Question: I am quite overweight. I am shy about my body in normal times but when I am doing any kind of exercise I am sure that everyone is laughing at how ridiculous I look. It is to the point where even thinking about exercise in public at all makes my heart race. Basically I just don’t do it because it is too unpleasant to think about. How do I overcome this anxiety. I think it is like a phobia that is how strong my fear is. But I do not know if this is considered a real phobia or not.

David Shannon Says...:

What you are experiencing resembles a couple things.  First of all, this sounds like a Social Anxiety Disorder, which is sometimes called Social Phobia.  This is characterized by a fear that you are being negatively judged by other people.  These fears can be triggered by perceived or actual scrutiny from others.  You feel humiliated and embarrassed about your weight, to the point of thinking everyone must be laughing at you.  That apparently only happens in a specific situation, when you are exercising in front of other people.  If it happened at other times and in other situations, it might be considered a generalized social anxiety disorder.

It is also somewhat similar to Body Dysmorphic Disorder, in which a person is preoccupied with an "imagined" defect in appearance.  However, you are uncomfortable about actually being overweight. Then the question is whether or not your preoccupation and concern is "markedly excessive."  If that concern adversely affected your eating habits, it might be the reason for Anorexia or Bulimia.

In any case, you have pretty extreme anxiety about exercising in public, and this is causing you a lot of distress, including panic symptoms like a racing heart beat.  To keep that in check, you avoid the situation entirely, therefore not getting the exercise that might help you lose the weight itself.  So it is kind of a vicious circle, that has physical health consequences as well as mental health ones.

You say that you don't exercise in public.  Do you exercise in private?  Granted, the equipment at a gym can be helpful, and you don't get the benefit of that, either in the specific kind of exercise you can do, or being better able to establish an exercise routine.

You say that you are shy about your body in normal times.  So that is a general concern.  But something about exercising triggers this more intense anxiety.  Does that happen with any kind of exercise in public?  Or is it only when you are doing certain kinds, or on certain pieces of equipment?  If you feel particularly awkward (and laughable?) doing specific exercises, perhaps a trainer or other bodywork professional could help you find alternate ways to get similar benefits.  I think right off the bat about water aerobics, which is excellent all around exercise, with the water both increasing the resistance, and supporting your body as you do it.  At the very least, most of you would be under water, and therefore less able to be scrutinized.  I see women (mostly) of all ages and body types in those classes, and they seem to be enjoying it.  It would help if you could find an instructor who understood various physical challenges, and could adapt routines to fit the individual.

The usual mental health treatments for social anxiety disorder are various antidepressant medications and/or cognitive behavior therapy.  You could ask your doctor about the meds.  And you could work with a therapist, learning how to identify, monitor, and replace your negative and self-defeating thoughts with ones that are more positive, realistic, or at least more neutral.  You can get in the habit of doing that as soon as you notice yourself becoming anxious.  Being aware of, and challenging, your thinking at those times can at least short-circuit the escalation, and reduce the intensity of your anxiety.  And that can help you get on with the exercise, knowing that you are taking care of your health, even though you may still feel self-conscious.

One of the great things about the gym or the spa is that, if you show up regularly, people will respect you for it, especially if you are out of shape to begin with.  They will think it is way better than sitting around at home, vegging out in front of the TV, eating junk food.  I'm not saying you do that, just that it is one common stereotype about overweight people.

Rather than being pitied or scorned for doing nothing to improve my appearance, I'd much rather be admired for making the effort, whether I look amusing doing it or not.  Chances are I'd smile right back at them, and then pat myself on the back ... okay, the shoulder ... giving myself credit for being there at all.  And being able to laugh at myself ... with affection, not derision ... has proven to be one of my most important coping and survival skills, through some pretty rough times.  Perhaps that would help you feel better about yourself, as well.  Good luck, and enjoy!

Question: There is no obvious cause that I can think of but I am now very anxious whenever I have to drive anywhere. I never used to have a problem but now I am so nervous that I avoid driving whenever I can and sometimes I have to pull over and call my husband to come and get me because I can't do it anymore. Why am I like this and what can I do to stop feeling this way?

David Shannon Says...:

You seem to have developed a driving phobia, but it could also be a more general anxiety disorder, or more specifically agoraphobia, which would be feeling anxious anytime you leave your house, either by yourself or with someone else.  It is also likely you are having a panic attack, by the time you have to pull over and call your husband for help.  I will start with a few questions for you:

Are you anxious only when you are driving?  Or are you anxious when you have to go somewhere by yourself?  Would you get anxious taking public transportation (if it exists)?  Are you anxious walking somewhere?

If only driving makes you anxious, does that only happen when you are alone?  Do you get as anxious with your husband sitting next to you in the passenger seat?  Does that feel safer?  Or would you feel even more anxious with a passenger in the car?

If you sit in the car long enough by the side of the road, are you able to calm down eventually?  Or do you stay just as anxious and panicky until you call your husband?  Do you start to feel better as soon as you know he is coming to get you?  Or do you remain that anxious at least until he arrives?  How long after that do you still feel anxious?  When do you eventually calm down?

