What is panic disorder?
Panic disorder occurs when you experience recurring unexpected panic attacks. The DSM-5 defines panic attacks as abrupt surges of intense fear or discomfort that peak within minutes. People with the disorder live in fear of having a panic attack. You may be having a panic attack when you feel sudden, overwhelming terror that has no obvious cause. You may experience physical symptoms, such as a racing heart, breathing difficulties, and sweating.
Most people experience a panic attack once or twice in their lives. The American Psychological Association reports that 1 out of every 75 people might experience a panic disorder. Panic disorder is characterized by persistent fear of having another panic attack after you have experienced at least one month (or more) of persistent concern or worry about additional panic attacks (or their consequences) recurring.
Even though the symptoms of this disorder can be quite overwhelming and frightening, they can be managed and improved with treatment. Seeking treatment is the most important part of reducing symptoms and improving your quality of life.
Panic disorder causes
The causes of panic disorder are not clearly understood. Research has shown that panic disorder may be genetically linked. Panic disorder is also associated with significant transitions that occur in life. Leaving for college, getting married, or having your first child are all major life transitions that may create stress and lead to the development of panic disorder.
It’s not known what causes panic attacks or panic disorder, but these factors may play a role:
- Major stress
- Temperament that is more sensitive to stress or prone to negative emotions
- Certain changes in the way parts of your brain function
Panic attacks may start off by coming on suddenly and without warning, but over time, they’re usually triggered by certain situations.
Some research suggests that your body’s natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared itself for a life-threatening situation. Many of the same reactions occur in a panic attack. But it’s not known why a panic attack occurs when there’s no obvious danger present.
Panic disorder Symptoms
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour.
-Shortness of breath or hyperventilation
-Heart palpitations or racing heart
-Chest pain or discomfort
-Trembling or shaking
-Feeling unreal or detached from your surroundings
-Nausea or upset stomach
-Feeling dizzy, light-headed, or faint
-Numbness or tingling sensations
-Hot or cold flashes
-Fear of dying, losing control, or going crazy
Is it a heart attack or a panic attack?
Panic attacks often strike when you’re away from home, but they can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or sitting on the couch at home.
Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, heart palpitations, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.
Many people experience panic attacks without further episodes or complications. There is little reason to worry if you’ve had just one or two panic attacks. However, some people who’ve experienced panic attacks go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.
You may be suffering from panic disorder if you:
- Experience frequent, unexpected panic attacks that aren’t tied to a specific situation
- Worry a lot about having another panic attack
- Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
Anticipatory anxiety – Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
Panic disorder with agoraphobia
Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks. If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help.
Because of these fears, you start avoiding more and more situations. For example, you might begin to avoid crowded places such as shopping malls or sports arenas. You might also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.
Although agoraphobia can develop at any point, it usually appears within a year of your first recurrent panic attacks.
Situations or activities you may avoid if you have agoraphobia:
- Being far away from home, driving, or going anywhere without the company of a “safe” person
- Physical exertion – because of the belief that it could trigger a panic attack
- Going to places where escape is not easy, such as restaurants, theaters, stores, or on public transport
- Places where it would be embarrassing to have a panic attack, such as a social gathering
- Eating or drinking anything that could possibly provoke panic, such as alcohol, caffeine, or certain foods or medications
Causes of panic attacks and panic disorder
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.
Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:
- Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly
- Hyperthyroidism (overactive thyroid gland)
- Hypoglycemia (low blood sugar)
- Stimulant use (amphetamines, cocaine, caffeine)
- Medication withdrawal
Panic disorder Treatment
- To find out whether you have panic disorder, your doctor will give you a physical exam and order blood tests to rule out other possible causes of your symptoms, such as thyroid issues.Your doctor will then give you a psychological examination — which may consist of a mental health questionnaire — or refer you to a mental health professional, who will make a diagnosis based on your symptoms.It’s important to know and record your symptoms to get an accurate diagnosis.Some research suggests that people may see 10 or more doctors before being diagnosed with panic disorder, according to the American Psychological Association.Panic disorder is most often treated with psychotherapy, which can have several goals, including:
- Identifying possible panic attack triggers
- Breaking up fearful situations into smaller, more manageable parts
- Developing techniques to better deal with panic attacks, such as breathing retraining exercises and positive visualization
- Being exposed to specific symptoms of an attack in order to learn how to prevent a full-blown attack
Medications — including anti-anxiety, antidepressant, and sometimes anti-seizure drugs — are sometimes also used to help treat panic disorder.
Cognitive behavioral therapy for panic attacks and panic disorder
Cognitive behavioral therapy is generally viewed as the most effective form of treatment for panic attacks, panic disorder, and agoraphobia. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering the panic attacks. It helps you look at your fears in a more realistic light.
For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.
Exposure therapy for panic attacks and panic disorder
In exposure therapy for panic disorder, you are exposed to the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.
If you have agoraphobia, exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.