Multiple: Panic Disorder

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Panic disorder is an anxiety disorder characterized by recurrent and unexpected panic attacks that are not caused by drugs, alcohol, or certain medical conditions like asthma. It can be a disabling condition, causing people to quit jobs or social activities, avoid going outside their home, or give up exercising. It also commonly leads to frequent and unnecessary visits to hospital emergency rooms.

Description

The most noticeable symptom of panic disorder is a panic attack, which is defined as a period of intense fear that comes on suddenly and builds to a peak within a few minutes (usually about ten minutes). The attack is often accompanied by a general feeling of doom and an urge to leave or escape from the setting in which the attack occurs. There may or may not be a pattern to a person's panic attacks. Some people may have one or two a week over a period of time, while others may have several attacks close together and then go for months or years before another attack.

Although panic attacks are a symptom of panic disorder, the two are not the same thing. It is possible for a person to have panic attacks without being diagnosed with panic disorder. To meet the official criteria for a diagnosis of panic disorder, a person must have recurrent and unexpected

panic attacks followed by at least one month of worry about having another panic attack. In addition, the official criteria specify that a person must have at least four of the following thirteen symptoms that characterize panic attacks:

• Heart palpitations or fast heartbeat
• Sweating
• Trembling or shaking
• Shortness of breath
• Choking sensations
• Chest pain
• Nausea or pain in the abdomen
• Dizziness or lightheadedness
• Tingling sensations
• Chills or hot flushes
• Depersonalization (a feeling that the self is unreal) or derealization (a feeling that the external environment is unreal)
• Fear of losing control (“going crazy”)
• Fear of dying

There are two subtypes of panic disorder: panic disorder with agoraphobia and panic disorder without agoraphobia. Agoraphobia is an unrealistic fear of going outside the safety of the home, particularly to use public transportation or visit large public places (shopping malls, sports arenas, or even parks or recreational facilities). About a third of Americans diagnosed with panic disorder have panic disorder with agoraphobia. Panic disorder with agoraphobia develops when the person's fear of recurrent panic attacks takes the form of avoiding places from which a quick exit or escape might be difficult or embarrassing (such as airplanes, trains, or buses; crowded stores; worship or other group activities, etc.). This form of panic disorder can interfere significantly with people's ability to complete their education, go to work, or meet friends outside the home.

Tips for Handling Panicky Feelings (Source: Anxiety Disorders Association of America)

Don't just stand there—move! Getting some physical exercise, whether it is yoga, jogging, or just going for a walk, can often lower one's anxiety level.

Talk to someone—a friend, parent, spouse, or doctor. Keeping anxious feelings inside often makes them worse.

Keep a diary or daily journal. It's a good way to find out what places, events, or other things stir up anxiety or panic attacks.

Eat a well-balanced diet; don't skip meals or eat a lot of junk food. It's also a good idea to cut down on coffee, tea, cola, or other drinks that contain caffeine.

Demographics

According to the National Institute of Mental Health (NIMH), between 1 and 4 percent of the American population suffers from panic disorder,

most of them adolescents or young adults. About 6 percent of the population will have a panic attack at some point in their lives. The average age of patients with panic disorder is twenty-four. It is unusual for people over forty-five to develop panic disorder for the first time.

Women are between two and three times more likely than men to develop panic disorder. With regard to race and ethnicity, researchers disagree. Some studies suggest that African Americans have a slightly higher rate of panic disorder than either Caucasian or Asian Americans, while other researchers think that these findings point to problems in the screening interviews used to detect panic disorder rather than the actual rates of occurrence.

People with certain medical conditions, such as hypertension (high blood pressure), migraine headaches, and irritable bowel syndrome, appear to have an increased risk of developing panic disorder.

Causes and Symptoms

The causes of panic disorder are not completely understood. Some possible causes that researchers are studying include:

• Genetic factors. A first-degree relative (parent, child, or sibling) of a person with panic disorder is eight times as likely to develop it as a person in the general population.
• Biochemical imbalances in the central nervous system. Some doctors think that differences in body chemistry cause some people to overreact to noises, lights, or other stimuli in the environment.
• Consuming large amounts of coffee, tea, or alcohol. These substances appear to trigger panic attacks in some people.
• A tendency to convert anxious thoughts into physical symptoms.
• A tendency to intensify minor physical sensations into the physical symptoms of a full-blown panic attack. For example, a man whose heartbeat speeds up when he is angry may worry when he notices the change in heart rate. He then experiences the resulting anxiety as the chest pain of a panic attack.

