A form of panic
Fear of losing control
The fear is not about what is happening, but about what you might do or become.
I am afraid of going mad, and the more I think about it the closer it seems.
What the fear of losing control is
In panic attacks the fear often has a specific object, and it is not always physical collapse. For many people it is something else: going mad, fainting in public, doing something irreparable, no longer recognising themselves.
What these share is that the fear is not about the present. It is about the moment immediately after — the one in which something would give way.
The forms it takes
The fear of going mad, often tied to the sense of unreality that accompanies panic. The fear of fainting, which comes from hyperventilation and the dizziness it produces. The fear of dying, with attention fixed on the heartbeat. And the form hardest to say out loud: the thought of being able to harm yourself or someone else.
That last one is the least talked about, and almost always for the same reason: people who have it fear that saying it makes it truer.
Why the mind produces those thoughts
Intrusive thoughts are a widespread phenomenon: content that arrives unbidden, often directly opposed to a person's own values. They do not reflect intention, and they do not predict behaviour.
What makes them persistent is the response to them. A thought given no weight passes; a thought that gets interrogated, monitored and pushed away comes back harder, because the mind has now classified it as important.
The control that enlarges the problem
The strategies are understandable and they all have the same effect: monitoring sensations in order to notice in time, avoiding situations where giving way would be worse, seeking reassurance about being a normal person.
Each brings relief for a few hours. Each teaches the system that the threat was real and that without the monitoring you cannot be at ease. That is the mechanism, not a failure of will.
What has to be ruled out first
Medical assessment comes first, as with any picture involving intense bodily symptoms.
And there is a second point worth stating plainly: distinguishing a fear of losing control from a condition of another kind is a clinical assessment, not a self-diagnosis to be made by reading. If the doubt is strong, it belongs with a professional — which is among the things a first session is for.
How the work goes
We start from the specific content of your fear, because the form changes the work: fear of fainting and fear of causing harm are not approached the same way.
Then the work is on your relationship with those thoughts — on what you do when they arrive — rather than on their content. And gradually on reducing the monitoring, which is the part that gives room back.
Frequently asked questions
The fear of going mad is among the most common fears during panic attacks, and the sense of unreality that accompanies them feeds it. That said, working out what is actually happening is a clinical assessment rather than something to settle by reading a page: if the doubt is there, it is one of the things a first session is for.
Intrusive thoughts are content that arrives unbidden, and they are frequently the opposite of the values of the person having them. What makes them persistent is not the content but the response: a thought that is interrogated and pushed away returns harder, because the mind has classified it as important. That relationship is precisely what the work addresses.
This is the area where reticence runs strongest, and for an understandable reason: saying a thought aloud feels like making it more real. In practice the opposite happens — content kept out of the conversation stays intact. You do not need to say everything at once, and I ask the questions: the pace is whatever is sustainable.
Dr. Giuseppe Iannone — Psychotherapist
FIRST STEP