How Fear of Disintegration Gives Rise to Anxiety Symptoms and Panic Attacks

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.

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Unbearable Emotions and Feelings

The term “eating disorders,” like so many diagnostic labels, describes a spectrum of experiences and dynamics; while two people might both overeat and purge, the psychological reasons why they do so can be very different.  I’d like to discuss one of my clients who suffered from bulimia, along with the emotional factors involved, because her story sheds light on a much larger issue:  how we may cope with unbearable emotions and feelings by trying to get rid of them.

When I began working with this client (I’ll call her Sharon), I had little experience with eating disorders. I understood that there might be a connection between childhood sexual abuse and bulimia; I was aware that low self-esteem and perfectionism likely played a role.  The first time we met, Sharon told me she’d been sexually molested by her step-father during her early teens; while she didn’t strike me as having particularly low self-esteem, she did seem quite perfectionistic and self-critical. In our early sessions, however, what struck me most was how little she could tolerate her emotions and feelings.

A pattern began to emerge:  whenever an experience threatened to stir up emotion (it could be an intensely pleasurable feeling just as well as an anxious or painful one) the powerful urge to overeat would arise. Eventually she would give in, binge eat and force herself to vomit afterward; an enormous sense of relief always followed.  We came to understand that what she wanted was to feel empty, void of emotion.  Her bulemia, in a very literal sense, was a process of emotional evacuation.  By throwing up, Sharon felt she’d gotten rid of the unbearable emotions and feelings along with the food she’d eaten.

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Mixed Emotions: Loving and Hating the Same Person

Each of us has a  mixture of feelings toward those people we’re intimate with, and learning how to tolerate ambivalence is a part of growing up.  Small children sometimes scream “I hate you!” when frustrated by their parents though they may be loving and affectionate an hour later.  Such hostility can be so powerful that for the moment, it obliterates awareness of every other feeling.  Very small children believe that what they are feeling right now is the only reality and they can’t remember they had other, loving feelings not long before.   “I wish you were dead!” they may cry, and in the moment, they may actually believe that’s what they want.  The adults around them hopefully understand that this hostility is a transient state, not the absolute and unchanging truth, and that young children usually can’t help themselves.

As we mature, our experience ideally  teaches us the same thing — that however angry and hostile we may feel right now, we won’t always feel that way, and it might be better for us to keep “I hate you!” to ourselves until the feelings passes.   In my psychotherapy practice, I’ve often been struck by how unable many of my patients are to do just that.  Saying “Fuck you!” in the heat of an argument seems to be very common.   One of my favorite quotes (from the old Laurence Olivier/Greer Garson film of Pride and Prejudice) is:  “Honesty is a highly over-rated virtue.”  I hold to this in general  in social relations, and in particular, I feel that hurling abuse and saying cruel words during an argument, even if you honestly feel that way at the moment, is destructive to long-term emotional trust .  Some truths are better left unspoken.

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About Neediness

I’ve never dealt with a client in psychotherapy who didn’t have trouble tolerating neediness in one way or another. In graduate school, the readings on this subject were fairly dry and theoretical, with talk about “feeding relationships,” or “good breasts” and “bad breasts” and how early frustration leads to particular defensive structures; but the bottom line is that the way we navigate that early experience of need often forms the basis for some en