A panic attack, the core feature of panic disorder, is a period of intense fear or discomfort that strikes suddenly, often in familiar places, where there is seemingly nothing threatening an individual. But when the attack comes, it feels as if there is a real threat, and the body reacts accordingly. The discomfort and sense of danger the attack brings is so intense that people with panic disorder often believe they are having a heart attack or other life-threatening illness.
Panic attacks are usually classified as being part of panic disorder if they occur more than once and are accompanied by at least four of the following symptoms:
- raging heartbeat
- difficulty breathing, feeling as though you 'can't get enough air
- terror that is almost paralyzing
- nervous, shaking, stress
- heart palpitation, feeling of dread
- dizziness, lightheadedness or nausea
- trembling, sweating, shaking
- choking, chest pains, distress
- fear, fright, afraid, anxious
- hot flashes, or sudden chills
- tingling in fingers or toes ('pins and needles')
- fearful that you're going to go crazy or are about to die
The most essential thing to learn about panic attacks are the experience of panic itself. Once it happens, a person's life changes dramatically. Panic attacks bring on the fastest and most complex changes known in the human body. It is experienced as overwhelming, uncontrollable dread, as if one is terribly ill, about to die or lose one's mind. A cascade of stimulants and hormones - adrenaline, epinephrine, glycogen, cortical, norepinephrine, among others - flood all the cells of the body via the bloodstream. Even violent poisons or traumatic injuries have less effect.
The impulse is to run, get out, or hide. The immediate cause is believing one is trapped and helpless, by some overwhelming threat. Often, panic happens after several weeks or months of stress. It happens more often with persons who are very worried, perfectionist, socially avoidant, or who have had abuse in childhood. What keeps panic going, and getting more intense and frequent, is worrying excessively about it and strenuously avoiding situations that appear to bring panic .
Unchecked Panic: A "Triple A" Threat
Panic attacks masquerade as a variety of medical disorders. Panic mimics some medical conditions almost completely, causing years of misdiagnosis. Almost everyone who panics believes they have a serious physical illness, and go from doctor to doctor for several years as symptoms shift. However, if told nothing is wrong or that the problem is psychiatric, the patient may feel frustrated or embarrassed and not seek further help. This can result in three serious consequences:
- Anticipatory anxiety - This condition is triggered by thinking about the possibility of having a panic attack. Once this develops, anticipatory anxiety can cause the person to become reclusive, opting to endure the attacks alone rather than in public where there is no chance of escape and slight chance of help.
- Avoidance - Panic attack sufferers may discontinue activities that seem to trigger panic attacks, such as going to the park, driving, riding in elevators, or doing anything that brings on frightening body sensations. While avoidance may temporarily help with the fear of the attack and loss of control, it makes normal life nearly impossible. It also does not stop the attacks from occurring.
- Agoraphobia - Often coupled with panic disorder, agoraphobia is the fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of a panic attack. Agoraphobia is a severe form of phobic avoidance and can cause those with panic disorder to avoid public places, crowds, or traveling by bus or plane. This pattern may progress to the point that the sufferer will not leave home.
How is panic disorder treated?
First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist. Panic disorder is generally treated with psychotherapy, medication, or both.
How common is this?
About 7.2% of all adults, or 1 in 15, have a panic disorder which is a primary part of their disorder, (NIH, 1993). In any given year, about 1/3 of American adults have at least one panic attack; most of these adults never develop repeated panic attacks. This startling data means that a phobia/panic disorder is the most common emotional disorder, more common than alcohol abuse or depression. Phobia/panic disorder also has the lowest rates for seeking help and finding it, about 22%. Phobia is the most common and the most hidden condition at the same time.
After a few months of panic, about 10% of people become housebound and unable to leave home alone. After a few years, about 30% of panic sufferers have a loss of job, pay or job responsibilities. Some 17% are at risk for alcoholism and about 40% risk a chronic depression as life opportunities are cut off. A majority have marital problems and much reduced travel and social life. The economic cost has been estimated at about $2600/year in misdirected treatment, and about $12,000 a year in lowered job earnings. For most, panic closes life off like a prison.
- Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating panic disorder. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful.
- Medication. Doctors also may prescribe medication to help treat panic disorder. The most commonly prescribed medications for panic disorder are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.
How common is this?
About 7.2% of all adults, or 1 in 15, have a panic disorder which is a primary part of their disorder, (NIH, 1993). In any given year, about 1/3 of American adults have at least one panic attack; most of these adults never develop repeated panic attacks. This startling data means that a phobia/panic disorder is the most common emotional disorder, more common than alcohol abuse or depression. Phobia/panic disorder also has the lowest rates for seeking help and finding it, about 22%. Phobia is the most common and the most hidden condition at the same time.
After a few months of panic, about 10% of people become housebound and unable to leave home alone. After a few years, about 30% of panic sufferers have a loss of job, pay or job responsibilities. Some 17% are at risk for alcoholism and about 40% risk a chronic depression as life opportunities are cut off. A majority have marital problems and much reduced travel and social life. The economic cost has been estimated at about $2600/year in misdirected treatment, and about $12,000 a year in lowered job earnings. For most, panic closes life off like a prison.
What is it like to have panic disorder?
"One day, without any warning or reason, I felt terrified. I was so afraid, I thought I was going to die. My heart was pounding and my head was spinning. I would get these feelings every couple of weeks. I thought I was losing my mind."
"The more attacks I had, the more afraid I got. I was always living in fear. I didn't know when I might have another attack. I became so afraid that I didn't want to leave my house."
"One day, without any warning or reason, I felt terrified. I was so afraid, I thought I was going to die. My heart was pounding and my head was spinning. I would get these feelings every couple of weeks. I thought I was losing my mind."
"The more attacks I had, the more afraid I got. I was always living in fear. I didn't know when I might have another attack. I became so afraid that I didn't want to leave my house."
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