Sunday, March 23, 2014

The Writing of Mental Illness: Panic Disorder

Before assigning your character a mental illness, it is important to understand how that mental illness operates. You don’t need a Ph.D. to write a believable mentally ill character, but it does help to know the markers that physicians look for in a particular diagnosis to make your character more believable. I’ll add specific ones over time, but if there is a diagnosis in particular that you would like me to cover, please ask. I’d be happy to help.

For now, let’s tackle Panic Disorder:
It is included in the anxiety disorders grouping:

ANXIETY DISORDERS: Panic, Specific or Social Phobia, Obsessive-Compulsive, Posttraumatic Stress, Acute Stress, Generalized Anxiety
1.       Panic Disorder:

 If your character has panic disorder, they are afraid that they will have a panic attack. The worry over this lasts at least one month.

 Agoraphobia can develop in panic disordered people, which is the avoidance of places/situations in which the person feels they would not be able to escape and/or would suffer embarrassment should a panic attack happen in that location.

For example: I had a patient who would not shop in the grocery store because she was afraid of leaving her cart of groceries in case she had a panic attack. This possibility was extremely embarrassing for her.
Panic attacks usually last less than ten minutes and come on fast, sometimes for no apparent reason, and others after a situation or a trigger has occurred. The frequency and severity of an attack varies depending on the individual, so as a writer, you can take a lot of creative freedom here.
Your character should experience at least four of the symptoms below during a panic attack.
a.       Heart palpitations

b.      Sweating

c.       Shaking

d.      Shortness of breath

e.      Feeling of choking

f.        Chest pain

g.       Nausea

h.      Dizziness

i.         Feelings of detachment

j.        Fear of losing control or going crazy

k.       Numbness or tingling

l.         Chills or hot flushes
If your character is getting therapy for this illness, Cognitive-Behaviorial therapy is the most common method used and works by helping the patient examine their irrational thoughts and replaces them with more reasonable ones. For further research, you should look up psychologists Aaron Beck, MD, the father of Cognitive Therapy, and Albert Ellis, Ph.D., who created and developed Cognitive Behavioral Therapy (CBT) and Rational Emotive Behavior Therapy (REBT).
Medications that your character might be on for their panic disorder could include an anti-anxiety, which slows the heart rate and can be fatal if taken in excess. Benzodiazepine tranquilizers can be habit-forming so they need to be closely monitored. Xanax (Alprazolam) is a common one, but be careful in naming medications in your book as they change frequently. Xanax currently comes in white (.25 mg), pink (.5 mg), and blue (1 mg) tablets or a long white tablet (2mg). Common side effects can include drowsiness, weakness, confusion, headache, disorientation, dry mouth, and nausea, but may subside after the patient becomes used to the medication.
A panic attack could occur at any moment, even while driving. However, it has been my clinical experience that many patients have their panic attacks after a dangerous situation has occurred and they have entered a safe space.
For example: One patient of mine witnessed gunshots fired. She escaped, thankfully, but it wasn't until she arrived at a safe place that she sat down and had a panic attack.
I hope you find this information helpful in making your mentally ill characters pop off the page. Please check back for more as I will add them periodically.
Until we meet again, Happy Writing!
*DSM-V Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association)
*The Pill Book (Fifteenth Edition)




  1. Sweet!! If I ever have a character that needs a psych eval, I am definitely sending the manuscript your way!!

    1. I'm glad to help, Jaimie! Thanks for stopping by. :)

  2. Hi Tori,
    Great post! I've been writing a character with a lot of those issues and it's good to know I'm on target.
    Maggie Cary