Panic Attack & Panic Disorder - Symptoms & Treatment
Anxiety and Panic Attacks
Panic Attacks: TheHallmark of Panic Disorder
A panic attack is a sudden surge of overwhelming fear that comeswithout warning and without any obvious reason. It is far moreintense than the feeling of being 'stressed out' that most peopleexperience.
Symptoms of a panic attack include:
racing heartbeat
difficulty breathing, feeling as though you 'can't get enoughair'
terror that is almost paralyzing
dizziness, lightheadedness or nausea
trembling, sweating, shaking
choking, chest pains
hot flashes, or sudden chills
tingling in fingers or toes ('pins and needles')
fear that you're going to go crazy or are about to die
You probably recognize this as the classic 'flight or fight'response that human beings experience when we are in a situationof danger. But during a panic attack, these symptoms seem to risefrom out of nowhere. They occur in seemingly harmless situations--theycan even happen while you are asleep.
In addition to the above symptoms, a panic attack is marked bythe following conditions:
-it occurs suddenly, without any warning and without any way tostop it.
-the level of fear is way out of proportion to the actualsituation; often, in fact, it's completely unrelated.
-it passes in a few minutes; the body cannot sustain the 'fightor flight' response for longer than that. However, repeatedattacks can continue to recur for hours.
A panic attack is not dangerous, but it can be terrifying,largely because it feels 'crazy' and 'out of control.' Panicdisorder is frightening because of the panic attacks associatedwith it, and also because it often leads to other complicationssuch as phobias, depression, substance abuse, medicalcomplications, even suicide. Its effects can range from mild wordor social impairment to a total inability to face the outsideworld.
In fact, the phobias that people with panic disorder develop donot come from fears of actual objects or events, but rather fromfear of having another attack. In these cases, people will avoidcertain objects or situations because they fear that these thingswill trigger another attack.
How to Identify Panic Disorder
Please remember that only a licensed therapist can diagnose apanic disorder. There are certain signs you may already be awareof, though.
One study found that people sometimes see 10 or more doctorsbefore being properly diagnosed, and that only one out of fourpeople with the disorder receive the treatment they need. That'swhy it's important to know what the symptoms are, and to makesure you get the right help.
Many people experience occasional panic attacks, and if you havehad one or two such attacks, there probably isn't any reason toworry. The key symptom of panic disorder is the persistent fearof having future panic attacks. If you suffer from repeated (fouror more) panic attacks, and especially if you have had a panicattack and are in continued fear of having another, these aresigns that you should consider finding a mental healthprofessional who specializes in panic or anxiety disorders.
What Causes Panic Disorder: Mind, Body, or Both?
Body: There may be a genetic predisposition to anxiety disorders;some sufferers report that a family member has or had a panicdisorder or some other emotional disorder such as depression.Studies with twins have confirmed the possibility of 'geneticinheritance' of the disorder.
Panic Disorder could also be due to a biological malfunction,although a specific biological marker has yet to be identified.
All ethnic groups are vulnerable to panic disorder. For unknownreasons, women are twice as likely to get the disorder as men.
Mind: Stressful life events can trigger panic disorders. Oneassociation that has been noted is that of a recent loss orseparation. Some researchers liken the 'life stressor' to athermostat; that is, when stresses lower your resistance, theunderlying physical predisposition kicks in and triggers anattack.
Both: Physical and psychological causes of panic disorder worktogether. Although initially attacks may come out of the blue,eventually the sufferer may actually help bring them on byresponding to physical symptoms of an attack.
For example, if a person with panic disorder experiences a racingheartbeat caused by drinking coffee, exercising, or taking acertain medication, they might interpret this as a symptom of anattack and , because of their anxiety, actually bring on theattack. On the other hand, coffee, exercise, and certainmedications sometimes do, in fact, cause panic attacks. One ofthe most frustrating things for the panic sufferer is neverknowing how to isolate the different triggers of an attack.That's why the right therapy for panic disorder focuses on allaspects -- physical, psychological, and physiological -- of thedisorder.
Can People with Panic Disorder lead normal lives?
The answer to this is a resounding YES -- if they receivetreatment.
