Understanding Panic Disorder
A panic attack is a brief period of terror and the physical symptoms of a fear response that occur without external cause or totally out of proportion to the risks of a given situation. Panic attacks can come out of nowhere and cause brief periods of extreme fear, with symptoms that can include feelings of doom, racing heartbeat, nausea or chest pain.
People who experience panic attacks are at risk to develop panic disorder. Panic disorder occurs when the experience of having panic attacks causes a severe fear of experiencing additional panic attacks (or severe worry about why you experience panic attacks) and this fear lasts for one or more months
Between and 1% and 2% of the population experience panic disorder at some point in life. The typical age of onset ranges from the late teen years to the mid 30s and women are between 2 and 3 times as likely as men to experience panic disorder.
Panic disorder is very treatable, but left untreated, it can significantly reduce quality of life. People with untreated panic disorder are at an increased risk for specific phobias, such as agoraphobia (a fear of leaving the house) and often suffer from one or more additional mental health conditions, such as depression or substance abuse.
The Symptoms of a Panic Attack
Panic that occurs as a result of a legitimate threat or danger is normal and healthy, but panic attacks pervert the bodily response to threats by causing a severe physical and cognitive fear reaction to a situation that does not warrant it.
Panic attacks can occur:
- Unprovoked – out of nowhere
- In reaction to a cue, such as a panic attack that occurs when seeing a spider in the room
To meet the diagnostic criteria for a panic attack, 4 of the following symptoms must present:
- Shaking or trembling
- Fear of losing your mind
- A real fear/belief of dying
- Nausea or stomach pain
- Hot flashes or chills
- Feeling dizziness or faintness
- Feeling like you can’t catch your breath
- Feelings of choking
- Feeling like it’s not real or you aren’t there
- Chest pains
- A racing hearty beat (pounding)
- A feeling of tingling or numbness
These symptoms will peak within about 10 minutes.
Unexplained panic attacks can cause panic disorder.
A Diagnosis of Panic Disorder
To meet a diagnosis of panic disorder you must:
- Have experienced re-occurring and unprovoked panic attacks
- After a panic attack, you must have experienced one or more months of: severe fear of having another panic attack, severe fear or worry about why you had a panic attack (such as a fear of going crazy) and/or a substantial change in behaviors or lifestyle as a consequence of the panic attacks.
The panic attacks cannot have occurred as a result of:
- Another physical health condition (Ex. Hyperthyroidism)
- Another mental health condition (ex. Social phobia, OCD or PTSD)
- Drug or alcohol use or abuse
Although for a diagnosis of panic disorder, the initial panic attacks must be unexpected, after diagnosis, a fear of panic attacks can lead to anxiety that provokes ever more panic.
Going out for a jog and feeling your heart rate increase – associating a racing heart with a panic attack - feeling increasing anxiety - experiencing a panic attack.
The Causes of Panic Disorder
Both genetic and environmental causes (often in combination) can cause panic disorder.
- Having a sibling or parent with panic disorder increases the risks by 800%
- Having a sibling or parent who experienced panic disorder with an age of onset earlier than 20 increases the risks by up to 2000%!
Yet, although the genetic link is clear, 75% those diagnosed with panic do not have a close relative with the disorder – environmental factors are obviously quite significant.
Big changes in life, such as moving out of the family home, getting married, starting a new job or having a baby often precede the onset of panic disorder. These big changes create stress and stress may lower our resistance to the disorder.
Medical conditions such as hyperthyroidism and hypoglycemia can also cause panic attacks, and your doctor will likely need to rule out these physical conditions as possible causes of your symptoms.
Certain medications, or the use or abuse of stimulant drugs (amphetamines, or even excessive coffee intake) can also trigger panic, and so your doctor will likely want to know about your consumption of certain substances.
Should You Go See a Mental Health Professional?
According to the American Psychiatric Association, you should consult with a mental health professional about panic disorder if:
- You have suffered from repeated panic attacks (4 or more)
- You experience consistent fear of experiencing another panic attack
Panic Disorder Treatments
Panic disorder can be treated with medications and through talk therapy, most normally cognitive behavioral therapy (CBT).
CBT teaches patients new ways to think about their condition to reduce its impact. CBT therapists often teach:
- About the disorder and what triggers attacks
- Methods of relaxation that can be used to reduce anxiety
- How to deal with thoughts about panic in more realistic and healthy ways
- Ways too practice panic minimization techniques, in safe and controlled settings
CBT provides patients with real world strategies that can improve quality of life within a period of weeks. The APA suggests that most patients begin to see real improvement in symptoms within 10 to 20 sessions and a very substantial improvement after a year of continuing therapy.
Medications sometimes used for panic disorder can include:
- Anti depressant medications - SSRIs such as Zoloft, Prozac or Paxil are often prescribed for people with panic disorder.
- Anti-anxiety medications – such as the benzodiazepines Ativan or Xanax
Panic patient sometime also find participation in community support groups to be helpful.
Panic disorder is a very treatable condition.
Without treatment, panic disorder can cause:
- Phobias – people start to associate certain situations with past instances of panic.
- An increased risk of substance abuse – panic disorder sufferers sometimes use drugs or alcohol as self medication
- Career problems – panic disorder often leads to phobias and avoidance behaviors, which can harm career performance. An employee may feel unable to travel far from home, thus compromising her performance as a sales rep, for example
- An increased risk of suicide
- Increased health problems
- A reduction in time spent engaged in enjoyable activities
- A reduction in quality of life
Panic Disorder and Agoraphobia
Some people who experience panic disorder try to control their experience of panic by limiting their exposure to stimuli and situations that could trigger an attack. Panic disorder can induce phobias, an extreme example of which is agoraphobia.
Agoraphobia causes a fear of public places, particularly public places that may be difficult to leave (escape) from quickly if needed. Roughly a third of people with panic disorder will develop agoraphobia.
To meet the diagnostic criteria for panic disorder with agoraphobia a person must:
- Have a fear of places that would be difficult to leave quickly in the event of a panic attack.
- Avoid these fearful situations or places, or experience substantial anxiety while enduring them
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