Questions and Answers

Question # 33

Are persons with NLD particularly prone to "panic attacks"?

Short answer: yes. The reasons for this relate particularly to one of the primary deficits of NLD, viz., extreme difficulty in dealing with/adapting to novel circumstances (see Content and Dynamics; Question # 4).

Not immediately grasping the novel dimensions of a situation, the person with NLD is likely to feel considerable uncertainty and even threat. This perception of threat, and the immediate judgment that he has no resources for dealing with it, would be expected to lead to anxiety. Continuing in this state, and perceiving no means for exiting the situation, his anxiety may rise to the level of panic. Such an "attack" has the psychic "benefit" of distancing oneself from the situation by focussing on inner turmoil rather than the threatening (external) event.

It is easy to see that persons with NLD are particularly prone to this sequence of events, ending in panic, because they prefer to deal with highly-overlearned situations. These are situations that they have encountered numerous times and to which they have become accustomed without any accompanying feelings of anxiety. Novel situations constitute drastic departures from these sorts of familiar, routine events and their attendant well-learned performance demands.

Novel situations usually do not include a simple behavioural menu that can be followed for adaptation to them. They may require any or all of these dimensions: exploration; problem-solving/trouble-shooting; trial-and-error learning with the appreciation for informational feedback; new concept-formation; and unrehearsed/unpracticed performances. All of these are prominent deficits/limitations for persons with NLD (see NLD Content & Dynamics). Thus, it should come as no surprise that the person with NLD is particularly prone to the experience of threat in novel situations, with consequent anxiety because of no readily available behavioural rubric to deal with this threat. In such a situation, with no clear way to alter or exit it, the person with NLD is likely to experience what is commonly referred to as a panic attack.

Clinical Implications. So far as possible, care-givers should anticipate novel situations and prepare the person with NLD to deal with them. Such preparation may take the form of talking through the elements of the situation, practicing behaviours that will be needed for adaptation to it, and progressive desensitization to those elements of the novel situation that are expected to pose the greatest obstacles to adaptation therein. Such preparation is not always possible, and may not achieve the desired results. If such is the case, and the person with NLD becomes very anxious, even to the point of panic, it is necessary to leave the situation immediately and apply procedures for calming and soothing the affected individual. Learning how to do this is relatively easy. Learning how to prepare the person with NLD to countenance this or similar situations in the future takes a good deal more time, effort, and focused skill-building. Most care-givers will benefit greatly from consultation with a clinical psychologist who has a behavioural orientation, and who is adept at anxiety-reduction, desensitization, and the like. Most often, it is found that involvement of the person with NLD directly in such consultations is very helpful. In some cases, such direct involvement is quite necessary.