Panic disorder is highly treatable, with a variety of availabletherapies. These treatments are extremely effective, and mostpeople who have successfully completed treatment can continue toexperience situational avoidance or anxiety, and furthertreatment might be necessary in those cases. Once treated, panicdisorder doesn't lead to any permanent complications.
Side Effects of Panic Disorder
Without treatment, panic disorder can have very seriousconsequences.
The immediate danger with panic disorder is that it can oftenlead to a phobia. That's because once you've suffered a panicattack, you may start to avoid situations like the one you werein when the attack occurred.
Many people with panic disorder show 'situational avoidance'associated with their panic attacks. For example, you might havean attack while driving, and start to avoid driving until youdevelop an actual phobia towards it. In worst case scenarios,people with panic disorder develop agoraphobia -- fear of goingoutdoors -- because they believe that by staying inside, they canavoid all situations that might provoke an attack, or where theymight not be able to get help. The fear of an attack is sodebilitating, they prefer to spend their lives locked insidetheir homes.
Even if you don't develop these extreme phobias, your quality oflife can be severely damaged by untreated panic disorder. Arecent study showed that people who suffer from panic disorder:
-are more prone to alcohol and other drug abuse
-have greater risk of attempting suicide
-spend more time in hospital emergency rooms
-spend less time on hobbies, sports and other satisfyingactivities
-tend to be financially dependent on others
-report feeling emotionally and physically less healthy than non-sufferers.
-are afraid of driving more than a few miles away from home
Panic disorders can also have economic effects. For example, arecent study cited the case of a woman who gave up a $40,000 ayear job that required travel for one close to home that onlypaid $14,000 a year. Other sufferers have reported losing theirjobs and having to rely on public assistance or family members.
None of this needs to happen. Panic disorder can be treatedsuccessfully, and sufferers can go on to lead full and satisfyinglives.
How Can Panic Disorder Be Treated?
Most specialists agree that a combination of cognitive andbehavioral therapies are the best treatment for panic disorder.Medication might also be appropriate in some cases.
The first part of therapy is largely informational; many peopleare greatly helped by simply understanding exactly what panicdisorder is, and how many others suffer from it. Many people whosuffer from panic disorder are worried that their panic attacksmean they're 'going crazy' or that the panic might induce a heartattack. 'Cognitive restructuring' (changing one's way of thinking)helps people replace those thoughts with more realistic, positiveways of viewing the attacks.
Cognitive therapy can help the patient identify possible triggersfor the attacks. The trigger in an individual case could besomething like a thought, a situation, or something as subtle asa slight change in heartbeat. Once the patient understands thatthe panic attack is separate and independent of the trigger, thattrigger begins to lose some of its power to induce an attack.
The behavioral components of the therapy can consist of what onegroup of clinicians has termed 'interoceptive exposure.' This issimilar to the systematic desensitization used to cure phobias,but what it focuses on is exposure to he actual physicalsensations that someone experiences during a panic attack.
People with panic disorder are more afraid of the actual attackthan they are of specific objects or events; for instance, their'fear of flying' is not that the planes will crash but that theywill have a panic attack in a place, like a plane, where theycan't get to help. Others won't drink coffee or go to anoverheated room because they're afraid that these might triggerthe physical symptoms of a panic attack.
Interoceptive exposure can help them go through the symptoms ofan attack (elevated heart rate, hot flashes, sweating, and so on)in a controlled setting, and teach them that these symptoms neednot develop into a full-blown attack. Behavioral therapy is alsoused to deal with the situational avoidance associated with panicattacks. One very effective treatment for phobias is in vivoexposure, which is in its simplest terms means breaking a fearfulsituation down into small manageable steps and doing them one ata time until the most difficult level is mastered.
Relaxation techniques can further help someone 'flow through' anattack. These techniques include breathing retraining andpositive visualization. Some experts have found that people withpanic disorder tend to have slightly higher than averagebreathing rates, learning to slow this can help someone deal witha panic attack and can also prevent future attacks.
In some cases, medications may also be needed. Anti-anxietymedications may be prescribed, as well as antidepressants, andsometimes even heart medications (such as beta blockers) that areused to control irregular heartbeats.
Finally, a support group with others who suffer from panicdisorder can be very helpful to some people. It can't take theplace of therapy, but it can be a useful adjunct.
