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Panic Attacks
Anxiety Disorders >> Panic Attacks, Panic Disorder And Agoraphobia

"A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience.”

Source: American Psychological Association UNDERSTANDING PANIC ATTACKS
What is a panic attack? A panic attack is a sudden and unexpected period of intense fear or discomfort. It comes out of the blue, without warning. Your heart begins to pound in your chest. You feel dizzy and sick to your stomach. It’s hard to catch your breath. You may feel like you’re dying or going crazy. You may even think you’re having a heart attack.

Panic attacks are terrifying. They can happen anywhere and at any time. Panic attacks often strike when you’re away from home. You may have one while you’re in a store shopping, walking down the street, or driving in your car. Panic attacks can even happen while you’re sleeping, causing you to wake up in a state of overwhelming fear.

Panic attacks are common. The Merck Manual reports that panic attacks occur in more than one-third of adults each year. You may experience an isolated panic attack yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, generalized anxiety disorder, or major depressive disorder.

What is the difference between anxiety and panic? Although panic attacks commonly occur in all the different types of anxiety disorders, there is a distinct difference between anxiety and panic. The difference lies in the duration and intensity of the symptoms. Panic attacks are episodes of intense fear that last only a short while. On the other hand, anxiety comes on more gradually, is less intense, and lasts longer.

What are the signs and symptoms of a panic attack? In a panic attack, symptoms develop abruptly and usually reach their peak within 10 minutes. A full-blown panic attack includes at least 4 of the following symptoms:
  • Shortness of breath or smothering sensation
  • Palpitations, pounding heart, or accelerated heart rate
  • Chest pain or discomfort
  • Trembling or shaking
  • Feeling of choking
  • Sweating
  • Nausea or stomach distress
  • Feeling unsteady, dizzy, lightheaded, or faint
  • Feelings of unreality or of being detached from yourself
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations
  • Hot or cold flashes

Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour.

Professionals group panic attacks into three types:
  1. Unexpected panic attacks occur spontaneously and for no clear reason. They might even occur when you’re relaxed or asleep.
  2. Situationally bound panic attacks are triggered by a specific situation (such as crossing a bridge or public speaking). This type of panic attack almost always occurs immediately after you are exposed or anticipate being exposed to the situation you fear.
  3. Situationally predisposed panic attacks are similar to situationally bound panic attacks. They are triggered by a specific situation. However, the difference is that the attacks only sometimes occur. Another difference is that they don’t always occur immediately after exposure to the feared situation. For example, if your trigger is public speaking, there are times when you give a speech without having a panic attack and other times when your panic attack only starts after you’ve already been speaking for 15 minutes.
What is panic disorder? If you’ve had a panic attack, this doesn’t necessarily mean that you have or will develop panic disorder. 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, if you meet the following criteria, you may be suffering from panic disorder:
  • You are experiencing frequent unexpected panic attacks.
  • You have been worrying for over a month about having another panic attack.
  • You’ve made a significant change in your behavior because of the panic attacks, such as avoiding places where you’ve previously panicked.
According to the American Academy of Family Physicians, panic disorder usually develops in the late teens and twenties. It rarely develops after the age of 35, and is twice as common in women as in men.

Once it develops, panic disorder tends to be a chronic condition. The frequency and intensity of the panic attacks tend to wax and wane over time. However, the sooner you get treatment, the better your outcome will be.

FACTS ABOUT PANIC DISORDER from the National Institute of Mental Health:
  • Approximately 2.4 million American adults ages 18 to 54, or about 1.7 percent of people in this age group in a given year, have panic disorder.
  • Panic disorder may coexist with other disorders, most often depression and substance abuse.
  • Appropriate diagnosis and treatment of other disorders are important to successfully treat panic disorder.
What causes panic disorder? Although the exact causes of panic disorder are unclear, the tendency to have panic attacks runs in families. If someone in your family has panic disorder, you are at an increased risk for developing it. 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.

