High Anxiety: AIDS Anxiety in the Worried-Wells and Worried-Sicks, Part Two

Read Part One of this blog entry, posted on Sept. 3, 2010.

Panic Attack: AIDS Anxiety in HIVers -- "The Worried-Sicks"

Recently I received the following post from "Apollo." It graphically demonstrates an AIDS-related panic attack as well as the anxiety that can be brought on by an HIV/AIDS diagnosis and disclosure worries.

HELP ... I don't know what's happening to me
Aug 20, 2010

Whether genetically, biologically or environmentally predisposed to anxiety, individuals facing physical challenges, such as chronic illness like HIV/AIDS or cancer, experience excessive worry and fear at a higher rate than the general population. The challenges associated with a virus that wants nothing more than to plant you six feet under, that has an unpredictable clinical course, and that is incurable can overwhelm even the most stable emotional constitution.

Studies have found that up to 70% of the virally enhanced community report persistent anxiety symptoms and that 40% meet the criteria for an anxiety disorder. When one considers the tsunami of thoughts, feelings and decisions a newly diagnosed HIVer faces, it is easy to see why anxiety is so prevalent.

Even those who have been HIV positive for a considerable period of time still need to cope with feeling discouraged by poor laboratory results; deciding to begin or change a drug regimen; worries about disease progression and drug resistance; changes in body shape, appearance and libido; fear of infecting others -- some worry even their touch has become toxic; fears surrounding stigmatization and discrimination; health insurance; career plans; job security; finding a Mr. or Ms. Right; fearing that "happily every after" is no longer even an option. The list goes on and on.

"Apollo" experienced a classic panic attack. Medically speaking here's what happened to him. His anxiety about being discovered activated his body's sympathetic nervous system. The sympathetic nervous system controls the "fight or flight" response I mentioned in Part One of this blog entry.

Anxiety is deactivated by the parasympathetic nervous system. It, by contrast, is responsible for the "rest, relax and digest" response. These are reciprocal systems that respond chemically to outside influences. The autonomic nervous system (comprised of both the sympathetic and parasympathetic systems) stimulates behavioral reactions via the neurochemicals these systems produce. It is a finely balanced feedback loop.

This feedback loop explains the mechanism by which normal fear can escalate into a full-blown panic attack. Once activated, the anxiety response (sympathetic system) can become self-reinforcing as more and more neurochemicals are produced by the anxious person's nervous system. Once the danger has passed, the nervous system should trigger the parasympathetic system to send out chemicals to, in essence, neutralize the anxiety hormones to reset the whole system. However, in the case of panic attacks the system gets stuck. The parasympathetic system never kicks in and the body continues to experience the fight or flight effects of continued sympathetic activity, leading eventually to extreme panic.

Coping With and Conquering Anxiety

Both medical and non-medical interventions are widely used to treat anxiety disorders. Psychotropic medications, psychotherapy/counseling, changing behaviors to reduce stress, developing new coping strategies and a variety of other non-traditional modalities, such as yoga, are often used to manage anxiety. The most effective treatment is an individualized regimen.

Psychotherapists use a variety of techniques to help anxious folks confront and conquer (or at least better cope with) the psychological and emotional underpinnings of their anxiety. Cognitive behavioral therapy is the most commonly employed psychotherapeutic intervention. Psychotropic medications, including antidepressants and anxiolytic agents, can often be used on a temporary basis to help someone through a crisis and provide time to identify and correct distorted perspectives and learn healthier responses to life's stressful situations.

Fear of becoming HIV infected or anxieties about health seen in those already infected are completely normal. However, debilitating anxiety disorders are not. AIDS phobia in the worried-wells can ruin health, happiness, career, relationships and life.

HIVers, due to the emotional and physical stress of coping with and managing their chronic illness, are highly susceptible to anxiety disorders. Anxiety has been linked to poor adherence to HIV medications, which can lead to disease progression, which, in turn, can produce additional anxiety.

Anxiety disorders remain underdiagnosed and undertreated in both the worried-well and worried-sick communities. When recognized and addressed, anxiety in most folks can be managed with a combination of focused relaxation, physical exertion and psychotherapy with or without psychotropic medications.

Want to get in touch with Dr. Bob? You can reach him through his "Ask the Experts" forum, by sending a message to the Robert James Frascino AIDS Foundation, or by leaving a comment for him below. (If it's a private message, or if it includes personal info such as your e-mail address or phone number, we won't post the comment, but we will send it along to him.)