The first time I remember having a panic attack, I was in my 20’s. I was between jobs and staying with my parents for a few weeks before moving to Chicago. My days were lazy – I’d sleep in, watch a little TV, hang out with my siblings, and stay up late reading the stacks of Reader’s Digests on the coffee table.

One evening, sitting in my car in a grocery store parking lot, I was overwhelmed by a sense of doom. Paralyzed, I couldn’t get out of the car – I was terrified someone might attack me on the way in. Later that night at home, I couldn’t stop obsessing about how easy it would be for someone to break into the house.

That was my first real taste of anxiety and it was miserable. Desperately in need of relief, I did some sleuthing, and wondered if maybe my steady diet of daytime talk shows and true crime mysteries might be contributing factors. Not to mention my routine of staying up late reading and sleeping until late morning.

I decided to keep a better schedule and change up my routine. I spent more time outside and went blueberry picking with my mom. I turned off the television and learned how to can peaches. And I started feeling better.

Since that time I’ve learned I’m not alone.

Anxiety is a debilitating disorder that affects over 40 million of us and is the most commonly diagnosed mental health disorder. Symptoms can be as benign as a mild sense of uneasiness or as serious as an inability to leave the house. The physical manifestations of anxiety can make us feel like we are dying (read more about why here). In fact, people often think they are having a heart attack when it’s actually anxiety.

While benzodiazepines (such as Ativan, Klonopin and Xanax) are often prescribed for anxiety, there are a lot of good reasons not to take them. For one, they function more like a band-aid, meaning they may provide some short-term symptom relief, but do not address the root of the problem. Two, these medications are highly addictive and can easily be misued. Withdrawal symptoms are miserable. (Some of the worst anxiety I’ve seen is in people who were unable to obtain Xanax after taking it for a long period of time.)

Ultimately, with a few exceptions, medication is not the answer. Lifestyle changes and behavioral interventions are far more effective. These don’t always provide the instant relief so many are looking for, but they will help address underlying causes, and hopefully prevent future symptoms from escalating. I’ve found a lot of people fail to see the connection between lifestyle habits and their anxiety symptoms, but the reality is, the choices we make can have a significant impact on our mental well-being.

If you are suffering from anxiety, ask yourself if any of these common habits could be exacerbating your symptoms:

  1. Staying up too late/interrupted sleep – according to the National Institutes of Health, 40 million Americans suffer from sleep disorders. (I can’t help but notice this is about the same prevalence of anxiety disorders.) The sleep/anxiety problem is a vicious cycle—poor sleep habits can cause anxiety and anxiety can disrupt our sleep. If you have trouble sleeping, try first to adjust your routine. Experts recommend avoiding screens within 2 hours of bedtime, going to bed the same time each night, keeping your room cool and dark, and developing a pleasant bedtime routine. If you have tried all these things and continue to have trouble sleeping, consult your doctor. Getting regular, quality sleep needs to be a priority in all of our lives. For more information, click here
  2. A diet high in sugar, processed foods – Full disclosure – there aren’t really any studies exploring the effects of food on anxiety. However, we do know that sugar and processed foods aren’t good for our overall health. We also know that the mind and body are connected, so what is bad for your body is bad for your brain. If your diet is heavy in sugar and processed foods, you probably aren’t consuming enough fruits and vegetables, which we know make us feel better. If you’re not convinced, keep track of your anxiety symptoms on your regular diet for 3-5 days. Then eliminate sugar and processed foods from your diet for 3-5 days and see how you feel.
  3. Lack of routine – Keeping busy can definitely help ward off anxiety symptoms. Many people tell me their symptoms of anxiety (and depression) can be worse on the weekends. As much as we may despise routine, it really is good for our mental health to have some order in our lives. Routine gives us purpose, helps keep us grounded, and can provide security. Again – if you’re not sure about this, try implementing a simple routine – even on the weekends, and see if there’s an impact on the way you feel.
  4. Unrestricted electronic time – As wonderful and convenient as it is to be able to access any piece of information we could possibly need any time we want, it can be overwhelming. Even now, I have my computer in front of me, my iPad playing music and my phone at my right hand. You’d think that staying on top of every phone call, email and penny in our bank account would provide a sense of relief and free us up to do other things. In reality, it typically just creates more anxiety. Try to put some limits on your media/music/electronic time. Stop watching the news before bedtime. Declare one day a week to be “device-free.” Delete the computer games from your phone. Just because you can access it doesn’t mean you need to.
  5. Procrastination – I confess, when it comes to procrastination, I am the worst. So I know from experience that how putting things off adds fuel to the fire of anxiety. Granted – we need a little anxiety to help get things done. But the more we put them off, the more anxiety snowballs. When we procrastinate, all we’re doing us dumping our current problems on our future self. If you’re a procrastinator, resolve to be better to your future self. Commit to doing one hard thing every single day. (Preferably as early in the day as possible.) This will give you a sense of accomplishment, and might even spur you on to do other hard things. I guarantee this will help decrease your overall anxiety level.

