A Case Study: Complex Emotions and Panic Attacks

Please note that all clinical vignettes have been de-identified of any personal health information. In some cases, clinical scenarios have been made up from multiple patient experiences.

Meet Becca

Becca is a 32-year-old woman who came to me after she started to have unrelenting feelings of anxiety while she was planning her wedding. She described herself as someone who generally doesn’t have much anxiety but for the past year has been struggling with overthinking and feelings of sadness that have overshadowed her engagement and recent marriage. When we reviewed the past year, she had told me that she was largely consumed by wedding planning and had a supportive fiancé who she felt distant from due to her ongoing emotions, which felt “out of her control.” 

I asked her when she began to feel this way and she stated it was around the time of the wedding planning, mentioning one particular event that bothered her but about which she felt she couldn’t “do anything.” She had a best friend named April who got engaged around the same time. Despite informing April of her chosen wedding date, when she asked April to be her bridesmaid, she couldn’t get a straightforward answer. A few weeks later, she found out April’s wedding date was the same month as hers and that she may not be present at all. According to Becca, her friend spoke to her like it was no big deal and told her “I’ll have to see about costs and not sure if I can swing it.” Becca was hurt but didn’t know how to address this with her friend and never did. She figured given her friend had already decided it was not a big deal, she must not be that great of a friend. 

After this played out, Becca found herself becoming more irritable, disconnected from her fiancé, and feeling disheartened. Not sure what more she could do, she continued to push through. She chalked up her feelings to stress about the wedding, and despite feeling terrible in the days leading up to it, she had a beautiful wedding day. A few days later, she had another panic attack and her symptoms did not improve. After encouragement from her fiance and mother, she came to see me, stating “I have felt unlike myself for the better part of a year.”

Becca’s Struggle

Many of the emotions we feel are tied to past and present experiences, making understanding emotions a complex task. Processing difficult emotions is essential for maintaining good mental health because unprocessed emotions can accumulate and negatively affect many areas of your life. Someone once told me, “Just like food, emotions – your psyche – needs to be digested. You have to chew on them, absorb the nutrients and excrete the waste. If you don’t you risk being emotionally constipated.” However, it’s not easy for everyone to do this alone. Ofen, the discomfort from unprocessed emotions can be alleviated by working with a mental health professional.

Let’s take the situation with Becca and look at two different scenarios, one where she decided to not seek professional health help.

Scenario #1

Becca actively chooses not to discuss the situation with April or her feelings about it. Her past is full of disappointments — her biological father who did not want to get to know her, a friend group from graduate school that ceased communication after graduation, and ex-partners who betrayed her. These experiences deeply hurt her and she never got closure. Why should this situation be any different? When her mom inquired about April’s name on the guest list, Becca hesitated, but ultimately remained silent, fearing her hurt was misplaced and that she should be happy for her friend. Her suppressed emotions continue to manifest as anger and annoyance towards others. Avoiding the issue, she began to feel depressed, and isolated, experiencing frequent full-blown panic attacks. Her sleep was disrupted by nightmares and she was plagued by racing thoughts about the wedding. She found temporary relief only through her mother’s Ativan. The cycle of discomfort persisted and bled into her work, marriage, and relationships.

Scenario #2

Becca, recognizing she doesn’t feel like herself, decides to seek professional help during wedding planning. In our meetings, we discuss her upbringing and her reasons for seeking psychiatric help. She realizes she is deeply saddened and heartbroken that April won’t be present on her special day. We link her current feelings to the all-to-familiar pain Becca experienced with her biological father who was largely absent and drunk during her childhood, leaving her mom to parent her alone and denying her existence, now living with a new family. She gains emotional insight into her emotional experiences, particularly emotional memories, which involve recalling feelings from similar past situations without remembering the specific events. This sheds light on why she feels so strongly about April not showing up – she’s actually recalling feelings of abandonment from childhood. Through recognizing and understanding her own emotions, Becca learns about the importance of safe relationships and her right to self-expression. She is able to see why her relationship with her fiancé is so healthy and that those feelings of security she deserves to have with friends as well. We focus on her addressing the situation with April, dissecting and discussing her fears and concerns about the conversation. Concurrently, we tackle her panic attacks, developing a more effective strategy than relying on her mother’s Ativan. She becomes educated about the risks of certain medications, including their potential for abuse and exacerbating anxiety, and learns to manage her anxiety with safer medications I prescribe, along with healthy coping mechanisms. After a few months of working together, she begins to sleep better and feel less irritable. Her panic attacks cease and she starts to feel more like herself and begins to look forward to her wedding.

Key Takeaways

• Emotions aren't just reactions; they're powerful signals about our needs, boundaries, and values.

• By exploring these signals together in a safe and supportive environment with a mental health profession, you can uncover deeper insights into who you are and how you interact with the world around you.

• Understanding your emotions is the first step towards lasting change and emotional resilience.

• I help people like Becca all the time. If this scenario resonates with you in any way and you or someone you know is struggling, it would be my pleasure to work with you.