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Panic disorder is a major health concern and one of the most frequently reported psychiatric disorders in the United States. Panic disorders fall under the umbrella category of anxiety disorders and relate to reoccurring and unexpected panic attacks. While a person might occasionally experience anxiety, sleeplessness and other turmoil, a panic attack has specific mental and physical characteristics.
One of the most telling characteristics of a panic attack is the experience of extreme fear without cause. In a panic attack, there is no real danger to ring the alarm bells of fear. The sense of danger comes from the accompanying feelings in the body that cause individuals to believe they may die or lose control. These physical symptoms help determine a diagnosis of panic attack and include the following:
- Rapid heart rate or chest pain
- Shaking or trembling, sometimes a numb or tingling feeling
- Difficulty breathing, feelings of choking or shortness of breath
- Stomach upset or nausea
- A sense of dizziness
- Feeling hot or cold
Since the main characteristics of a panic attack are similar to heart attack, it’s easy to see why these physical characteristics cause such concern and account for many visits to the emergency room. However, panic attacks are usually short lived. They reach their highest level of discomfort in about 10 minutes, then pass. Individuals sometimes report their recovery may take several hours.
In addition to the physical expressions listed above, individuals experiencing panic attacks often report thoughts of doom and personal catastrophe. They think they will die, lose consciousness, go crazy or just “lose it.” They may have feelings of being detached from the body or not being real. Many therapists and doctors believe that how individuals interpret these thoughts provides the key to treating panic disorder. Indeed, researchers have found that as the individual selectively focuses on these thoughts, panic symptoms escalate.
Some individuals can trace the onset of panic attacks to known triggers, such as being in a crowded elevator, while others experience panic attacks with no known cause. When panic attacks always occur in certain situations, they are called “situationally-bound panic attacks.” Others may be susceptible to panic attacks in certain environments and situations but the panic attack is not inevitable. In this case, the individual is considered “predisposed” to panic attacks. When panic attacks occur unexpectedly, without known cause and with no warning, they are considered “unexpected panic attacks.” Individuals may experience all three triggers to panic attacks, often beginning with unexpected attacks and then developing either situational or predisposed types of attacks.
Agoraphobia is deeply intertwined with panic attacks and panic disorder. Agoraphobia describes fear or anxiety about placing oneself in places or situations where it might be difficult or socially unacceptable to leave, or where it might be problematic or impossible to get help if a panic attack occurs. Agoraphobia is mistakenly understood as a fear of crowds, but many individuals experience it when they are alone outside their home. In many cases, individuals with agoraphobia will restrict their travel outside the home to limit the possibility of panic attacks. Having companionship on outings often helps alleviate this anxiety and allows individuals to continue their daily routine.
What It Is and Isn’t
A diagnosis of panic disorder results from a history of panic attacks, either with or without agoraphobia. The diagnosis requires ongoing worry about the panic attacks and a major change in lifestyle or behavior because of the panic attacks.
Panic disorder is not occasional worry. It’s not an experience of “freaking out” and feeling heightened anxiety. Panic disorder is a combination of physical sensations and mental thoughts that combine over time to seriously limit one’s ability to function.
It’s important to also distinguish panic disorder from other anxiety disorders such as social phobia or post-traumatic stress disorder (PTSD). Anxiety and fear related to unique objects or situations, such as flying, is categorized as a “specific phobia” rather than a panic disorder, even if some of the physical symptoms are similar.
Medications generally do not cure panic disorder; they simply allow individuals to experience some control and relief over their symptoms. Other treatments include panic education, relaxation and guided imagery, breath retraining and respiratory control. Interoceptive exposure is a therapy that employs repeated, deliberate exposure to the bodily sensations of panic attacks to lessen and control the fear response to those sensations.
Therapists often attempt to help individuals control their fear of the panic attack through the use of healthy self-talk and coping statements. Here are some examples of coping statements for panic disorder:
- This too shall pass.
- I’ve survived other situations like this and I will survive this one too.
- I’m not in danger.
- I can just breathe and get through this.
Panic attacks sometime disappear without apparent cause. However in some cases, panic attacks can become chronic and greatly reduce an individual's quality of life. Untreated panic attacks can lead to serious health consequences, including increased risk for depression and substance abuse. Early intervention from a professional can provide needed relief from recurring panic attacks and reduce the risk that additional mental health conditions will arise.