Panic Disorder

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Visit the BPhoenix Panic Disorder Support Group.

One out of every 75 people experience recurrent panic attacks. Panic disorder usually first appears during the teens or early adulthood, and while the exact causes are unknown, there does seem to be a connection with major life transitions, such as graduating from college, getting married, having a first child, etc. There may also be a genetic predisposition to this disorder and studies have shown a higher risk of developing it when there is a strong family history of anxiety disorders or depression.

More women suffer from this disorder than men, and recent studies estimate that one in five emergency room visits are panic related and that panic disorder patients are twelve times more likely to visit emergency departments and represent 15% of all medical visits.

Symptoms of Panic Attacks:

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience. Symptoms of a panic attack may include:

- racing heartbeat
- difficulty breathing, feeling as though you 'can't get enough air'
- terror that is almost paralyzing
- dizziness, lightheadedness, nausea or vomiting
- trembling, sweating, or shaking
- choking or chest pains
- hot flashes or sudden chills
- tingling in hands or feet (pins and needles)
- fear that you're going to go crazy or are about to die

In addition to the above symptoms, a panic attack is marked by the following conditions:

- it occurs suddenly, without any warning and without any way to stop it.
- the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.
- it passes in a few minutes and the symptoms gradually fade over the course of about an hour. However, repeated attacks can continue to recur for hours.

A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild worry or social impairment to a total inability to face the outside world.

DSM-IV Diagnostic Criteria:

Panic Disorder Without Agoraphobia

A. Both (1) and (2):

(1) recurrent unexpected Panic Attacks

(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

   (a) persistent concern about having additional attacks
   (b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
   (c) a significant change in behavior related to the attacks

B. Absence of Agoraphobia.

C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

Treatment of Panic Disorder:

Treatment can bring significant relief to 70 to 90 percent of people with panic disorder, and early treatment can help keep the disease from progressing to the later stages where agoraphobia develops.

Before undergoing any treatment for panic disorder, a person should undergo a thorough medical examination to rule out other possible causes of the distressing symptoms. This is necessary because a number of other conditions, such as excessive levels of thyroid hormone, certain types of epilepsy, or cardiac arrhythmias, which are disturbances in the rhythm of the heartbeat, can cause symptoms resembling those of panic disorder.

Most experts agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases, but is rarely used alone.

Therapy can help the patient understand exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. Realizing this is not true is often a huge first step in getting control over the symptoms of the disorder. Cognitive therapy can help the patient identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.

In some cases, medications may also be used to help treat panic disorder. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.

Strategies for Coping with Panic:

Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.

Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.

Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.

Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!"

Stay in the present. Notice what is really happening to you as opposed to what you think might happen.

Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.

When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backward from 100 by 3's or snapping a rubber band on your wrist.

Notice that when you stop adding frightening thoughts to your fear, it begins to fade. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.

Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

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