Panic disorder is a condition in which a person regularly experiences panic attacks , which are commonly experienced as sudden, brief episodes of fear and anxiety which cause symptoms such as a racing heartbeat, heavy perspiration and shortness of breath. About 6 million Americans aged 18 and older suffer from a panic disorder at some point in their lifetime, according to the National Institute of Mental Health.
Panic disorder is among the most common anxiety disorders. In most cases, people with panic disorder experience panic attacks that occur seemingly at random, but may be associated with particular situations, such as crowded rooms or high places. Panic disorder is diagnosed when a patient has experienced one of the following after at least one attack during a period of at least one month:
Ongoing concern that attacks will continue
Worry about the potential significance and impact of an attack
Change in behavior to avoid future attacks
About one in three patients diagnosed with panic disorder also suffers from agoraphobia, which is an inability or unwillingness to venture beyond comfortable surroundings due to fear of intense anxiety.
Panic disorder is a serious, potentially debilitating condition. Left untreated, it can have devastating consequences, with 20 percent of patients attempting suicideaccording to the National Mental Health Association.
For those who do seek help, panic disorder is usually highly treatable. Cognitive behavioral therapy techniques are particularly effective, and may be as effective as medication in the short term. However, in the majority of cases, a combination of therapy and medications is the most effective treatment.
About panic disorder
Panic disorder is a type of anxiety disorder in which a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last between 10 and 15 minutes, but may have side effects that last for hours, and cause symptoms such as a racing heartbeat, heavy perspiration and shortness of breath. About 6 million Americans aged 18 and older suffer from panic disorder at some point in their lifetime, according to the National Institute of Mental Health (NIMH).
In most cases, people with panic disorder experience attacks that seem to occur randomly and appear to be unrelated to the environmental situation. These are known as unexpected or uncued attacks. However, attacks may also be related to a specific type of situation – for instance, whenever a person crosses a bridge or is in a crowd.
Panic disorder is among the most common anxiety disorders. It is diagnosed when a patient has recurrent panic attacks. In addition, a patient needs to have experienced one of the following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV after at least one attack during a period of at least one month:
Ongoing concern that attacks will continue
Worry about the potential significance and impact of an attack
Change in behavior to avoid future attacks
Recurrent panic attacks are not diagnosed as panic disorder if another medical condition (such as an overactive thyroid gland), or another type of anxiety disorder or other mental disorder is responsible for the attacks. Such disorders may include:
Obsessive-compulsive disorder(OCD)
Post-traumatic stress disorder(PTSD)
Separation anxiety disorder
Specific phobia
Social phobia
Panic disorder also is not diagnosed if the use of medications or other substances (such as caffeine or illegal drugs) is responsible for the attacks.
Panic disorder is likely to first appear during the period between late adolescence and a person’s mid-30s. About half of all people who develop panic disorder do so by age 24. In some cases, patient attacks peak in late adolescence, subside for some time and then peak again during a person’s mid-30s. Onset of panic disorder is unusual after age 45. Women are twice as likely as men to be diagnosed with panic disorder.
Deep emotional distress is common in patients diagnosed with panic disorder. Personal relationships, job performance and overall happiness may suffer as patients become demoralized and depressed.
Patients may use alcohol or recreational drugs to attempt to deal with these feelings. Among patients with panic disorder, about 30 percent use alcohol and 17 percent use illegal drugs to combat stresses brought on by panic attacks, according to the National Mental Health Association. Recent research indicates that panic disorder may contribute to the development of an alcohol use disorder and vice versa.
Left untreated, panic disorder can have devastating consequences, with 20 percent of patients attempting suicide.
Although panic disorder is highly treatable, research suggests that it is often undertreated. Barriers to effective care, especially in the United States, include difficulties with detection and diagnosis by primary care physicians, patients’ uncertainty about where to seek help and problems with insurance coverage and concerns about cost of care. People who experience agoraphobia sometimes do not seek treatment because the fear of intense anxiety upon leaving home results in an unwillingness to go to an appointment. These individuals may require in-home services in the early phases of treatment.
Types and differences of panic disorder
Panic disorder is usually divided into two categories. According to the National Institute of Mental Health(NIMH), about one in three people diagnosed with panic disorder also suffer from agoraphobia, which is an unwillingness to venture beyond comfortable surroundings due to fear of intense anxiety. When the two disorders co-exist, it is is known as panic disorder with agoraphobia. The remaining patients with panic disorder are diagnosed with panic disorder without agoraphobia.
