National Anxiety Foundation, Helping Sufferers of Panic, Anxiety and Obsessive-Compulsive Disorders

There are two additional fears that people with panic disorder sometimes experience. One of the additional fears is of being away from help, especially medical help, should they have one of their attacks. A woman, for example, may not want to leave town because she is too far from a hospital, or a man may not want his wife to go away overnight on a business trip because there would be no one there to get him to the hospital if he were to become critically ill during her absence. A second additional fear is a fear of the opposite of claustrophobia - a fear of wide-open spaces, for example, a fear of standing in a vast parking lot at the mall. Perhaps the root of this fear of wide-open spaces is actually, again, a fear that one will be alone and too far from help should they have what feels like, and might be, a life-threatening attack.

The overwhelming majority of fears that people with panic disorder experience are ones of the claustrophobic type. A few years ago, Dr. Cox, the founder of the National Anxiety Foundation, may have stumbled across the reason for this. "After seeing perhaps one too many panic disorder patients after the end of a long day at work, I wondered why people with panic disorder always have the same fears, if they have any fears at all. I found it curious that of all the thousands of things and situations a person could be afraid of, in panic disorder, it is almost always one or two or three fears out of a list of only about a dozen situations.

This phenomenon really began to fascinate and preoccupy me. One day, when I was trying to think of anything at all that every one of these things had in common. There were only three such factors:

1. They were all enclosed spaces.

2. There were always people in the spaces, even if it were only the person himself or herself.

3. There was a high ratio of the number of people to the volume inside the space.

As I was thinking the word 'people', the light bulb went off in my mind - carbon dioxide! "Back in 1977 Dr. Cox and Ekkehard Othmer M.D. replicated the research of Drs. Ferris Pitts who was the first to publish experimental results describing the ability of an infusion of sodium lactate intravenously to trigger panic attacks in persons with panic disorder. Soon afterwards, other chemical triggers were discovered such as:

subcutaneous (under the skin) injections of adrenaline

breathing mixtures of carbon dioxide (5% carbon dioxide/95% room air) from a mask and tank

progesterone pills

massive amounts of caffeine

Incidentally, carbon dioxide is not to be confused with carbon monoxide which is a deadly gas in exhaust from your car. Dr. Cox reasoned that people exhale carbon dioxide into the room or the vehicle that they are in, where it is not free to exchange with outdoor fresh air. Dr. Cox questioned that perhaps these confined, closed-in, claustrophobic environments have more carbon dioxide than outdoor fresh air. "I went to my medical texts and found out that we humans exhale about 500 liters (about 500 quarts) of pure carbon dioxide a day! I could find no record where anyone had measured carbon dioxide levels in the air in these claustrophobic places. So I set about designing a simple straightforward study to measure carbon dioxide in these environments.

"Dr. Cox enlisted two colleagues in this work, the imminent international anxiety expert, Dr. David Sheehan, and Jeff Lawrence, Ph.D., a biochemist who did work on the anxiety receptor in the brain (GABA), and who was the president of PTRL, an international laboratory, a chemical analysis and synthesis laboratory in the USA and in Germany." Jeff and I took official EPA air collection bags and collected samples from our day to day travels – in elevators, in the car, in restaurants, in commercial aircraft and in churches. My daughter and her neighbor friend took collection bags to school to collect samples from the classroom.”

When the air samples were analyzed for carbon dioxide content, the results were not what Dr. Cox had hoped for. "We hoped to see 3 or 4 % elevations in carbon dioxide in the air samples that were collected in the claustrophobic environment. The results were not coming back 3-4%, they were coming back 100% to just over 200% higher than outdoor fresh air carbon dioxide. This was very exciting. We felt like Watson and Crick when they discovered DNA. It is rare privilege in today's world when individuals discover something truly new and important.

"It all began to make sense then. I thought that I understood finally why these people with panic disorder so frequently have their first attack in claustrophobic environments. The high levels of carbon dioxide in aircraft cabins produced by all those people who have raced to the gate with heavy carry-on bags in tow are exhaling clouds of carbon dioxide into this airtight metal tube-like cabin. The carbon dioxide levels shoot up. The people with panic disorder, who are hypersensitive to this carbon dioxide, start to feel the anxiety effects of these elevated levels. Then the cabin door is closed with a dull 'whoomp' sound and the carbon dioxide continues to rise further. A person with panic disorder is more apt to have a panic attack at this point due to carbon dioxide exposure inside the aircraft. They want to get off because they are feeling that familiar dreadful feeling that can only be relieved by getting out of the confined space and into the open air. In most situations, like a Wal-Mart, they can go right outside and, if so, just as soon as they get outside, they start to feel better. Now we know why they feel better. It's not because they have some irrational fear of Wal-Mart or of an aircraft cabin. These people with panic disorder and claustrophobia are usually psychologically average, normal people. They just happen to be hypersensitive to certain chemical factors in the environment and to ones even in their own bodies.

"More on this carbon dioxide matter will be discussed under the "There is hope and Help" section.

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