We've discussed the topic of the differential diagnosis of anxiety states in dysautonomia in the past:http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/Psych-Eval/show/1209919http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/Mental-health-and-dysautonomia/show/1032741
In light of more recent discussions of anxiety, though, and a passage I happened to come across while reading one of my medical textbooks this week, I thought it would be a good topic to revisit. Here's the passage to which I'm referring, from _Stress,_Catecholamines,_and_Cardiovascular_Disease_ by Dr. David S. Goldstein (New York: Oxford UP 1995, pp. 40-41):
"Neurochemical activation alone does not itself produce distress (Cameron et al., 1990). The experience of distress requires both physiological arousal and appropriate cognitions by the organism (Schachter and Singer, 1962). Although several emotions include distressing elements (e.g., fear, anxiety, panic, guilt), other emotions do not (e.g., libido, joy), yet adrenomedullary activation accompanies even positive emotional experiences (Frankenhaeuser, 1975). According to the present concept, adrenomedullary activation does not imply the experience of distress, because such an experience requires appropriate cognitions and because sympathetic activation can accompany even nondistressing emotions . . . "
I'm not sure how much of that makes sense to a layperson outside of the context of having some background in this field. Unfortunately sometimes it's hard for me to step outside of myself and imagine how these things read to a person who *doesn't* sit around reading textbooks on catecholamines "for funsies." :-p I think the take-home lesson from this, similar to the linked journal articles in the threads I referred to above, is that the physiological symptoms in dysautonomia which are one and the same with many of the physiological symptoms of anxiety states are not an indication that a person with dysautonomia is experiencing anxiety, per se. This is the real nugget of gold up there, and it bears repeating: "sympathetic activation can accompany even nondistressing emotions." When I turned this over and over in my head, a new dimension of this understanding regarding the difference between the symptoms of an overactive sympathetic nervous system and true anxiety finally began to take shape. The MIND may or may not interpret these symptoms as indicative of something worthy of distress, depending on context. The same cluster of symptoms (racing heart, flushed face, tremulousness from adrenaline, etc.) can be interpreted with negative emotion in one context (such as a panic attack or if it happens in response to something scary that startles you) while being interpreted with positive emotion in a different context (such as if it occurs in response to opening your door and finding Publisher's Clearinghouse at it with a giant check in your name or, as put benignly in the quote, "libido").
The thing for me is, there's no burglar breaking down my door, but neither is there Publisher's Clearinghouse ringing my doorbell. Most days, I'd prefer to live life on a bit of an even keel without sudden unprovoked onsets of those symptoms coming and going throughout the day. What some doctors may fail to realize (or fully think about) is that the physiological changes that accompany these adrenomedullary and pituitary-adrenocortical activations include a sort of heightened sensitivity and hyperreactivity that can be rather ... unpleasant ... for those of us cycling through it throughout the day. My hope is that armed with the research of experts like Goldstein, we can help our docs reach an understanding of what it is like to live inside our bodies, and help them better to treat us toward the end of an optimal quality of life.