If you suffer from panic disorder, these therapies can help you.But you can't do them on your own; all of these treatments mustbe outlined and prescribed by a psychologist or psychiatrist.
How Long Does Treatment Take?
Much of the success of treatment depends on your willingness tocarefully follow the outlined treatment plan. This is oftenmultifaceted, and it won't work overnight, but if you stick withit, you should start to have noticeable improvement within about10 to 20 weekly sessions. If you continue to follow the program,within one year you will notice a tremendous improvement.
If you are suffering from panic disorder, you should be able tofind help in your area. You need to find a licensed psychologistor other mental health professional who specializes in panic oranxiety disorders. There may even be a clinic nearby thatspecializes in these disorders.
When you speak with a therapist, specify that you think you havepanic disorder, and ask about his or her experience treating thisdisorder.
Keep in mind, though, that panic disorder, like any otheremotional disorder, isn't something you can either diagnose orcure by yourself. An experience clinical psychologist orpsychiatrist is the most qualified person to make this diagnosis,just as he or she is the most qualified to treat this disorder.
This brochure is designed to answer your basic questions aboutpanic disorder; a qualified mental health professional will beable to give you more complete information.
Panic disorder does not need to disrupt your life in any way!
This part of our Article has been resourced from :
American Psychological Association
Office of Public Affairs
750 First St. N.E.
Washington, DC 20002-4242
(202) 336-5700
Panic Disorder
Panic Disorder is the fear of having an 'uncued'..spontaneouspanic attack. It was first recognised and included in theAmerican Psychiatric Association's Diagnostic& StatisticalManual (DSM) 111 in 1980.
Ongoing research has increased the knowledge and understanding ofthis Disorder and is clearly evident in the current version ofthe DSM...No-4. In the DSM-111 and the DSM-111R no distinctionwas made in the different types of panic attacks. A panic attackwas a panic attack.
DSM 4 recognises three different types of panic attacks.
uncued (spontaneous) panic attacks
cued (specific) panic attacks
situationally predisposed panic attacks
Spontaneous panic attacks relate to panic disorder
Specific panic attacks relate to social anxiety disorder,obsessive compulsive disorder and post traumatic stress disorder.Situationally predisposed panic attacks may occur on exposure tothe situational cue or trigger, but do not necessarily occurimmediately after the exposure.
The symptoms of a panic attack are described in the DSM-4 as a"discrete period of intense fear or discomfort in which four(or more) of the above symptoms develop abruptly and reached apeak within ten minutes.
Mix &Match
Symptoms of a panic attack are palpitations, sweating, tremblingor shaking, sensations of shortness of breath or smothering,feeling of choking, chest pain or discomfort, nausea or abdominaldistress, dizziness or lightheadedness, derealisation ordepersonalisation, fear of losing control or going 'crazy', fearof dying, paresthesias, and chills or hot flushes'.... 'Attacksthat have fewer than 4 symptoms are referred to as 'limited -symptom attacks.'
While the DSM-111R acknowledged that the avoidance behaviour (agoraphobia)relating to the panic disorder was a result of a fear of having aPanic Attack, this lack of distinction upheld the prevailing viewof the time that a panic attack and the avoidance behaviourresulting from the attack was a "phobic" response tosituations and/or places. Many of the earlier treatment methodsfor panic disorder/ agoraphobia focussed on gradual exposure tothe avoided situation and/or place and did not directly deal withthe panic attack itself. It is now recognised that a spontaneouspanic attack is not associated with specific situations andplaces.
The avoidance behaviour associated to Panic Disorder isrecognised "as anxiety about being in situations and placesfrom which escape may be difficult or embarrassing or in whichhelp may not be available in the event of having an unexpected orsituationally predisposed panic attack or panic like symptoms".The spontaneous panic attacks attack comes without any apparentwarning warning, day or night irrespective of what the person isdoing. Many people report that panic attacks happen when they arerelatively 'calm' or 'relaxed' eg when they are watching TV orreading a book. In fact, a study we undertook in 1993 on theuncued/ spontaneous panic attack showed that 78% of PanicDisorder participants reported experiencing a panic attack whenrelatively 'calm'. 69% of Panic Disorder participants report theyexperience a panic attack while going to sleep and 86% reportthat the panic attack wakes them from sleep at night.
