Elena Darmenko

Expat Psychotherapist

Anxiety Attack.
What You Need to Know About an "Expat Anxiety"

An anxiety attack occurs when stress, anxiety, and worry become overwhelming.
Being an expat is exciting, but not easy. You're challenged by all the practical issues you have to face, but also by all the emotional situations you're involved in – loneliness and isolation, adaptation to the new culture and cross-culture shock, which sometimes leads to misunderstanding, possible conflicts, and tension at work and in the family, stress, dissatisfaction and even the fear of the future. This all becomes the source of an anxiety attack and sometimes of a phenomenon called an expat anxiety.

Living abroad, people don't have the support of their family, old friends, and colleagues. They miss their favorite places and food, cultural references that seemed to be so "usual" that you even didn't pay attention to them. And what's more important, you lose the feeling of being "rooted" in a place you live. This situation can bring up emotions of isolation and loneliness. As expats, you can be more vulnerable to these types of suffering.

As an expat psychologist I know that sometimes people move to another country just to escape from the insecurities and fears they had in their home country. However, that's not a proper solution. But until you realize and accept it, and throw it away from your suitcase, you might also suffer from different types of anxiety attacks.

Anxiety Attack vs Panic Attack

Sometimes clients suffering from anxiety and panic attacks, don't really know the difference between them. So, let's try to figure it out.

An anxiety attack occurs when stress, anxiety, and worry become overwhelming. They are brought on by persistent worry either over big events, like illness and death, or small, everyday things. The attack is the result of building anxiety over time that reaches a breaking point. An anxiety attack is not so much an attack but just when anxiety comes to a head. They are episodes of intense worry, fear, and dread that trigger physical symptoms. They feel more predictable since they are the result of you worrying about something. Anxiety symptoms are not as intense as those of a panic attack, though they may last much longer.

The symptoms of a panic attack must include at least four of the following: palpitations, tingling and numbness, shaking, hot flashes or chills, perspiration, choking sensations, feeling short of breath, abdominal discomfort, feeling light-headed, chest tightness, feeling detached from oneself and reality, and fear of losing control and dying. Unlike anxiety attack, which is future-oriented, panic is concerned with the here and the now. Panic is also much more closely associated with the fight-or-flight response – the body's rapid preparation to fight a threat or run away from it. This explains why panic attacks, compared to anxiety attacks, are often more abrupt, somatic, intense, and time limited.

If You Have Anxiety Symptoms

As I've mentioned before, a social anxiety is a quite common phenomenon. So, if you see the symptoms of it in your behavior, this advice may be helpful:

1. Be kind to yourself! Allow yourself make mistakes. It's so easy to over-emphasize all the ways you felt awkward and to de-emphasize the ways in which you did well. But remind yourself that you're doing a hard work and exercise self-compassion.

2. Find someone in a local community you trust. Let this person be your "insider" in the new culture. Those who prefer to not interact with nationals, miss the opportunity to root in a place and connect with a culture. Once you have your own "expert", you can ask dozens of questions about the culture. Attending a cultural training organized by locals might be helpful too.

3. Learn Managing Anxiety Skills. You can use deep breathing, and progressive muscle relaxation for increase relaxation and lower anxiety. I'd also recommend trying yoga exercises.

4. Struggle with avoidance. Anxiety is rooted in avoidance – social situations make you nervous and you begin to avoid them. Ask yourself if there are any specific situations that you try to avoid and why? Make a list of "Fear Hierarchy" – rank feared situations, so you will see where action is mostly needed. Start with the easiest situation in your hierarchy. Intentionally seek out that situation. When you feel the anxiety rising, try to stay in the situation to let the anxiety ease. Use the relaxation techniques mentioned above to cope with the situation. As you're successful in each situation, reward yourself, and move up the hierarchy.

Remember, struggling with anxiety attack takes a long time. Start with learning and practicing different coping and self-managing skills, and don't hesitate to ask for professional help.