DEAR DR. NERDLOVE: I was hoping a fresh perspective from someone who isn’t my therapist could help me. I’m 28, have had one girlfriend in college, and have otherwise never talked to a single girl in my life (she approached me). Granted, I wasn’t particularly attracted to her physically or emotionally, but I wasn’t about to squander my chance to lose the V card, so we had our fling for about 6 months and then amicably/mutually split.
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Whether it’s making a dating profile, or approaching a woman with romantic intent, I have a full-fledged panic attack/meltdown. Trying to get me to date is like that scene in Rain Man at the airport when Tom Cruise tries to get Dustin Hoffman on the airplane; he protests, he’s unsure, he is anxious, and when Tom Cruise tries to force Hoffman onto the plane, he has a full-fledged meltdown at the gate. I have a similar response with expressing any modicum of romantic intent. I lose all sensibilities and will claw, kick, and punch to get me the F--K OUT OF THERE! I know nothing worse than a bruised ego will happen if I approach a woman, I know I won’t be cast out from society if I make a dating profile, I know that women desire men, and I’m not an unlovable monster nor a creep for making advancements. I have no logic to attach to these overwhelming feelings.
I am currently (and have been for about 3 years) medicated on an NDRI and an anti-psychotic for major depression/anxiety with NSSI tendencies that I’ve exhibited since I was a kid. My therapist and I have explored many angles to no avail such as exposure therapy to just outright taking the plunge and have all resulted in the same thing: a meltdown. I can talk to girls I am not attracted to and/or when there’s zero chance of any non-platonic engagement. But the expression of romantic intent on my end sends shockwaves of panic through me. I do want to find love and build an amazing life with a woman and stem the tides of loneliness, but I’ve yet to vault this lifelong wall of a hurdle. I’m hoping you’ve seen this before or you could provide some unique perspective.
From,
Man of Many Meltdowns
DEAR MAN OF MANY MELTDOWNS: There are a lot of times when people use hyperbolic language to describe the level of fear or anxiety they experience when dealing with an intimidating or scary experience. This can actually make things harder, because a lot of terms in casual use have actual medical meanings and definitions. As a relevant example, people will use the term “panic attack” to describe the mundane feeling of “this makes me very upset and anxious, makes me nauseous and gives me knots in my stomach”. The problem is… that’s not a panic attack. In medical terms, people who are experiencing panic attacks often mistake the symptoms – chest pains, numbness in the extremities, hyperventilating or an inability to breathe and an honest, intense sense that they are literally about to die – for heart attacks.
This is one of the reasons why it can be important to really think about your word choice and how you describe what you experience. There’s a world of difference between an anxiety attack and a full-bore panic attack and conflating the two makes it much harder to tell someone what to do about it.
So MOMM, I’m going to assume that when you say you have a full-blown panic attack, you mean you have a literal, physical fight-or-flight response that feels like you are going to die. Because otherwise… well, this is one of those times when exaggerating for effect or overstating what you’re actually experiencing can get in the way of actual help.
The first thing I would ask is whether you’ve talked to your prescribing physician about the medications you’re taking. You want to first make sure that there aren’t any side-effects that may be affecting you. A number of NDRIs, for example, can increase anxiety. It’s not common, but it can happen. I’d be more worried about whether it’s having an adverse interaction with your anti-psychotics.
The second thing I would suggest is that, after having double checked that your meds aren’t the cause, to think carefully about how these attacks come on. There is a significant difference if, for example, it’s something you feel ramping up or if it’s an abrupt, binary state. Is it that you can talk to someone but if there’s any romantic or sexual interest, you feel the panic come on? Or is it the equivalent of someone saying the words “Niagra Falls” and suddenly a switch in your brain flips. That might tell you a bit more about precisely where the issue is and how to deal with it.
If it’s more of a ramping up, then what you’re going to want to do to start is focus on the symptoms. One of the keys to managing anxiety and panic is to remember that the body rules the brain, not vice-versa. Our brains respond to the input our bodies give; when we feel the symptoms of a feeling, such as an elevated heart rate, a dry mouth and sweaty palms, we don’t immediately assume we’re afraid; we feel the physical sensations and then ascribe a reason to them based on what’s happening around us.