People who have panic disorder with agoraphobia may develop the disorder as a result of suffering numerous, unpredictable panic attacks. Patients who experience the terror of these attacks will often do anything to avoid them. As a result, they become increasingly reluctant to enter into any situation that might trigger another attack and find themselves shunning social contact and staying at home. This type of agoraphobia often begins just a few weeks after the onset of panic attacks, but may take up to a year or longer to develop.
Recent research indicates that panic disorder with agoraphobia may contribute to the development of an alcohol use disorder and vice versa.
Some experts speculate that panic disorder without agoraphobia is actually underreported and may be more common that generally believed. According to some estimates, women diagnosed with this condition outnumber men by two to one.
Potential causes of panic disorder
The exact cause of panic disorder has not been determined. However, stress and various biochemical factors are believed to contribute to the condition. It is also believed that heredity plays a role, as panic attacks are more likely to affect people with a family history of such attacks. A close family member with a history of the disorder increases a person’s risk of experiencing symptoms by up to eight times. The risk increases to 20 times in situations where panic attacks first appear before age 20.
Some evidence suggests that biological factors may be at least partially responsible for panic disorder. These include possible abnormalities in a person’s autonomic nervous system, increased arousal and sudden chemical imbalances.
The brain of the affected person is also capable of turning occasional panic attacks into a full-blown disorder. People who previously have experienced attacks may develop an exaggerated response to normal bodily reactions, which can trigger panic attacks. An example is hyperventilation, which initiates a rapid heartbeat and creates fear that a panic attack is occurring.
Signs and symptoms of panic disorder
Patients with panic disorder may experience panic attacks in a variety of different patterns. Panic attacks occur suddenly, with symptoms following rapidly and reaching a peak within 10 minutes. Symptoms of panic attack include:
Palpitations (rapid or pounding heartbeat)
Heavy perspiration
Shortness of breath or feeling of suffocation
Chest pain
Dizziness or lightheadedness
Tightness in the throat
Nausea or abdominal cramping
Chills or hot flashes
Tingling and numbness in the hands
Trembling
Sensation of choking
Feelings of unreality or being detached from oneself
Fear of losing control or “going crazy”
Fear of dying
A person who experiences four or more of these symptoms could be having a panic attack. As these symptoms multiply, the individual may feel an impending sense of doom or a loss of control. Gradually, these feelings and symptoms will subside. Once the attack has passed, a feeling of fatigue may set in.
In some cases, patients diagnosed with panic disorder may experience panic attacks that occur regularly and frequently. In other cases, patients may have short periods in which they experience many attacks followed by periods of relative calm.
In addition, people with panic disorder are likely to experience many attacks in which just a handful of symptoms appear. These are known as limited-symptom attacks. They may also experience full panic attacks, in which many more symptoms appear.
Patients with panic disorder may have disturbed sleep patterns because of panic attacks that occur at night. Sleep may also be disrupted because of chronic, panic-related anxiety.
Patients with panic disorder are likely to experience symptoms in between attacks. These are chiefly psychological and involve worrying about future attacks and the potential consequences of such attacks. Their behavior may change dramatically as they take steps to avoid any situation that might trigger an attack. This can become so significant that the patient eventually is diagnosed with agoraphobia, which is an unwillingness to venture beyond comfortable surroundings due to fear of intense anxiety. Symptoms of agoraphobia may come and go in tandem with the incidence of panic attacks, or agoraphobia may be chronic and constant.
In many cases, panic disorders are associated with other mental disorders. For example, panic disorder is closely associated with major depression. Other conditions associated with panic disorder include agoraphobia, post-traumatic stress disorder and phobias (e.g., social phobias, specific phobias).
In some patients, the overwhelming feelings of fear may be accompanied by various symptoms of sympathetic nervous system arousal, such as sweating, palpitations, diarrhea, and often, an angina-like chest pain resembling a heart problem. However, detailed medical cardiac “workups” in patients with panic disorder typically show no abnormalities.
Finally, patients diagnosed with panic disorder may experience other medical conditions such as asthma (respiratory disorder characterized by wheezing), obesity, irritable bowel syndrome (disorder of the lower intestinal tract) and mitral valve prolapse (disorder in which a heart valve does not properly close). Whether these disorders cause panic disorder or, in certain cases, are secondary to it or exacerbated by it remains unclear.