Three internationally recognised experts in Panic Disorderdescribe a panic attack as follows:
"An intense recurring spasm of panic that start ... justbelow the breastbone and seem to spread like a white hot flame ..passing through the chest, up the spine, into the face, down thearms and even down into the groin to the tips of the toes" C.Weekes.
"The attacks start with a tingling feeling going up my spinewhich enters my head and causes a sensation of faintness andnausea" J.Hafner.
"A rushing sensation of a hot flash through the body ..sometimes associated with a sick feeling and a sensation offading out from the world but this faintness is more like a'white out' than a 'black out' and that the head may literallyfeel light." Sheehan
C. Weekes (1962): Self Help for your Nerves. London: Angus &Robertson pp33.
J. Hafner (1986). Marriage and Mental Illness. New York: TheGuildford Press pp 39
Sheehan (1983). The Anxiety Disease. Charles Scribner's Son N-1.
In our own research into the subjective experience of thespontaneous panic attack, we found that many people with PanicDisorder can experience a various sensations moving through theirbody - either before or during the actual panic attack. Thesesensations can change from one 'attack' to the next which onlyadds to the confusion people feel. These sensations can include:
electric current moving through the body
hot prickly sensation moving through the body
intense heat or burning pain moving through the body
"unusual" intense flows of energy throughout the body
rushes of 'energy' shaking the body
tingly sensation moving through the body
creeping sensation moving through the body
wave-like motion of energy moving through the body
vibration moving through the body
white hot flame through the body
ice cold sensation through the body
"ants crawling" sensation over the body
For more information see also
'An Analysis of an uncued panic attacks' - symptoms
The Evaluation of the Effectiveness of a panic anxiety managementworkshop
Our research also found many people can dissociate first and thenpanic as a result of the dissociation. Dissociation can includedepersonalisation and derealisation. For more information see ourDissociation page
As with the other anxiety disorders, people with panic disorderalso experience other symptoms including racing heart beat,'missed heart beats', palpitations, difficulty breathing, chestpain, left arm pain, jaw pain, nausea, shaking and trembling, achoking sensation. For a full list of symptoms see our Symptompage
Many people who experience spontaneous panic attacks feel as ifthey are dying and / or having a heart attack, feel as if theyare going insane or will lose control. The fear of having aspontaneous panic attack leads to panic disorder. This is turncan lead to the secondary conditions associated to panic disorderwhich include avoidance behaviour (agoraphobia), major depressionand/or prescribed drug addiction and/or alcohol abuse. While theexperience of spontaneous panic attacks can be minimised to alarge degree, the development of panic disorder, and thesecondary conditions can be prevented.Anxiety and panicattacks
Picture this, your walking through the mall and all of a suddenyou feel short of breath, you notice your heart is racing andyour sweating. You begin to feel scared and wonder what ishappening to you. Are you having a heart attack? Are you going todie? These are questions millions of Americans ask themselves atone time or another. The biggest question is "what's wrongwith me"?
Many people visit countless numbers of doctors each year tryingto figure out what their problem is. They are searching forreasone why they are experiencing nervousness, sweaty palms, aqueasy stomach, or lightheadedness.
The first time you experience a panic attack, you may go to thedoctor, only to be told there's nothing physically wrong. So youtry to reason with yourself: "if nothing is wrong with me,then i'll just try to stay calm and the panic attacks will goaway." But it seems the harder you try, the more frequentlythey return.
You may develop phobias, unreasonable fears of flying or ridingin elevators or crossing bridges. You might even develop the mostserious panic disorder, a fear of fear itself otherwise known asagoraphobia. This is the most severe a phobia that keeps youimprisoned in your home, afraid that if you go outside you willhave another panic attack.
Here are some symptoms of anxiety:
1. Often feeling tired even though You have had a good night'ssleep.
2. Your heart seems to race out of control even though the doctorsays you dont have a heart problem.
3. Insomnia
4. Bouts of backache that hit for no apparent reason.
5. Indegestion, diarrhea, or headache frequently keeping you fromfunctioning at your best.
6. Hyperventilating
7. Feeling like your falling to pieces
8. Noticing that certain situations make you feel extremelynervous.
9. Feeling like you are going crazy
Are you going crazy? No. You may have a chemical imbalance thatpredisposes you to feeling anxious. You may not be coping withstress in a constructive way so as to prevent your anxiety frombecoming panic. You are not mentally ill, but if the fear thatyou have is irrational and keeps you from doing normal everydaythings that most people take for granted, you may have a phobiawhich can go hand in hand with anxiety and panic attacks.
