Stress: A Case Study

Read the story of a women who thought she was having a heart attack, but was instead diagnosed with panic disorder, panic attacks.

A young woman sought psychological services after her cardiologist referred her for stress management and treatment of "heart attack" symptoms. This 36 year old woman had the world by the tail. Marketing director for a local high-tech firm, she was in line for promotion to vice president. She drove a new sports car, traveled extensively, and was socially active.

Although on the surface everything seemed fine, she felt that, "the wheels on my tricycle are about to fall off. I'm a mess." Over the past several months she had attacks of shortness of breath, heart palpitations, chest pains, dizziness, and tingling sensations in her fingers and toes. Filled with a sense of impending doom, she would become anxious to the point of panic. Every day she awoke with a dreaded feeling that an attack might strike without reason or warning.

On two occasions, she rushed to a nearby hospital emergency room fearing she was having a heart attack. The first episode followed an argument with her boyfriend about the future of their relationship. After studying her electrocardiogram, the emergency room doctor told her she was "just hyperventilating" and showed her how to breathe into a paper bag to handle the situation in the future. She felt foolish and went home embarrassed, angry and confused. She remained convinced that she had almost had a heart attack.

Her next severe attack occurred after a fight at work with her boss over a new marketing campaign. This time she insisted that she be hospitalized overnight for extensive diagnostic tests and that her internist be consulted. The results were the same--no heart attack. Her internist prescribed a tranquilizer to calm her down.

Convinced now that her own doctor was wrong, she sought the advice of a cardiologist, who conducted another battery of tests, again with no physical findings. The doctor concluded that stress was the primary cause of the panic attacks and "heart attack" symptoms. The doctor referred her to psychologist specializing in stress.

During her first visit, professionals administered stress tests and explained how stress could cause her physical symptoms. At her next visit, utilizing the tests results, they described to her the sources and nature of her health problems. The tests revealed that she was highly susceptible to stress, that she was enduring enormous stress from her family, her personal life, and her job, and that she was experiencing a number of stress-related symptoms in her emotional, sympathetic nervous, muscular and endocrine systems. She wasn't sleeping or eating well, didn't exercise, abused caffeine and alcohol, and lived on the edge financially.

The stress testing crystallized how susceptible she was to stress, what was causing her stress, and how stress was expressing itself in her "heart attack" and other symptoms. This newly found knowledge eliminated a lot of her confusion and separated her concerns into simpler, more manageable problems.

She realized that she was feeling tremendous pressure from her boyfriend, as well as her mother to settle down and get married; yet, she didn't feel ready. At the same time, work was overwhelming her as a new marketing campaign began. Any serious emotional incident--a quarrel with her boyfriend or her boss--sent her over the edge. Her body's response was hyperventilation, palpitations, chest pain, dizziness, anxiety, and a dreadful sense of doom. Stress, in short, was destroying her life.

Adapted from The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, Ph.D.

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