While many people hope that taking a pill can alleviate their symptoms, the relief provided is temporary at best. If you want to get a handle on anxiety, start by evaluating your daily habits and see if there are some adjustments you can make


When I was 7 years old, my family took a road trip from Indiana to California via Arizona. There was a sandstorm and we went to Disney. Those two things are about all I remember—well—except for the Pacific Ocean.

Although I had grown up near Lake Michigan (which sure looks like an ocean to a 7-year-old), I seemed to understand that there was something far more majestic and dangerous about the Pacific. I stood respectfully at its edge, next to my mom, who was holding my sister; who stood next to my dad, who was holding my brother.

Then—a violent wave.

I ran.

For my life.

To the car.

Even though it’s been a few decades, I can still remember standing there gulping for breath, terrified, but grateful to be alive. Momentarily I heard my mother calling my name. Actually she was screaming.  Then it occurred to me that my mom thought I had been swept out to sea. Honest mistake on her part, given the swiftness with which I had disappeared. When that wave hit the shore, there was no rational thought. My brain shut off, my body went to work.

This response to danger is called fight-or-flight and was first identified in animals. It is a God-given, physiological response that is quite amazing. When we sense a threat to our survival, our brains and our bodies are flooded with stress hormones. These chemicals heighten our senses, increase our heart rates, shallow our breathing, quicken our muscles and pour every ounce of strength we have into one singular task: survival.

Fight-or-flight makes us run faster and/or stand to face our enemies. It allows mothers to lift cars off children and unleashes physical capabilities that would otherwise be dormant. All non-essential bodily functions are temporarily shut down. Digestion, reproduction and rational thought are irrelevant. Can you imagine pausing to eat a cheeseburger, get pregnant, or solve a calculus problem while fighting off an angry bear?

Intense as they are, these stress hormones are designed to subside the moment we no longer need them. Once the danger has passed, our brain is supposed to release a chemical to signal the “all-clear.” At that point, everything goes back to normal. We can return to our dining and procreating and pursuing world peace. But here’s the problem: our brains have a real tendency get confused. Our stressful environments combined with our habits of abusing our bodies leave many of us in a constant state of arousal. Traffic jams, parking tickets, screaming babies, long lines at the grocery store or irritable mothers feel as threatening to us as an angry bear or 10-foot wave.

We are well-aware there is a link between stress and infertility, digestion problems and trouble concentrating. This is why. The stress chemicals that are so useful to us in very concentrated and very temporary doses leak out into our bodies at inopportune times and marinate our brains and other vital organs. With no place to go, these chemicals can begin to suck the very life out of us.

In order to thrive well in this world, to regulate emotions, tolerate discomfort, express ourselves appropriately and have meaningful relationships, we must learn to manage these stress hormones.

Here are five things you can start doing today to get things in check:

  1. Breathe. When our bodies are in fight-or-flight, our breathing becomes quick and shallow (called over breathing). This is quite helpful if we need to take off and run, but otherwise, it just exacerbates feelings of anxiety. When you consciously slow your breath down, by inhaling and filling your lungs with air, and slowly exhaling, it reminds your brain that everything is okay. You wouldn’t be breathing like that if you were being chased! A simple breathing exercise, called square breathing, is to inhale for four counts, hold it for four counts, then release for four counts. Do this four times to make a “square.” 
  2. Be mindful. Mindfulness means using all 5 of our senses to engage with current moment. Take a moment to notice your surroundings. What do you see, hear, taste, touch and smell? Mindfulness doesn’t solve your problems, but it can give your brain a much-needed distraction so you can think a little more clearly. One simple mindfulness exercise is to find 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can touch.
  3. Be grateful. No matter how bad things are, there is always something you can be thankful for. So your car may not have A/C, but aren’t you grateful you can drive to work? The quickest way to be grateful for something is to try to imagine your life without it. I am typing madly away on my keyboard — I can’t imagine not having my 10 fingers! Gratitude doesn’t make our problems go away, but it does allow us to co-exist with them a little more easily.
  4. Exercise. All those fight-or-flight chemicals swirling around in our bodies can make us feel extremely restless. So go out and take a walk! Ride your bike. If you can’t get outside, run up and down the stairs a few times, or do some gentle stretching. Help your body release those chemicals naturally.
  5. Talk about it. It’s amazing how just speaking our fears out loud can make them less scary. Sometimes all we need is a friend to look us in the eye, nod their head, and say, “I’m so sorry you’re feeling this way.” It’s obviously important to share with someone you know will validate you (past history is a good indicator!) But support groups and therapy can also be an excellent source of validation. If talking’s not your thing, try writing your feelings on paper. The idea is to get them out of you.

