HYPERVENTILATION SYNDROME

A psychophysiologic (psychosomatic) disorder of the respiratory system characterized by repeated anxiety attacks accompanied by “overbreathing”—that is, the patient breathes rapidly and deeply even though he may not always realize that he is doing so. If the overbreathing continues for any length of time it usually produces a lightheaded sensation, palpitation, shortness of breath, perspiration, and tingling in the fingers. Prolonged overbreathing may result in loss of consciousness.The anxiety which produces hyperventilation is generally caused by stress situations which bring unbearable feelings of anger, fear, or sexuality close to the surface. Sometimes the attacks may follow a disturbing dream or a nightmare. In diagnosing these cases, the psychiatrist asks the patient to overbreathe for two minutes to show him that giddiness and other symptoms are bound to result. This procedure sometimes leads to immediate and continuing relief, since the patient becomes aware of the relation between his symptoms and the hyperventilation. Sometimes relaxation and breathing exercises are also prescribed to be carried out under the direction of a physiotherapist. Usually, however, psychotherapy is needed to help the patient understand and handle the problems that are at the root of his anxiety attacks.Illustrative Case: HYPERVENTILATION SYNDROME The patient, a fifty-seven-year-old woman had been under medical care for symptoms of menopause beginning at age fifty, but her husband had abruptly terminated this treatment two yearspreviously. He brought her to the psychiatrist’s office, stating that he could no longer stand her “huffing and puffing.” The attacks occurred every morning and had the effect of delaying his departure for work and keeping his wife from doing her housework.The two-minute test was used to show the patient that her symptoms could be produced through overbreathing. In discussing her attacks, she revealed that she had been concerned about the possibility of her husband’s dying. She also spoke of the recent death of her brother, the fact that her children were grown and no longer needed her, and that the family had threatened to place her in a mental hospital because of her menopausal symptoms. She was a driving, energetic woman who had been completely immersed in her family. Her remarks about death suggested that she harbored buried feelings of resentment toward her husband, who showed little sympathy for her: “It soon seemed apparent that situations arousing repressed hostility toward her husband and family, feelings that were unacceptable to her as a conscientious person, and threats of separation from her family induced the acute anxiety attacks manifested by over-breathing.”Questioning revealed that the patient had given up an excellent job to marry her husband. She had married suddenly after having been jilted—and her own daughter had likewise been jilted six months before the consultation. The husband was self-centered, buried in his work, and had a disparaging attitude toward his wife’s activities. He was advised to spend more time with her.The patient was seen four or five times, and encouraged to ventilate her unacceptable feelings toward her husband—feelings which had culminated when he forbade her to continue treatment for menopause. She was also encouraged to plan activities outside the home in order to be less dependent on the family. This short-term psychotherapy was successful, and within six weeks the patient was completely free of overbreathing attacks. (Adapted from Noyes & Kolb, 1963)