Panic disorder
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Contents |
Overview
Panic Disorder is one diagnosis in a category of mental health conditions known as anxiety disorders. It is generally thought that 1-2% of the population has this disorder and that there is a strong predisposition toward Panic Disorder in certain families. Some research shows that individuals with first-degree relatives (parents, grandparents, siblings, for example) who have a Panic Disorder are 8 times more likely to also have the disorder.
Panic disorder is characterized by unpredicted, recurring episodes of intense fear accompanied by such physical symptoms as heart palpitations, chest pain, shortness of breath or hyperventilation, perspiration, weakness, dizziness or faintness, fatigue, or abdominal pain such as nausea or a feeling of being smothered or crushed.
These bouts are known as panic attacks and produce an unrealistic sense of doom, loss of control, or pending death. Panic attacks last about 10–15 minutes on average, but can occur in succession of one another, or in “waves.” Panic attacks can happen at any time, creating even more anxiety in the individual as they intensely dread or worry about their next attack. One may believe they are experiencing a heart attack, death, or insanity during these attacks.
Panic disorder is based on perceived threats and fears, and can be treated with proper medication or cognitive psychotherapy, yet there is no cure at this time. Even though it is a very treatable disorder, some people tend not to address their symptoms when early stages are apparent due to various reasons such as embarrassment or shame. This causes the disorder to worsen and encourages the development of other anxiety disorders or conditions.
Individuals who have frequent panic attacks may start to avoid places where attacks have taken place, causing them to dread these places and form new fears. If the anxiety is intensified to this point, it can become very disabling. Panic disorder can inhibit normal, daily activities and affect the individual’s personal choices and plans for the future. If the condition goes untreated and the individual begins displaying such behavior, they may progress to a stage of comorbidity with agoraphobia—fearing to be in open areas or public places in which they believe they are helpless with no means of escape.
People with panic disorders often develop other serious conditions including depression or substance abuse. Panic disorders are twice more common in women than men and afflict more than 6 million Americans. Not everyone who experiences panic attacks has a panic disorder, but the frequency of panic attacks appears to be genetically inherited.
Panic Attack Symptoms
Panic Disorder is characterized by recurring Panic attacks. A Panic attack is the experience of intense fear or discomfort that occurs without being caused by actual events that could endanger one’s wellbeing. Along with intense fear or discomfort during the episode, at least four of the following symptoms usually occur in a Panic attack:
1. Trembling or shaking
2. Sweating
3. Accelerated heart rate 4. Shortness of breath
5. Chest pain or discomfort
6. Chills or hot flashes
7. Fear of dying
8. Nausea or GI distress
9. Numbness or tingling
10. Dizziness
11. Sensation of choking
12. Fear of losing control or of going crazy
13. A sense of unreality or detachment
Types of Panic Attacks
There are 3 types of Panic attacks. These are classified according to how the episode is triggered. The 3 types of Panic attacks are:
• Unexpected or Uncued panic attacks are not triggered by identifiable situations in the individual or in the environment. Unexpected panic attacks seem to occur in various situations and randomly. Those who have this type of panic attacks cannot predict their onset.
• Situationally Bound or Cued panic attacks occur almost invariably in certain circumstances and conditions and are said to be triggered by these circumstances and conditions. Triggers can be internal or external and include such things as places, activities, events, thoughts, beliefs and feelings
• Situationally Predisposed panic attacks occur when episodes are triggered by certain circumstances and conditions but not every time these circumstances and conditions occur. In situationally predisposed attacks, there will be times in which an attack is not triggered by these cues. Due to the ‘hit and miss’ nature of the attacks, an individual cannot predict when exposure to the ‘trigger’ will cause an attack and may, for example, drive without distress on most days, but have Panic attacks when driving sometimes.
Types of Panic Disorders
Everyone who experiences a panic attack does not have a Panic Disorder. The disorder involves more than one episode over a period of time and a group of certain symptoms occur during an attack and between panic attacks when one has the full disorder. There are 2 different types of Panic Disorder: with or without agoraphobia. These 2 types are called specifically:
• Panic Disorder Without Agoraphobia
• Panic Disorder With Agoraphobia
Both types of Panic Disorder involve recurrent panic attacks that cause significant distress when they are occurring and afterward. During the panic attacks, the symptoms of panic attack listed above occur (at least 4 of the 13) and after the attack, for a prolonged period, there is distress such as:
• Significant concern about whether more attacks will occur
• Significant worry about the effects of the attacks such as fear of being disabled or going crazy, and
• A significant change in behavior because of having had panic attacks and the fears and worries about having more
Agoraphobia
The 2 types of Panic Disorder are characterized by whether one is agoraphobic or not. Agoraphobia is an intense anxiety about being in places or situations from which one feels unable to easily leave or in which one feels help may not be available if needed. Agoraphobia is not used to describe anxiety in situations of real potential harm, but indicates an experience in which others may comfortably be there without distress and there are no apparent risks. Agoraphobia is experienced during the course of usual daily events and situations for those who suffer from this condition. Some of these are, for example, leaving one’s home, being alone, being in a crowd, being on a bridge or traveling.
People with agoraphobia may avoid situations in which they experience intense anxiety and may, for example, be unable to leave their homes or drive across bridges. Others will do these successfully but still experience intense distress that most people without panic symptoms do not.
Ruling out Other Conditions
Since a Panic Disorder involves many physiological symptoms such as an accelerated heart rate, shortness of breath, sweating, nausea and sometimes chest pain, it is important to consult a physician when these symptoms occur. Such physiological symptoms of Panic Disorder can indicate other medical conditions. A thorough physical examination is the first step in clarifying a diagnosis. Panic Disorder symptoms can also be caused by the use of substances or medications and any use of these should be accurately reported so during an evaluation of symptoms. Symptoms of withdrawal from certain substances can, for example, mimic the symptoms of a Panic Disorder.
Other mental health conditions such as Post-traumatic Stress Disorder (PTSD), Phobias, and obsessive-compulsive disorder (OCD) or in children, Separation Anxiety, have symptoms that are similar to those of Panic Disorder. Mood disorders such as depression and Bipolar Disorder also can cause intense anxiety that may be confused with the symptoms of Panic Disorder.
Panic Disorder Treatment
The treatment for Panic Disorders is usually a multi-faceted approach with a combined use of therapies such as individual and group therapy as well as medications for some. Many medications are non-addictive such as anti-depressants and can be effective in reducing anxiety levels. For some, mood stabilizers are also beneficial. Some anti-anxiety medications such as benzodiazepines cause physiological dependence and are contraindicated for long-term use or use by those with Substance Disorders.
Therapy which focuses upon relaxation techniques and other stress management issues can help manage Panic Disorders. This is usually combined with other therapy techniques which teach coping skills, self-soothing and explore the triggers and associated thoughts and feelings as well as ways to manage these.
No substance or medication or medical condition or other disorders such as phobias, OCD or PTSD or Separation Anxiety (for children)