Diagnosis of panic disorder
Although panic attacks are frightening, they do not typically cause physical harm, and many people have just one or two attacks during their lifetime. However, patients should notify their physician when panic attacks occur frequently or interfere with daily functioning, because this may indicate the presence of panic disorder.
Before diagnosing panic disorder, a physician will perform a complete physical examination and compile a thorough medical history. The physician will also want to rule out other medical conditions that could be causing symptoms, such as a heart problem or an overactive thyroid gland.
Panic disorder is diagnosed when the patient has recurrent, unexpected panic attacks, and experiences one or more of the following for a month or longer:
Ongoing concern about future attacks
Concerns about the significance of future attacks and their potential consequences
Change in behavior to reduce the likelihood of future attacks
In addition, the patient’s attacks cannot be caused by a general medical condition or the use of substances, and cannot better be explained by another anxiety disorder or mental illness.
If the patient also has signs of agoraphobia, a diagnosis of panic disorder with agoraphobia is likely.
A patient who appears to have panic disorder may be referred to a psychiatrist or other mental health professional for an evaluation. Experts in mental health care can help determine whether panic attacks are the result of panic disorder, or if symptoms arise chiefly due to another disorder, such as post-traumatic stress disorder(PTSD), social phobias or specific phobias.
Treatment options for panic disorders
Patients diagnosed with panic disorder have several treatment options. In the majority of cases, a combination of therapy and medications is the most effective treatment. Antidepressant medications which have been proven to work as a treatment for anxiety disorders are usually effective in preventing future attacks, even in patients who are not depressed. Anti-anxiety medications may also be prescribed to help stabilize symptoms while the long term medication is being started.
It is important to note that use of both antidepressants and anti-anxiety medications should be closely monitored by a physician. They may take time to become effective and the effectiveness varies by patient. A physician may have to modify the dose of a medication several times, or even change medications, before identifying the optimal one for the patient’s symptoms, while minimizing any side effects. Patients should not stop using antidepressant or anti-anxiety medications unless under close supervision of a physician, because this may cause withdrawal symptoms, one of which is likely to be increased anxiety. In addition, use of antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents, according to the U.S. Food and Drug Administration(FDA).
Cognitive behavior therapy(CBT) can help patients learn techniques that will enable the development of particular coping skills to handle attacks when they occur. Patients will learn to recognize the signs of an impending attack and to use breathing and relaxation techniques to reduce symptoms. In addition, patients may be gradually exposed to situations that are frightening and in which they can test new coping skills. This is known as exposure therapy.
Support groups can also help patients relieve their anxiety. These are sessions in which people with panic disorders share their own experiences and offer encouragement and understanding to one another.
Most patients require only short-term therapy and concurrent use of medication to learn to control panic attacks. The right treatment regimen can help reduce or prevent panic attacks in between 70 and 90 percent of patients, according to the National Mental Health Association.
Prevention methods for panic disorder
In addition to medications and therapy, patients diagnosed with panic disorder can take other steps to reduce their odds of suffering panic attacks. Patients who have too much stress in their lives may be at a higher risk for panic attacks. Relaxation techniques such as meditation, muscle relaxation, breathing techniques and guided imagery may help people feel more relaxed.
Taking time to engage in leisure and recreational activities can help restore balance to patients’ lives, leaving them less vulnerable to stress and panic. Adhering to a healthful diet and getting plenty of rest and regular exercise as well as avoiding certain substances – such as caffeine, alcohol, nicotine, amphetamines, cocaine and marijuana – can reduce the likelihood of panic attacks.
Finally, patients with panic disorder can find great relief in peer support. Understanding and supportive family and friends can reduce anxieties that will reduce the odds of panic attacks.
Questions for your doctor about panic disorder
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to panic disorder:
Why do you suspect I may have panic disorder?
What tests or evaluations must I undergo to verify a diagnosis of panic disorder?
Do you have experience treating people with panic disorder?
Do I have any underlying conditions that may cause or contribute to my panic disorder?
What type of panic disorder do I have?
Do I have any other emotional disorders in addition to panic disorder?
What can I do to reduce the impact of panic disorder on my overall health?
What are my treatment options? How effective are treatments?
How can I prevent panic attacks associated with panic disorder?
Might I benefit from medications? Which do you recommend? What are the potential side effects?
What type of therapy might benefit me? Can you recommend a qualified therapist?
Are my children at greater risk of panic disorder or other anxiety disorders because I have panic disorder?
