Panic Disorder
My experience is that individuals with Panic Disorder identify strongly with two competing beliefs, represented by two separate Child Ego States: (i) They see themselves as being a ‘strong person’, (a self-validating belief,) and (ii) they believe they are ‘not good enough’ (an invalidating belief, internalised from perception
of their value by a parent). Being a ‘strong person’ may originate as a child having to take on adult
responsibility or deal with difficult life events or circumstances, so as an adult, this is a core self-validating
part of their identity. The belief in ‘not being good enough’ may originate from a critical parent or critics from some other significant authoritative source such as a cult-like or hell-fire-and-brimstone religion which emphasises to child members that they are sinners, not good enough, unworthy of God’s love. Striving to be ‘good enough’ may lead to them erroneously being labelled as a ‘perfectionist’.
Then, one day, something terrible happens that is completely outside their control and they feel they were not strong enough to prevent the event or deal with the outcome very well. They may not have even been present so couldn’t have done anything to prevent the ‘terrible event’. Regardless, this event hits at their self-validating belief as a ‘strong person’, undermining their sense of self. In addition, what this does is confirm the competing belief that they are ‘not good
enough’. Thereafter, they live in anxiety, fearing future events that will further undermine their sense of being a ‘strong person’ and further confirm their belief in ‘not being good enough’. This is a scary prospect because if their self-validation
as being a ‘strong person’ is destroyed completely, all they are left with is identifying with the invalidating belief of being ‘not good enough’. If they believe in the stigmatizing misconception that depression is a sign of weakness, then the loss of the self-validating belief in being a strong person associated with the Panic Disorder can leave them vulnerable to depression.
Alternatively, there is another potential Panic Disorder-Depression pathway. For someone whose identity is tied up in their
belief of being a ‘strong person’ – and they believe that only weak people can become depressed - the precipitation of an episode of depression can be the ‘terrible event’ that triggers the first panic attack. For a vulnerable individual who holds the two competing beliefs, Panic Disorder can come first and may (or may not) lead to depression, or depression can come first and may (or may not) lead to Panic Disorder.
Any treatment for Panic Disorder (and depression linked with Panic Disorder) needs to address the issues associated with the two competing beliefs.
of their value by a parent). Being a ‘strong person’ may originate as a child having to take on adult
responsibility or deal with difficult life events or circumstances, so as an adult, this is a core self-validating
part of their identity. The belief in ‘not being good enough’ may originate from a critical parent or critics from some other significant authoritative source such as a cult-like or hell-fire-and-brimstone religion which emphasises to child members that they are sinners, not good enough, unworthy of God’s love. Striving to be ‘good enough’ may lead to them erroneously being labelled as a ‘perfectionist’.
Then, one day, something terrible happens that is completely outside their control and they feel they were not strong enough to prevent the event or deal with the outcome very well. They may not have even been present so couldn’t have done anything to prevent the ‘terrible event’. Regardless, this event hits at their self-validating belief as a ‘strong person’, undermining their sense of self. In addition, what this does is confirm the competing belief that they are ‘not good
enough’. Thereafter, they live in anxiety, fearing future events that will further undermine their sense of being a ‘strong person’ and further confirm their belief in ‘not being good enough’. This is a scary prospect because if their self-validation
as being a ‘strong person’ is destroyed completely, all they are left with is identifying with the invalidating belief of being ‘not good enough’. If they believe in the stigmatizing misconception that depression is a sign of weakness, then the loss of the self-validating belief in being a strong person associated with the Panic Disorder can leave them vulnerable to depression.
Alternatively, there is another potential Panic Disorder-Depression pathway. For someone whose identity is tied up in their
belief of being a ‘strong person’ – and they believe that only weak people can become depressed - the precipitation of an episode of depression can be the ‘terrible event’ that triggers the first panic attack. For a vulnerable individual who holds the two competing beliefs, Panic Disorder can come first and may (or may not) lead to depression, or depression can come first and may (or may not) lead to Panic Disorder.
Any treatment for Panic Disorder (and depression linked with Panic Disorder) needs to address the issues associated with the two competing beliefs.