Diagnosis

The diagnosis of panic disorder is usually a diagnosis of exclusion, which means that the doctor arrives at the diagnosis by ruling out other possibilities rather than by positively identifying the disorder on the basis of

tests. There are no laboratory tests or imaging studies for panic disorder. The doctor will examine the patient for such medical conditions as disorders of the thyroid gland; asthma or other breathing disorders; or substance abuse. Men in particular are likely to drink alcohol in order to cope with panic attacks. The doctor will want to make sure that the patient is not abusing alcohol or prescription drugs.

If people go to the emergency room complaining of chest pain, the doctors there will commonly ask two simple questions to screen for panic disorder: 1) Have they had a spell or attack in the past six months when all of a sudden they felt anxious, frightened, or very uneasy? 2) In the past six months, have they ever had a spell in which they felt their heart race, could not catch their breath, or felt faint? A “yes” answer to either question is considered a positive screen for panic disorder.

Treatment

Panic disorder is highly treatable. Most patients are given a combination of medications and psychotherapy. The two forms of psychotherapy that are most useful in treating people with panic disorder are exposure therapy (for those with agoraphobia) and cognitive behavioral therapy. In exposure therapy, patients are introduced to their feared situation in gradual stages until they feel comfortable with it. For example, someone who is afraid to go shopping for groceries might start by just opening the front door, then walking down the front path to the sidewalk. Next, the person walks a few blocks, then goes to the store itself and purchases only one item, and so on. Some people recovering from agoraphobia refer to exposure therapy as the “five Rs,” which stand for react, retreat, relax, recover, and repeat.

In cognitive behavioral therapy (CBT), patients are given some education about anxiety and are taught to recognize and control their reactions to panic attacks. In CBT sessions, people learn to recognize things that trigger panic attacks or make them worse, such as specific thoughts or situations. They also learn to modify behavior so that it is more useful than simply avoiding the feared place or situation.

Doctors may prescribe medications in addition to psychotherapy, particularly if the patients' panic attacks are keeping them virtually house-bound. The medications prescribed for adults are usually antidepressants or tranquilizers. It may take several weeks for the medications to take effect. The doctor may need to try more than one medication before

finding the drug that works best for the specific patient, but most patients with panic disorder are helped by these drugs.

Complementary and alternative therapies that are effective in treating panic disorder include yoga, meditation, relaxation techniques, guided imagery, and hypnosis.

Prognosis

Most people do very well when treated for panic disorder provided they stick with their treatment plan. In addition, people who have been treated with psychotherapy can usually make arrangements for “booster sessions” if they feel the need for further help. There are also many support groups and online communities for people with panic disorder.

Prevention

There is no known way to prevent panic disorder because its causes are not yet fully understood. People can, however, lower their risk of panic attacks by avoiding the use of recreational drugs and learning stress management or relaxation techniques.

WORDS TO KNOW

Agoraphobia : An irrational fear of venturing outside the home or into open spaces, so strong that a large number of activities outside the home are limited or avoided altogether. Agoraphobia is often associated with panic attacks.

Cognitive : Pertaining to thinking, learning, or memory.

Diagnosis of exclusion : A diagnosis that the doctor arrives at by ruling out other diseases one by one rather than making the diagnosis on the basis of laboratory tests or imaging studies, or other test results.

Panic attack : An episode of intense fear that lasts for several minutes and is accompanied by physical symptoms or temporary disturbances of thinking.

Phobia : An unfounded or morbid dread of a specific object or situation that arouses feelings of panic.

The Future

Panic disorder is likely to continue to be a disabling condition for many people, particularly those who do not know that it is treatable. It is

possible that further research will help doctors learn more about the causes of the disorder and develop even more effective treatments.

SEE ALSO Alcoholism; Hypertension; Irritable bowel syndrome

For more information

BOOKS

Campbell, Nancy M. Panic Disorder. Mankato, MN: LifeMatters, 2002. National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 06-3879. Bethesda, MD: NIMH, 2006.

WEB SITES

Anxiety Disorders Association of America (ADAA). Panic Disorder. Available online in PDF format at http://www.adaa.org/bookstore/Brochures/panic_adaa.pdf (accessed May 5, 2008). This four-page brochure includes a self-test for panic disorder.

National Alliance on Mental Illness (NAMI). About Mental Illness: Panic Disorder. Available online at http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23050 (updated May 2003; accessed May 5, 2008).

National Institute of Mental Health (NIMH). Panic Disorder—A Real Illness. Available in PDF format at http://www.nimh.nih.gov/health/publications/panic-disorder-a-real-illness/complete.pdf (updated October 2005; accessed May 5, 2008).