Panic Disorder:
Physical (Somatic) Symptom-Shifting

A perplexing problem faced by most people with panic disorder is that the physical symptoms of panic tend to shift, or change, over time. Every person's constellation of symptoms is slightly different, although many of the symptoms are the same. The confusing element is that, over time, and even during therapy, a person's physical symptoms may change.

This is many times frightening to the person who doesn't understand what is happening to them. For example, as a part of panic disorder, a person may be plagued by feelings of nausea for a long period of time, enter into therapy, and as the panic attacks are gradually cut off, the nausea disappears -- only to be replaced by a headache that the person is afraid is a brain tumor.

What is really happening here is actually positive. Once the person fully and completely realizes the nausea is simply a symptom that the mind associates with fear and panic, the symptom disappears. In its place another symptom appears -- whatever feels different or out of the ordinary. Then, the process begins again: The catastrophic misinterpretation -- blowing a physical symptom way out of proportion -- and then paying attention to it. And, as we know, the more attention you pay to these symptoms, the bigger they grow and the worse they get.

The person who understands that this will happen is two steps ahead of the game. Panic is very tricky -- it will continue to plague you as long as you let it. In therapy, we learn quickly to expect this symptom shifting and then to realize that this is a positive event -- a major symptom has gone away, and a new symptom has appeared. This new symptom is then identified for what it is, and we learn not to pay attention to it. Any of these "new" symptoms are, as a result, not as dramatic and intense. The shorter period of time it takes before you realize that a symptom has shifted and that panic is playing a trick on you, the quicker and easier the symptom will be to deal with and eradicate.

Once the panic attacks are eliminated, and the symptom-shifting starts, a person is well on the way to recovery. Symptom-shifting is a positive element that, when viewed properly, indicates that you are on the road to recovery.

-- Thomas A. Richards, Ph.D., Psychologist

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