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Panic Disorder
I¡¯m just freaking out and I feel like my body¡¯s freaking out. I mean the shaking and the breathing and the sweats, and the heart pounding and the pain in the chest¡ªI feel like I¡¯m going to have a heart attack or something. Except I never do . . ."
The Attack
The 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 to be afraid of. But when the attack comes, it comes as if there were a real threat, and the body reacts accordingly. A combination of symptoms erupt¡ªthe heart races, breathing gets shallower and faster, and the whole nervous system signals:
DANGER!
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:
- Sweating
- Shortness of breath
- Heart beating very rapidly
- Chest pain
- Feeling unsteady
- Choking or smothering sensations
- Numbness or tingling
- Hot or cold flashes
- Faintness
- Trembling or shaking
- Nausea or stomach pains
- Feelings of unreality
- Fears of losing control, dying, or "going crazy"
The discomfort and sense of danger the attacks bring is so intense that people may think they are having a heart attack or stroke.
Unchecked Panic: A "Triple A" Threat
Unfortunately, once the first panic attack begins to fade, many often believe it was a fluke. Consequently, many don¡¯t seek treatment, which can result in the emergence of three serious side effects:
Avoidance. A person may discontinue any activities that seem to be triggers, for example, going to the park, driving, or riding in elevators, or doing anything that brings on frightening bodily sensations. While avoidance may help temporarily with the fear of the attack and its accompanying loss of control, it makes a normal home and work life nearly impossible. And it doesn¡¯t keep the attacks from happening.
Anticipatory anxiety. Anxiety that is triggered by merely thinking about the possibility of having a panic attack is called anticipatory anxiety. Once this develops, it could even cause the person to become reclusive, opting to endure the attacks alone rather than in the open where there¡¯s no chance of escape and little chance of help.
Agoraphobia. Often coupled with panic disorder, agoraphobia is the fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of a panic attack. It can drive people with panic disorder to avoid public places, crowds, or traveling by bus or plane. This pattern may progress to the point where the person will not leave his or her home.
E Panic in the Population
Approximately twice as many women as men experience panic disorder, but the illness knows no racial, economic, or geographic boundaries. The disorder typically begins when its victims are in their 20s. Often a serious event, such as the death of a parent or divorce, will trigger the first attack. According to the National Institute of Mental Health, over 3 million Americans will experience panic disorder sometime in their lives. Studies have shown that panic disorder runs in families, which supports the idea that the condition may pass genetically from generation to generation. People with panic disorder are more prone to experience depression and its complications than the average person. In fact, 50% to 60% of people with panic disorder will experience depression at least once during their lifetimes. Also, the illness is often complicated by drug and alcohol abuse.
Treatment
Two main treatment options are available for people with panic disorder: medication and cognitive behavioral therapy. A number of medications that are used to treat depression also help from 75% to 90% of patients with panic disorder. Cognitive behavioral therapy consists of five key elements:
- Learning. In the first stage, the therapist explains the illness, teaches the patient
to identify the symptoms, and outlines the treatment plan.
- Monitoring. The patient keeps a diary to monitor panic attacks and record
anxiety-inducing situations.
- Breathing. The therapist teaches breathing relaxation techniques to combat the
physical reactions of a panic attack.
- Rethinking. The therapist helps the patient change his or her interpretation
of physical symptoms from catastrophic to realistic.
- Exposing. The therapist helps the patient encounter situations that evoke
frightening physical sensations at levels of gradually increasing intensity.
These treatments are equally effective and can be chosen on the basis of each patient¡¯s preference.
Effective treatments and ongoing re-search have brought new hope of recovery to people with panic disorder. And continuing medical education is helping more and more physicians recognize the disorder and get patients the help they need. Earlier detection is significantly reducing the complications of untreated panic disorder. With appropriate psychiatric treatment, up to 90% of people who experience panic disorder will recover and return to normal life activities.
The American Psychiatric Association is a cosponsor of the National Public Education Campaign on Clinical Depression in cooperation with the National Mental Health Association, National Alliance for the Mentally Ill, National Depressive and Manic Depressive Association and the DEPRESSION/Awareness, Recognition, and Treatment (D/ART) Program, National Institute of Mental Health.
Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This pamphlet was developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.
One in a series of pamphlets designed to reduce the stigma surrounding mental illnesses by promoting informed factual discussion of the disorders and their psychiatric treatments.
© Copyright 1999 American Psychiatric Association
ISBN 0-89042-357-1 | 