If it only happens when you are driving, with or without someone else along, then there must be something specific about driving that makes you anxious.  You say that you are not able to come up with any reason for it.  I would suggest noticing what your thoughts are as this develops.  Have a notebook handy next to you.  When you notice thoughts that you have as the anxiety develops, write them down, when it is safe to pull over to the side and do so.  Especially record what you are thinking when it becomes too much for you, and you have to call your husband.  Do this when driving by yourself, as well as with someone else along.  If you do this a number of times, and on several occasions, you may notice that certain thoughts recur frequently, if not every time.  Once you have an idea about your usual sequence of thoughts, you will be able to challenge each one of them individually.  The goal is to notice your negative (and fearful) self-talk, and to replace those thoughts with statements that are more true, positive, or at least more balanced.  You may not be able to do this at the time you first write them down.  But look them over when you are calmer and in a less stressful situation.  You may need the help of another person, such as a therapist, or perhaps a family member or close friend.  Once you have identified replacement thoughts, you will likely be able to remember them and use them, while they are occurring, in the process of becoming anxious.  You will get better at this, with repetition over time.

As for panicking, notice the physical symptoms you experience when it gets to that level, such as racing heart rate, shortness of breath, sweating, dizziness, becoming disoriented.  Each time you become aware of such symptoms, say to yourself, "I recognize what's happening.  I am having a panic attack.  I have experienced and survived these before.  It will take some time for this to subside, and I need to wait it out, until I calm down, and come back to normal."  This can take a minimum of 10-15 minutes, and possibly longer.  Remember to breathe, and focus on that if you can.  It has been said that panic attacks are getting very anxious about being very anxious.  The more you recognize the process, especially that escalating second layer of anxiety, and give it time to resolve itself, the less time it may eventually take.  Try to do this when you have to pull over, and give it the time it needs, *before* you call your husband.  As you get more used to and more comfortable with that, you may find that you have to call him less often, and can proceed by yourself eventually.  It is still very inconvenient, and probably scary.  But the more you can manage the situation, the better you will feel.

You may benefit from working with a therapist on this, especially if it may relate to something that happened in the past, or something else currently going on in your life.  Be sure to choose one who understands cognitive behavior therapy.  Fortunately, most experienced therapists do use that method, among others.  Best wishes for learning how to cope with and manage these episodes!

Question: For about a week I have felt like I have a lump in my throat all the time and sometimes I am so stressed at work, I am a chef, I can feel my heart start pounding in my neck and I always wonder if I am going to have a heart attack. My friend is a nurse and she took a look at my throat with the light thingy and said there was nothing physically wrong that she could see and she said that stress caused lots of weird symptoms like this. How can I tell for sure if it is stress that is causing my problems? I am sure you can understand that it is hard to taste food properly when I feel like I cannot swallow right.

David Shannon Says...:

Sometimes it is difficult to sort out what is causing physical symptoms like those you describe.  If you have specific concerns about that, I would suggest following up with your doctor.  Having trouble swallowing could result from several things I can think of off the top of my head, such as stomach reflux, sinus drainage, or some physical condition that might take more testing than your nurse friend's visual exam could reveal.  Having that talk with your doctor might be a good idea anyway, since they may suggest an anti-anxiety medication for you to try.

However, when you say "I can feel my heart start pounding in my neck and I always wonder if I am going to have a heart attack," that sounds very much like a panic attack.  One overly simplistic but useful way to think about panic attacks is that they happen when you get very anxious about being very anxious.  So there is a multiplying and escalating effect to your original worrying, and you may wonder what brought all this on.  Panic attacks almost inevitably causes physical reactions.  It is quite common to experience a pounding or racing heartbeat.  It might also cause you to perspire more.  It is pretty easy to get disoriented, lose concentration, suddenly need to sit down, or have to get up and pace.

When panic attacks are recurrent and you start to live in fear of having more of them, then you may have what is called panic disorder.  You may go to great lengths to avoid situations and stressors that might cause another panic attack to happen.  This can be debilitating, and interfere with many aspects of your life.

Treatment options include both medications and psychotherapy.  Specifically, cognitive behavior therapy can help you identify, interrupt, and challenge the thought patterns that drive the escalating panic, and the resultant physical responses. 

For a more comprehensive discussion about panic attacks and panic disorder, I recommend the Mayo Clinic's eleven part treatment of the subject:   http://www.mayoclinic.com/health/panic-attacks/DS00338 .

There are things that you can do to help manage panic attacks, when they do occur.  The first thing is to remember to breathe.  That will allow you to start thinking rationally about the situation.  If you have experienced them before, you can say to yourself, "Oh, I recognize these symptoms.  I'm having a panic attack.  I've had them before, and I've survived."  It may take a period of at least 10 minutes for the physical symptoms to subside.  You may have to just wait that out, as calmly as possible, knowing that they will diminish and end eventually.  When this happens on your job as a chef, of course, it may be very difficult to take time out for that process to work.  You may need to plan for ways to manage it that specifically fit with the demands of your work.  For example, if you have other competent staff present, you could ask them to take over a particularly important task that requires close attention, and just cannot wait.  If you are not able to structure temporary solutions like that, you may just have to tough it out.  That makes managing the attacks more difficult, but you can keep reminding yourself to breathe.  You can employ other relaxation techniques that you know or can learn, while you are going about your business.  You can have the dialogue with yourself about recognizing what is happening and reassuring yourself that you can survive it.  If you have developed a treatment plan with your doctor or mental health provider, you can recommit to following it, take comfort in the belief that it will work eventually, and have realistic hope that future attacks will be less frequent and less severe.

All of these interventions have a better chance of working, once you have sought medical and/or psychotherapeutic help.  You'll have a much better idea of what is going on, and what you can do about it.