>> Panic Attacks, Panic Disorder
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
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.
ANXIETY VS. PANIC
What is the difference between anxiety and
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.
SYMPTOMS OF AN PANIC ATTACK
What are the signs and symptoms of a panic
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
- Shortness of breath or smothering
- Palpitations, pounding heart, or accelerated
- Chest pain or discomfort
- Trembling or shaking
- Feeling of choking
- Nausea or stomach distress
- Feeling unsteady, dizzy, lightheaded,
- Feelings of unreality or of being detached
- 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
WHEN PANIC BECOMES PANIC DISORDER
What is panic disorder?
- Unexpected panic attacks occur
spontaneously and for no clear reason. They might
even occur when you’re relaxed or asleep.
- 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.
- 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.
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
- 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
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
FACTS ABOUT PANIC DISORDER
from the National Institute of Mental Health:
CAUSES OF PANIC DISORDER
What causes panic disorder?
- 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 may coexist with other
disorders, most often depression and substance
- Appropriate diagnosis and treatment of
other disorders are important to successfully
treat panic disorder.
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.
DIAGNOSING PANIC DISORDER
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,
EFFECTS OF PANIC ATTACKS
What are the effects of panic disorder?
- Irritable bowel syndrome,
a disorder characterized by stomach cramps,
abdominal pain, bloating, constipation,
- Mitral valve prolapse,
a minor cardiac problem that occurs when
one of the heart’s valves doesn't
- Chronic fatigue.
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
- 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
Other possible complications of panic disorder are:
What is agoraphobia?
- 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
- 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.
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).
- 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
According to the Anxiety
Disorders Association of America
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.
TREATMENT FOR PANIC DISORDER
How is panic disorder treated?
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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