How is panic disorder diagnosed? Panic disorder can be difficult to diagnose because of its similarity to certain medical conditions. Most of the symptoms of a panic attack are physical. In fact, these physical symptoms (such as chest pain and difficulty breathing) mimic those found in medical illnesses such as heart disease, asthma, and hyperthyroidism. Many people with panic disorder 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. In order to diagnose panic disorder, your physician will first need to rule out these other possibilities. Unfortunately, time may be lost before physical symptoms are equated with panic disorder and a correct diagnosis is made.

There are also a number of physical disorders and problems that commonly co-occur with panic disorder, including:
  • Irritable bowel syndrome, a disorder characterized by stomach cramps, abdominal pain, bloating, constipation, and diarrhea.
  • Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly.
  • Chronic fatigue.
What are the effects of panic disorder? 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.
You are likely to experience:
  • Anticipatory anxiety – Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense. This anxiety resembles that of Generalized Anxiety Disorder and stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
  • Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack.
Other possible complications of panic disorder are:
  • Depression – Depression is common in people with panic disorder. Panic attacks and the anxiety they cause can severely disrupt your normal routine. If you feel your life is out of control, you may become depressed.
  • Substance Abuse – You may try to treat your anxiety with alcohol or drugs. The National Mental Health Association reports that 30% of people with panic disorder use alcohol and 17% use drugs in an attempt to deal with their symptoms. Unfortunately, these attempts to self-medicate only make things worse.
  • Suicide – According to the National Mental Health Association, approximately 20% of people with panic disorder attempt suicide. If you are feeling suicidal, see Helpguide's Coping with Suicidal Thoughts and Feelings.
  • Agoraphobia – Agoraphobia is a common and disabling consequence of untreated panic disorder.
What is agoraphobia? Agoraphobia is translated as “fear of the marketplace.” It 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 have agoraphobia, you are afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You are also afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you may begin to avoid crowded places such as shopping malls or sports arenas. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.

The American Academy of Family Physicians lists a number of situations or activities that you may avoid if you have agoraphobia:
  • 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 would be difficult (examples include restaurants, theaters, stores, and public transportation).
  • Driving.
  • Places where it would be embarrassing to have a panic attack (such as parties and other social gatherings).
  • Ingesting substances that could possibly provoke panic (alcohol, caffeine, or certain foods).
According to the Anxiety Disorders Association of America, approximately one in three people with panic disorder eventually develops agoraphobia. Although the onset of agoraphobia can occur at any point, it usually appears within a year of your first recurrent panic attacks.

How is panic disorder treated? Panic disorder is generally treated with cognitive behavioral therapy, medication, or a combination of the two.

Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is generally viewed as the most effective form of psychotherapy for treating panic attacks, panic disorder, and agoraphobia. CBT focuses on changing your thinking patterns and can help you develop better ways of coping with your fears. The first aspect of treatment for panic disorder and agoraphobia typically involves education. You are taught about the nature of anxiety and the fight-or-flight response experienced during a panic attack. You learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy. Simply knowing more about your disorder can go a long way towards relieving your distress. You also will be taught to identify and evaluate the automatic thoughts you have during a panic attack. Many of these thoughts are irrational and exaggerate the dangerousness of the situation. You are taught to think through these thoughts and decatastrophize. 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 your learn that nothing disastrous is going to happen, the experience of panic becomes less terrifying.

Another aspect of cognitive behavioral therapy involves teaching you how to control your breathing. You are first asked to hyperventilate. Hyperventilation brings on many sensations such as lightheadedness and tightness of the chest that occur during a panic attack. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious. If you know how to control your breathing, you are also less likely to create the very sensations that you are afraid of.

Exposure to the physical sensations you fear is also an important part of treatment. In addition to hyperventilation, you may be instructed to run in place, shake your head from side to side, or hold your breath. These different exercises cause a number of sensations similar to the symptoms of panic. As you gradually expose yourself to these feared sensations, your panic and anxiety begins to go away. 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.

Melinda Smith created this article with contributions from Jeanne Segal, Ph.D. Last modified on 10/15/06.

Reprinted with permission from http://www.helpguide.org/. C 2008 Helpguide.org. All rights reserved.

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SOURCE: www.helpguide.org

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