As I have written in other chapters, our autonomic (will-independent) nervous system consists of two parts, sympathetic and parasympathetic. In anxiety, there is an imbalance between the two. But there is a whole group of conditions in which this balance is disrupted at the organic level. The collective term is dysautonomia.

Here we have a rather serious diagnostic problem. Neurosis and dysautonomia often produce identical symptoms. In practice this means that, at least in some countries, a lot of patients with autonomic system disorders are simply diagnosed with anxiety or panic disorders, and then they are treated with psychotropic drugs for sometimes decades, without much improvement in their condition.

It may be that sometimes dysautonomia is simply a symptom of nutritional deficiency, just as anxiety neurosis can be such a symptom. But there are situations where it is a symptom of some physical damage, such as nerve palsy from a viral infection, or physical pressure on some nerve.

This is what the phenomenon of dysautonomia often consists of, there is a paralysis or hypersensitivity of some part of the body, responsible for regulating the “relations” between the sympathetic and parasympathetic systems. As a result, one of them reacts too strongly, the other too weakly. But this can affect only one part or aspect of the body, for example, only the heart rate. Or blood pressure. Breathing rate. Sweating rate. Maybe a combination of several of these, or it could be that one system has an advantage in one aspect, another in another. The possibilities are almost endless.

It is impossible to discuss the whole issue on a website, a thick book could prove too short to describe all possible dysautonomias. I just wanted to point out that such diseases exist and are rarely properly diagnosed in some countries. Because what patient in, say, Poland, before getting a diagnosis of panic disorder, had at least a basic orthostatic test, something that can be done in the office by a general practitioner?

I will describe the simplest test that anyone can do on their own at home. Doing it at home is seemingly easy, but a person without medical training can make a mistake at any stage that they are not aware of. Therefore, such a self-made test can be at most an indication to repeat it to a doctor, if the results are strongly disturbing.

It looks trivial. We lay down comfortably and lie for 5 minutes. We measure our pulse and blood pressure with a home device. Then get up, stand quietly for 3 minutes, measure again the heart rate and blood pressure, remembering that the hand should not hang loosely along the body, but should be placed at the height of the heart, in the same position as in classical measurement while sitting.

A drop in systolic (the higher one) above 20, or diastolic above 10 units is an indication of a diagnosis of orthostatic hypotension. Additionally, an increase in heart rate above 40 beats per minute is an indication of a diagnosis of orthostatic tachycardia. These two diagnoses accompany a very large proportion of dysautonomic disorders.