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Hard-to-treat men with panic disorders.

Because the symptoms include chest pain, pounding heart and shortness of breath and because men are traditionally considered to be more prone to heart attack than women, panic attacks in men often go undiagnosed because the symptoms mimic a heart attack.

This is possibly the most prevalent of the many reasons for the apparent inequality in diagnosis of a panic attack in men compared to women. There are other reasons, however – to the extent that there appears to be almost a sex bias. On the surface women suffer from panic disorder and other anxiety disorders in significantly higher numbers than men, but this may be because they seek help more readily. Whatever the reason, such disorders are, consequently, more often associated with women. Female behaviour in recognizing fear and asking for help has always been characterized as weakness while traditional male behaviour in hiding or dealing with emotional problems alone is perceived to be strong and manly. Somehow even the heart attack scenario may be seen as more manly than admitting to a panic attack – something traditionally associated with women and nerves...

It’s not only the victims of panic attack themselves, however, whose perceptions are ruled by such fallacy. Diagnoses in men are highly influenced by the more usual “male” illnesses and, while doctors may recognize psychological disorders in women, preliminary diagnoses of the identical symptoms in men usually point to physical ailments..., the most obvious being the suspected heart attack. Other conditions – of which symptoms of panic attacks are commonly suspected of being – are mitral valve collapse, excessive production of thyroid hormone, cardiac arrhythmias and epilepsy.

The result of a man’s first panic attack, then, is likely to be painful tests in the hospital, the medical possibilities being ruled out and subsequent panic attacks which may or may not eventually be diagnosed as panic disorder.

Another common reason for men with anxiety disorders – whether panic disorder, generalized anxiety disorder, social phobia or agoraphobia – not being diagnosed and treated is due to the likelihood of self-treatment of the problem with alcohol. Clinical studies of both alcoholic and non-alcoholic male and female agoraphobics show that twice as many of the men as the women are alcoholics.

The American Journal of Psychiatry recently reporteda five year comparison study of the differences in the course of panic disorder in men and women. All selected patients had panic symptoms of comparable levels of severity. Women proved to be somewhat more likely to have panic disorder with agoraphobia, while men showed about the same degree of likelihood to have panic disorder without agoraphobia. Rates of remission and recurrences were analysed and compared in the male and female patients over the five year period. Both sexes achieved the same rates of remission for both panic disorder and panic disorder with agoraphobia. Recurring symptoms were ten per cent higher in women than in men. In summary, men with panic disorder were found to be less likely than women to have agoraphobia and less likely to have a recurrence of symptoms after remission.

Men often resist recognizing the fact that they are experiencing an anxiety disorder simply because they are conditioned to associating “emotional” illness with women. Many refuse to come to terms with it and stumble on to lives controlled by agoraphobia and further complicated by alcohol and drug abuse. It is not until the patient accepts that – yes, he does have an anxiety disorder – and understands that it is treatable, that he can discuss the treatment options with his doctor and make decisions on how to get on with his life. Learning about anxiety disorders and accepting that they can happen to anybody is preferable to attempting to hide or to ignore the problem and allow it to jeopardize – and eventually – to ruin career, marriage and relationships with children, parents and friends.

Copyright Jean Jardine Miller.

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