The good news is that anxiety and panic attacks are considered tobe the most treatable of all psychiatric conditions. You can betaught mental tools to help you overcome your physical symptoms.
When you worry, think negatively, or have improper attitudestoward stress, you produce vivid mental pictures of the situationyou fear. Your body becomes aroused just as if the situation youimagine is actually happening. Then it releases adrenaline, whichbrings on the physical anxiety symptoms. Therefore, if you caneliminate worry, negative thinking, and improper attitudes towardstress with your mind, you can overcome much of the anxiety thatbrings on a panic attack.
If you have a lot of stress and do not know how to cope with it,your body becomes aroused because it is being bombarded withanxiety producing stimuli. Nature's purpose in allowing the bodyto become aroused is protection. When faced with sudden danger,you become physically ready to react by either fighting thestressor or fleeing from it. When the brain puts into action whatis called the "fight or flight" response, it releaseshormones known as corticosteroids. These powerful hormonesconstrict the blood vessels in the peripheral parts of the bodyin order to drive blood into the brain and deep down into thelarge muscles for added strength. The heart pounds, digestionshuts down, breathing increases, and muscles tighten.
In the beginning of the 1980's, doctors began to frequentlyprescribe tranquilizers and antianxiety medications such asxanax, klonopin, and valium. These medications can help people tocalm down, but seldom do they cure the problem.
First, go to your regular doctor to rule out any medicalconditions that may be causing these problems. If nothing can befound, a good doctor should realize that you may be sufferingfrom anxiety and panic attacks, and will refer you to apsychologist for some talk therapy.
Here are some things a psychologist may have you try after he orshe evaluates you and decides that you are suffering from anxietyand panic attacks:
1. Visualizations:
Picture yourself with a relaxed look on your face at work and athome.
Visualize yourself refusing requests that will cause you tooverwork.
See yourself being able to participate in hobbies that you haveavoided because you have not felt like doing them.
2. Affirmations:
Tell yourself that you feel perfectly normal and that you can doany activity that you want.
Tell yourself that you are worthy of the love of others even whenyou don't think that you are.
When you wake up in the morning, look at yourself in the mirrorand repeat positive affirmations to yourself. Anything that youcan think of that is positive and not negative. You can find manybooks in the bookstore or library on positive affirmations. Makethem part of your everyday routine.
3. Cognitive Restructuring:
Stop thinking in the black and white mode by stopping thethoughts that you will have a headache or you will have a panicattack if you go certain places or attend certain functions.
4. Relaxation Exercises:
These can be very helpful. Teach yourself how to breathecorrectly. Most of us breathe from our upper chest area insteadof our abdominal area. Practice deep breathing. Studies havefound that it is impossible to have a panic attack when you arebreathing deeply and properly.
Learn how to meditate, take yoga, get a massage, and most of allexercise.
Exercising can be the best prescription. You will have feweranxiety producing illnesses if you achieve physical fitness. Youcan have a new and exciting lifestyle if you are functioning atoptimal levels of health. Set a goal and become more physicallyfit and then commit yourself to achieving it. Your unconsciousmind will make it easier to exercise and eat right if you programit with visualizations and affirmations.
Although these are just a few suggestions, there are many manymore things that can be done to help alleviate the terrifyingfeelings that come along with anxiety and panic attacks. Makesure to schedule an appointment with your doctor and to see apsychologist to help you on your road to recovery. Also, thebookstore can be a great help. Because this is such a commonproblem and has been for years, there are a lot of self helpbooks available. Not only can they help you to deal with thedifficulties that accompany anxiety, they can help you to feelbetter instantaneously just by validating your feelings. You maypick up a book and feel like someone wrote it just for you.
The bottom line is that anxiety and panic attacks are 100%treatable. Don't suffer anymore than you have to. Take charge andget yourself on the track to a better quality of life. It maytake some work, but I can assure you that it will be worth it.
