accept
You won’t believe how much better you can start to feel!