Panic Disorder The first panic attacks are often the worst, mostly because you have no clue to what is happening to you, and because they appear so suddenly. You experience intense discomfort and a number of symptoms appear within a minute or so. The intensity of the attacks is not in proportion to the triggering factor, if any, and this contributes even more to the feeling of unsecurity and anxiety. During a panic attack you feel symptoms such as heart palpitations, sweating, dizziness, shaking, choking, nausea, feelings of derealization, fear of losing control, becoming crazy, or fear of dying. It is common to have several of these symptoms at the same time. No wonder you think you are dying during these first panic attacks. The anxiety and the bodily symptoms are very strong and you have no earlier experiences to rely on. Many end up in the emergency room, believing that they have had a heart attack or an allergic shock. The right diagnosis is seldomly given right away, and once received it can be hard to accept. The experience of panic is so frightening that it is difficult to get rid of. You start worrying that it will come back and start noticing signs of symptoms from the body. The anxiety from being scared by the panic attack is almost as intensive as the attack itself. You are almost certain that you were about to die, or that you had contracted a deadly disease. You develop a fear of the panic, so called anticipational anxiety. The thoughts about a possible new attack remain in your head and you get uneasy, sad and restless. Your life is tainted by a fear of death. Every little signal from the body is registered and read as a threat. The body tension is increased, and so is the risk for a new attack. After a while the thought "I must not panic" threatens the body and you react with panic. Already at this stage you can experience that it is difficult to get outside your own home. Panic attacks can happen to anyone. 10-30 per cent of a population have had single panic attacks but never develop panic disorder. About 2-5 per cent (different numbers can be found) develop panic disorder after their first attack. Women have three times as high frequency as men. The diagnosis panic disorder is given after at least four attacks within a month, or one panic attack which resulted in fear of a new attack during at least one month. There is in fact something called "Non-fearful panic disorder", implying attacks with dizziness or fainting, without anxiety. Often the first panic attack appears after a stressful or difficult period, with excessive demands and a changed life situation. The panic disorder often begins in the late teens or mid twenties, when you need to decide about job and relations. Maybe you have had your first child or a close relative has passed away. The anxiety often appears some time after the life-changing event, when everything has calmed down, and this makes it less obvious that there is a connection. The persistent stress has activated the body's alarm system and the tension has increased. The natural response of the body is anxiety and panic. You have mobilized for fight and the body is prepared. The stress in your life is not the cause of panic disorder but can be the triggering factor. The body cannot discriminate between fantasy and reality. If you close your eyes and intensely imagine a threat, your body will react as if the threat were real. The mental and biochemical reactions are intertwined, and you can never think or feel without chemical reactions taking place. If you imagine that you are standing by a steep slope, you may react with vertigo. If you have panic disorder you experience fear even though nothing dangerous is happening. Our thoughts make the body react, but since it cannot run or fight the fantasy, we get anxious and tense. The body works at a high level of tension, which may result in shivering and aching muscles. The body reacts more rapidly with each panic attack. Less threat is needed and the anxiety can get stronger with the same triggering factor. In your mind you start to interprete more body signals as threatening. If you experienced hear palpitations during your first panic attack, you might now avoid physical strain, since the heart then beats more rapidly. Persons with panic disorder can easily develop agoraphobia, avoiding situations where they feel locked in if panic should appear. Please read more about this in the section about agoraphobia. Another consequence of panic disorder can be depression. You feel insecure, might get job problems and find it difficult to meet the demands from family and society. This becomes a vicious circle, leading to increased anxiety and a poor quality of life. Panic disorder must therefore always be treated. And even if the anxiety may go on for long periods of time, the prognosis is good. You can learn to deal with the anxiety and get a better life!