My Jigsaw Puzzle

I am continuing to work on this jigsaw puzzle I call my life. I have the whole set laid before me on the floor and I have begun work on identifying the pieces that frame the outside border. It’s a strange feeling to take a step back from the everyday hustle and bustle, evaluate the situations, traumas and emotions in your life, and attempt to piece them together in a way that makes sense. Although this work is exhausting, I think it might be the greatest thing I have ever done in my lifetime.

I have been a nervous Nelly for as long as I can remember, but I don’t think I have ever fully understood the intricacies of anxiety. It is not a one size fits all diagnosis. Instead it is a blanket term for a number of disorders that are classified into two groups: continuous symptoms and episodic symptoms. Anxiety disorder is divided into generalized anxiety disorder, phobic disorder and panic disorder; each has its own characteristics and symptoms.

My therapist Nancy Whiteley, LCP explained to me that anxiety is when the mind and body are completely in sync with one another. Your body creates a physical reaction for an emotion you are feeling, which can be both good and bad. Having a base diagnosis of anxiety and then experiencing post-traumatic stress disorder (PTSD) on top of it, is where I am currently.

Here are the different forms of anxiety I am now experiencing with PTSD:

Post-traumatic stress disorder (PTSD) is an anxiety disorder which results in from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying or even a serious accident. It can also result from long term (chronic) exposure to a severe stressor, for example soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression. There are a number of treatments which form the basis of the care plan for those suffering with PTSD. Such treatments include cognitive behavioral therapy (CBT), psychotherapy and support from family and friends. These are all examples of treatments used to help people suffering from PTSD. —Wikipedia

I am now processing the emotions that I previously just coped through from my battle with stage-III breast cancer four years ago. Jenn has brought me the “gift of grief” and is allowing me to move through my emotions while supporting her in her battle against breast cancer.

Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop. For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences; in severe cases, one can be confined to one's home. —Wikipedia

It took two years before I would let Matt drive with me in the passenger seat. I always have to be the one driving. I often play the “what if” game and work myself into a frenzy. What if I get sick? What if we’re at the restaurant and I have a panic attack? My friends will get mad at me and blame me for ruining their evening. I often will come up with excuses to get out of going completely, or to drive separately. I have an errand to run beforehand, so I’ll meet you all there. And the worst part is, I then feel guilty about lying and nothing bad happens anyway. I don’t get sick and no one blames me for a bad time. It’s all just silly and I hate it. I always have to know where a bathroom is, too. Once I know where it is, I typically relax. Going to a new place I haven’t been before causes some anxiety until I scope it out and know all of my “plan b” options. I’m that thorough. CONFESSION: I have, at times, gone to a place prior to the actual day of the event just to scope it out and find where the exits and bathrooms are located.

Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder. Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances even a brief separation can produce panic.—Wikipedia

I get anxious when I think about going off of the Tamoxifen in two years. In my head I associate the Tamoxifen with keeping the cancer away. My therapist said that this is onset now because Jenn is receiving chemotherapy, which parallels my cancer treatment.

In panic disorder, a person suffers from brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours and can be triggered by stress, fear, or even exercise; the specific cause is not always apparent.

In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. Accordingly, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis). —Wikipedia

The agoraphobia typically leads to panic disorder. I have maybe had 50 in my lifetime. It always starts with my jaw tightening and then I began panicking knowing what is about to happen. I shake, tremble, get dizzy, my heart beats out of my chest, I go to the bathroom or vomit, I sweat profusely and my stomach will spasm and convulse. I cannot focus on anything—it completely consumes me. Once it passes I am literally exhausted and fall asleep.

Obsessive–compulsive disorder (OCD) is a type of anxiety disorder primarily characterized by repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals). It affects roughly around 3% of the population worldwide. The OCD thought pattern may be likened to superstitions insofar as it involves a belief in a causative relationship where, in reality, one does not exist. Often the process is entirely illogical; for example, the compulsion of walking in a certain pattern may be employed to alleviate the obsession of impending harm. And in many cases, the compulsion is entirely inexplicable, simply an urge to complete a ritual triggered by nervousness.

In a slight minority of cases, sufferers of OCD may only experience obsessions, with no overt compulsions; a much smaller number of sufferers experience only compulsions. —Wikipedia

If I feel like other things in my life are out of control, or beyond my control, I will get transfixed and obsessive about my house being clean. I do this, according to my therapist, because it is something I can control. I kept a calendar for which days I clean what and even do things sequentially. Poor Matt just smiles and puts up with my crazy. My argument: at least I have a clean home.

There is another concept that I am not as familiar with called “self-trust.” For most of my life I have had a pretty good idea of how I feel about certain things. Typically you fall in the middle of the scale and can look at both sides and say “That doesn’t seem right” or “I agree with that,” but trauma in the form of life or death illness catches you off guard, like getting hit by a brick. It puts you in an indecisive and vulnerable state where you don’t necessarily trust your own opinion anymore, so you look to others to guide you. This also enhances all of your other anxieties, hence why I am struggling to put these jigsaw pieces together.

The good news, you ask? Most people with all of the above are off medication and complete therapy in seven months. I have to remember what my therapist told me at the beginning, “feel deeply and recover quickly.” That is what I intend to do. Am I always going to be a nervous Nelly? Yeah, probably, but I will have cognitive ways to manage my response to situations … and my home will remain clean.