If you answered yes to any of these questions, you may have been diagnosed with an anxiety disorder, the number one mental health problem in the United States. At some point in their lifetime, one fourth of the population or some 65 million people will become incapacitated by panic, anxiety or abnormal fears. Some 13 percent of the general population has reported at least one phobic reaction, the most common anxiety disorder, while 10 percent will experience panic attack symptoms during their lifetime. Two and a half million Americans develop obsessive/compulsive disorder, a complicated form of anxiety disorder. 

Yet, you may not have any mental illness. Anxiety symptoms are not specific to anxiety disorders. Any anxiety symptom can indicate a biological problem: illness; a neurological insult to the brain; sensory processing problems; misaligned skull; something in the food you’ve eaten, the water you drank or the air you breathed. Biological problems from sugar imbalance to heart problems to vitamin deficiencies can produce symptoms identical to a panic attack. Head injuries, brain tumors, strep throat or encephalitis can create obsessive-compulsive disorder. Sensory defensiveness -- hypersensitivity to ordinary sensation like a tap on the shoulder -- can create symptoms that mimic psychiatric conditions from generalized anxiety to obsessive-compulsive disorder to depersonalization. Environmental pollutants and allergens can produce panic like symptoms. 

Consider some common “mimickers” of anxiety symptoms:

· Hypoglycemia can create irritability, a fast heart beat, fatigue, lightheadedness, shakiness and panic attack

· Hyperthyroidism can cause a pounding heart, sweats, tremors and panic attack

· Hyperventilation can create muscle tension, lightheadedness, a rapid heartbeat and panic attack

· Mitral valve prolapse, a minor heart condition in which the left valve doesn't close completely, can create chest pain, palpitations, fatigue, difficulty breathing, and anxiety. One out of every three panic attack victims has mitral valve prolapse.

Yet, if you’re like most, your physician or psychiatrist will assume your anxiety to be psychogenic in origin -- a result of stress, sensitivity, low self-esteem, a learned fear, poor coping, dependency, or negative thinking. In fact, a recent survey found that primary care physicians believe that some form of anxiety prompts at least one-third of all office visits. Rarely investigating further, most physicians and psychiatrists will dish out Xanax or Zoloft. Over 50 million prescriptions for anti-anxiety medications alone are written each year. Yet, in many cases psychotropic medication is entirely unnecessary. Take inner-ear dysfunction. Dr. Harold Levinson, clinical associate professor of psychiatry at New York University Medical Center has found in his practice that 90% of phobia and panic patients actually suffer from inner-ear balance system dysfunction. Medical treatment alone eliminates the phobia and panic symptoms. Hypoglycemia, a common anxiety mimicker, can be regulated through proper diet and quickly alleviate symptoms such as accelerated heart rate, sweaty palms, and nocturnal panic attacks that you may have experienced helplessly for years!

You may also have a psychiatric condition secondarily to a physical one and both need to be treated. But you can’t know this until the physical problem is treated and alleviated and anxiety or panic still persist. 

Misdiagnosis and mistreatment of anxiety symptoms can have dire consequences. A serious organic condition, such as hypoglycemia, hyperthyroidism, or a brain tumor can progress undetected when in fact the solution in some cases may be simple. You may struggle for years in psychotherapy that is expensive, time consuming and misses the mark, experience drug side effects, including anxiety, and even addiction, and endlessly pursue self-help techniques and stress reduction strategies that barely make a dent, while your symptoms progressively worsen. As you don’t get better, you assume that you are to blame -- you are weak, neurotic, crazy. 

How do you know if the primary trigger of your anxiety symptoms is psychological or biological? Here are some guidelines for biologically induced anxiety or panic:

You experience:

• Sudden, unexplainable and random panic

• Irritation or even panic to bright lights, loud or piercing noises, odors others don't notice, light touch or certain textures, or crowds

• Sickness or light-headedness from chemicals in the environment that others find innocuous

• Giddiness when confronted with heights or vast space; easy loss of balance; vertigo

• Disorientation, confusion, or spaciness

• Sudden change in behavior or feelings radically different from usual

• Anxiety or panic in absence of obvious psychological markers: relationship problems; low self-esteem; unstable emotions; moodiness; non-productivity

• Anxiety predictably at certain times of the day: following a meal; after consuming too much sugar, carbohydrates or caffeine

• Anxiety predictably in response to: smoking cigarettes; exercising; feeling uncomfortably hot or cold; feeling overwhelmed by an overstimulating environment; being under the influence of drugs or alcohol or when trying to stop consumption; being ill; menstruation, childbirth, or menopause for women

• Heightened agitation, tension, anxiety or panic that has not responded effectively to psychotropic drugs or therapy

If you suspect your anxiety may be biologically triggered, what can you do? Basically, you have to become your own detective and systematically sift through the many possible non-psychological triggers of anxiety symptoms: sensory; medical; nutritional; neurological; neurocranial; musculoskeletal; or environmental As many of you will discover your anxiety or panic to have multiple determinants it’s important to approach the diagnosis and treatment of your symptoms holistically. 

For detailed information on physical triggers of anxiety and holistic treatment options, check out The Anxiety Myth: Why Your Anxiety May Not Be “All in Your Head” But from Something Physical, at www.anxietymyth.com.

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Sharon Heller, Ph.D. is a developmental psychologist and author of four popular psychology books, including Too Loud, Too Bright, Too Fast, Too Tight, What To Do If You Are Sensory Defensive In An Over stimulating World (HarperCollins, 2002). She lives in Delray Beach, Florida.