When triggered at appropriate moments, the body’s fight-or-flight system is an amazing response. However, it is all too easy for this system to malfunction, leaving us feeling completely out of control. These five strategies can help you calm your body down so you can work smart, not hard.

First a bit about personality disorders in general…

The Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5), published by the American Psychiatric Association in 2013, has identified ten personality disorders, along with three other “unspecified” categories of personality disorders.

A personality disorder is a pattern of “inner experience and behavior” that is significantly different from the person’s cultural expectations of behavior.

Individuals with personality disorders have major problems in at least two of the following categories: thinking, mood, relationships, or impulses. These problems typically start in adolescence or early adulthood and are evident in a wide range of areas in the person’s life. They tend to affect work, school and social functioning and impact the way a person cares for themselves.

A diagnosis of a personality disorder is usually only given after all other possibilities are ruled out, including other serious mental health diagnoses, substance abuse, or certain medical conditions.

Borderline Personality Disorder (BPD) is characterized by problems in relationships, self-image, mood and behavior and is noticeable in almost all areas of a person’s life. Individuals with BPD typically struggle with:

  • Fears of abandonment (real or imagined) – they will frantically try to avoid the abandonment of others
  • Unstable and intense relationships – they bounce back and forth between loving and hating people and typically experience a lot of “drama”
  • Personal identity – they feel unstable and have a hard time figuring out who they are
  • Impulsivity – they may have trouble with self-damaging behaviors that include sexual activity, substance abuse, risk-taking, binge-eating
  • Suicidal ideation and behavior – a pattern of thinking about suicide, making suicidal gestures or threats, or self-harm
  • Unstable mood – their moods can go up and down within hours or days, and they can be very reactive
  • Feeling chronically empty inside
  • Difficulty controlling anger
  • Sometimes feeling extremely paranoid or “detached” from the world around them.

At least five or more of the above symptoms must be present to qualify for this diagnosis.

According to the National Education Alliance for Borderline Personality Disorder (NEA BPD), BPD affects about 14 million Americans (or 5.9% of adults) at some time in their life. 20% of patients admitted to psychiatric hospitals likely have BPD, and BPD affects about 10% of people in outpatient mental health treatment.

What if I think I have it?

If you think you might meet the criteria for BPD, you’re probably feeling some mixed emotions. On the one hand, it may be a relief. There’s a name for your struggles and other people have similar problems. It might be nice to know you’re not alone. On the other hand, figuring this out could bring more questions than answers. A BPD diagnosis is serious, and should not be made or taken lightly.

So what should you do if you think your symptoms may apply?

  1. Don’t assume it’s BPD before ruling out other possibilities. Other diagnoses, such as bipolar disorder or anxiety disorders can have similar symptoms. Additionally, many individuals who meet the criteria for BPD have significant trauma in their past. Once they work through the trauma, the problematic symptoms may improve. It is important to get an accurate diagnosis, because diagnosis informs treatment. An experienced mental health clinician can help sort this out (see #4).
  2. Track your symptoms. Keeping a mood/behavior log can be helpful. (Find one here.) It doesn’t have to be fancy. For 5-7 days, try keeping track of your habits: hours of sleep, exercise, and eating, as well as your mood throughout the day, making note of any triggers, strong emotional reactions, and behaviors. This can help you identify predictable patterns as well as provide valuable information for your mental health provider. 
  3. Take care of yourself. We all need to do this, but for those who have chronic mental health conditions this is especially important. Sleeping (not too much, but enough), eating right, exercising, taking your meds and avoiding drugs and alcohol are essential for individuals with the symptoms of BPD, and can make the symptoms less intense.
  4. Seek professional help. Most importantly, do your due diligence and find a mental health professional who is familiar with this condition and who has experience treating it. (A good resource is the therapist listing at Psychology Today,where you can enter your zip code and filter results by interests and experience.) You will most likely need a team, which ideally would include an individual counselor, group therapy and a psychiatrist.

Borderline Personality Disorder can be a confusing and overwhelming condition, but symptoms can be managed. If I can answer any questions, please contact me here.