Understanding and Managing Anxiety and Panic Disorders in Disability

Business Development

By Dr. Lawrence Burstein, Ph.D.

September 2017

BOSTON, MA – Many disability cases involve anxiety as either the primary source of impairment or as a secondary source. A common misconception, even among medical professionals, is that individuals need to avoid anxiety or anxiety-provoking situations, which often includes work.

Like it or not, anxiety and panic are a normal part of life and, in fact, we are designed to be anxious/panic as a survival mechanism. Anxiety lets us imagine, and potentially avoid, dangerous/problematic situations. Panic is our fight/flight response for when we are actually in a dangerous situation. Although the symptoms of panic attacks can be scary, as we are not fighting or fleeing when they occur, those symptoms are not dangerous.

Panic symptoms are mediated within our Autonomic Nervous System by the Sympathetic and Parasympathetic Nervous Systems. Think of the sympathetic nervous system engages the fight/flight response and the parasympathetic nervous system makes sure this response does not get out of control and cause harm as well as restoring us to a relaxed state. So when we sense danger, the sympathetic nervous system prepares us for fighting and/or fleeing by doing such things as increasing our heart rate and breathing. The problem is that our sympathetic nervous system doesn’t do a good job distinguishing between a real thereat (i.e., someone trying to attack us) and abstract threats (i.e., my boss will “kill me” if I don’t get this done on time) where we really aren’t in physical danger, so our bodies can go into fight/flight mode when we really don’t need to fight or flee. This feels scary because we are not aware of why we are having the physical sensations associated with the fight/flight response. However, the parasympathetic nervous system will always make sure we are ok.

While anxiety and panic are not dangerous, many people mistake their symptoms for heart attacks and other serious health problems. Some physicians, will pursue investigations to rule-out significant health issues even when the evidence points to panic attacks. This can lead to requests that the claimant be out of work until various tests can be completed, despite the lack of evidence of a diagnosis that would require the claimant to refrain from any activities. At other times, the recommendation is to avoid “stress” and work is reported to be a stress the claimant should avoid. Often, job issues are a factor in these recommendations. However, avoidance is counter-therapeutic. When we avoid situations we fear, they usually become scarier, as we become less familiar with them. This can lead to unnecessarily extended absences from work, especially when there is no mental health professional treating the claimant.

Peer Reviews can be a good tool for early intervention on such claims as a peer reviewer can determine if there is an impairment and can often negotiate a quicker return to work or suggest mental health treatment when none is being administered by a mental health provider.

Dr. Lawrence Burstein, PHD is a licensed clinical psychologist and board certified by the American Board of Disability Analysts. He provides operational insight of our Disability Review Program as our VP Of Operations, Disability Services.