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
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.