Part of why this can be important is because it means that controlling the symptoms means controlling the feeling. The racing heartbeat and rapid shallow breathing is your body flooding your blood with oxygen and adrenaline, getting you ready to fight or flee. But if you control your heartbeat, you change how you feel. Without that racing heartbeat, you aren’t going to be as afraid. You may feel a more intellectual anxiety – something more abstract – but you aren’t feeling like you’re in immediate danger of death or injury.
So if these attacks start by ramping up, even if they ramp up very quickly, then part of what you want to do is focus on your breathing. If you control your breath and force yourself to breathe in a measured, controlled way, you force your heart to slow down. Slowing your heartrate down decreases your level of fear and anxiety. Controlling your breathing like this also forces you to be present – you’re having to divert your bandwidth to being aware and mindful of your body. This helps pull your attention away from the hypotheticals that are causing you to have this sudden surge of fear.
You want to do four-count breathing; breathe in for the count of four, hold it for the count of four, then breathe out for a count of four. Keep doing this – in slowly, hold it, out slowly – until you feel the panic start to subside. It can take some time to get used to doing this with a measure of control; after all, when you’re in full freak-out mode, you’re not thinking rationally if you’re thinking at all. Practicing this technique, especially when you’re feeling the early stages of this panic, can help you turn that into muscle memory, something you do on autopilot, rather than something you have to remember to do.
The next thing I would do is talk to your doctor about the possibility of beta-blockers. These prevent adrenaline from coming in contact with the beta-receptors in your heart, keeping the adrenaline from making your heart pump faster and spread the adrenaline through your system. Beta-blockers are usually prescribed for managing heart disease, but they’ve long been used off-label for managing anxiety and keeping people calm in stressful or dangerous situations. This can help keep you from melting down just because you think someone’s cute and want to ask her for her number.
However, this is emphatically needs to be discussed with your physician first, because you want to make double and triple sure that this isn’t going to have any interactions with the meds you’re taking.
The last thing I would suggest is that you need to address the actual triggers. After all, controlling the symptoms is just that: controlling the symptoms, not the source. They’re a bandage, not a cure. The issue at the heart of this is why you freak out. Maybe it’s something residual from the woman you dated – the one you said you were only with because you wanted to lose your virginity. There may be lingering issues there; feelings of guilt because you feel like you were using her, feeling like you did something wrong by being with her when you didn’t like her, even the possibility of trauma from trying to force yourself to be attracted and to want to be with her.
Or there could be something else entirely. That’s for you and your therapist to dig into, not a loudmouth with an advice column.
Now there’s one thing that I think you may want to consider and that’s that you may need a different therapist or a different form of therapy. One of the things folks often don’t realize is that not every therapist is going to be able to help with their particular issues, nor is their form of treatment helpful or appropriate for the condition they’re dealing with.
Sometimes it’s a matter of needing a different therapist; therapy is, in some ways, a lot like dating, and you need someone you actually click with and work well with. But other times, it’s a matter of needing a different tool for the job. Some mental health issues respond to medicine, some to talk therapy and others to things like cognitive-behavioral therapy or other techniques.
Think of it like trying to accomplish a particular task. You could, for example, use a knife to cut a tree branch… but you’d accomplish it a lot faster and more efficiently with a saw. So it is with therapy. Some treatments can work, but not as well; others are functionally useless for the issue you’re dealing with.
You’ve mentioned that talk therapy and exposure therapy haven’t helped. It may well be that you need to try something a little further afield. If this is akin to something like PTSD, then maybe what you need is to look into treatment like EMDR. This form of therapy was created specifically to alleviate the fear and pain from traumatic memories and experiences; it’s been used to great effect with first-responders, combat veterans and other people who’ve dealt with the sorts of situations that f--k people up for life.
This isn’t necessarily for everyone, and you may well not be a good candidate for it. But talking about this with your therapist and looking into other therapy options may be helpful if what you’ve been doing thus far hasn’t worked.
Now I know a lot of folks have a hard time telling their therapist that what they’re doing isn’t working, much as people have a hard time telling their doctor that the treatment they’ve been prescribed isn’t helping. There’s an understandable feeling of “well, maybe I’m not doing the work/ not doing it hard enough/ not doing it for long enough”. But the only person who knows what’s going on in your head is you. If you know that things aren’t helping or are causing other issues, then you have to be your own first and best advocate for your own needs.
But first, start with talking to your prescribing physician to rule out drug interactions and work on controlling your breath. If you can manage to get things under control this way, then you’ll have a lot more available bandwidth to start digging into the root of the problem and addressing things from there.
Good luck.
Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com