Panic disorder

Panic disorder is characterised by the incidence of repeated panic attacks. They can last from a few seconds to a few minutes, and are experienced as extremely terrifying and uncomfortable .

Proper treatment with cognitive-behavioural therapy, medications, or a combination of the two helps most panic disorder sufferers.

Alternative name

Panic attack

What is panic disorder?

• In a typical case, the sufferer is overcome by intense feelings of fear which seem to come out of nowhere and last a few minutes. Often, in the middle of an attack, people may fear they are having a heart attack, or are going crazy.
• They often experience a racing or pounding heartbeat, chest pains, dizziness, light-headedness, nausea, a feeling of being smothered, breathlessness, tingling or numbness in the hands, hot flushes or chills and a feeling of losing control. However, not all these symptoms have to be present for it to be classified as a panic attack.
• Anyone can develop the disorder, although it usually begins between late adolescence and the mid-30s. Children may also suffer from it, and women are more prone than men.
• The first attack may occur after a stressful life event such as the death of a close family member or friend, or a loss of a close interpersonal relationship.
• Sometimes the sufferer will consult various doctors and medical specialists, such as cardiologists, physicians, or neurologists, as they fear they suffer from a life-threatening disease. Often a person may go for years without an accurate diagnosis being made. This can in turn lead to other complications, such as the patient avoiding situations or places and developing agoraphobia.

What causes panic disorder?

• Initially, doctors assumed the disorder was related to psychological problems, but it’s now known that brain chemistry and genetic factors play a role, as do stressful life events or circumstances.
• First-degree relatives of people with panic disorder have a greater chance of developing the disorder.

Symptoms

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

• Palpitations, pounding heart, or accelerated heart rate,
• Sweating,
• Trembling or shaking,
• Sensations of shortness of breath or smothering,
• Feeling of choking,
• Chest pain or discomfort,
• Nausea or abdominal distress,
• Feeling dizzy, unsteady, light-headed, or faint,
• Derealisation (feelings of unreality) or depersonalisation (being detached from oneself),
• Fear of losing control or going crazy,
• Fear of dying,
• Paresthesias (numbness or tingling sensations), and
• Chills or hot flushes.

Diagnosis

• A clinician (usually a GP) makes the diagnosis. A psychiatrist should do a thorough assessment, including taking an in-depth history of the patient and his or her family.
• The diagnosis is made according to the criteria in the DSM-IV (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders). Clinicians will need to confirm that panic attacks are followed by at least one month of continual worry about having another attack, as well as implications or consequences, and that the attacks have led to significant behaviour changes (like agoraphobia).

Treatment

• Studies have shown that proper treatment with cognitive-behavioural therapy, medications, or a combination of the two, helps most panic disorder sufferers.
• The cognitive-behavioural approach educates patients how to perceive the panic situations in a different way, and show ways to reduce anxiety, either by breathing exercises or by techniques to refocus attention, for example.
• Sometimes exposure therapy can also be used to help alleviate phobias formed as a result of the disorder. In exposure therapy, people are very slowly exposed to the fearful situation until they become desensitised to it.
• Some people find the maximum respite from panic disorder symptoms from certain prescription medications. The two types of medications shown to be safe and effective are antidepressants and benzodiazepines.

Prognosis

A panic disorder is treatable and symptoms can be effectively relieved. If antidepressants are used as a treatment, the patient is usually started on a low dose, which is slowly increased. This treatment can last several weeks but will bring an end to the panic attacks. A key element of the psychotherapy for panic disorder is ‘exposure’ to feared stimuli. Learning not to avoid is a crucial aspect of treatment.

When to call your doctor

The most important step is to consult a professional for an accurate diagnosis. Help is available and in most cases is effective in relieving symptoms. In some cases, people who suffer full-blown, repeated panic attacks can become disabled by the condition, and their lives can become restricted to the point where they avoid normal, daily activities. In this case they should seek treatment before it develops into a more serious condition, such as agoraphobia. Often a panic disorder can be accompanied by other serious problems, such as depression, drug abuse, or alcoholism. These problems should also be treated.

How can panic attack be prevented?

There are, however, several ways to help decrease such feelings of anxiety:

First, learn to ‘accept’ anxiety. Don’t feel under pressure to relax; it’s OK to feel anxious, and to simply practise facing these symptoms. Indeed, therapists may suggest ways of increasing ‘interoceptive exposure’, that is, teach people to increase anxiety levels, and then encouraging them to simply accept this feeling of anxiety.

Second, take it slow. It may be useful to make a list from one (least anxiety provoking) to 10 (most anxiety provoking) that describes different situations that are being avoided. Gradually learn to face each of the different kinds of situation labelled.

Third, relaxation exercise can be useful when anxiety levels mount during exposure to internal cues (for instance, feeling dizzy after rapid breathing) or external cues (for instance, moving up on the hierarchy of avoided situations). Visualising a relaxing scene or a supportive person using all your senses and slow steady abdominal breathing may be useful.

Early treatment can limit the level of disability/dysfunction reached and may help prevent the development of coexisting conditions such as depression and alcoholism, or the progression to agoraphobia.

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.