Panic Disorder
Introduction

Panic Disorder is a serious condition that around one out of every 75 people might experience. It usually appears during the teens or early adulthood, and while the exact causes are unclear, there does seem to be a connection with major life transitions that are potentially stressful: graduating from college, getting married, having a first child, and so on. There is also some evidence for a genetic predisposition; if a family member has suffered from panic disorder, you have an increased risk of suffering from it yourself, especially during a time in your life that is particularly stressful.

What Is Panic Disorder?

People with panic disorder have feeling of terror that strike suddenly and repeatedly with no warning. They can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike. Between episodes they feel a persistent, lingering worry that another attack could come any minutes. When a panic attack strikes, your heart most likely pounds, and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or choking sensations, a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you’re having a heart attack or stroke, losing your mind, or on the verge of death. Attacks can occur any time, even during nondream           

Sleep. Most attacks average a couple of minutes, but occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more.

Panic disorder is often accompanied by other conditions, such as depression or alcoholism, and may produce phobias, which can develop in place or situations where panic attacks have occurred. For example, if a panic attack strikes while you’re riding an elevator, you may develop a fear of elevators and start avoiding them. Some people’s lives become greatly restricted-they avoid normal, everyday activities such as grocery shopping, driving, or even leaving the house. They may be able to face a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurred. When people’s lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency towards panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.

“THE FIRST STEP TO OBTAINING HELP IS TO ACCEPT THAT GETTING HELP IS THE RIGHT THING TO DO”!   

Panic Attacks: The Hallmark of Panic Disorder

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. Symptoms of a panic attack include:

racing heartbeat
difficulty breathing, feeling as though you 'can't get enough air'
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 situation of danger. But during a panic attack, these symptoms seem to rise from out of nowhere. They occur in seemingly harmless situations-they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following conditions:

It occurs suddenly, without any warning and without any way to stop it.
The level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.
It passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks 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.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild work or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack. 
 

Who Gets Panic Disorder?

Panic disorder strikes at least 1.6% of the population and is twice as common in women as in men. It can appear at any age, but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder-for example, many people have one attack but never have another. For those who do have panic disorder, though, it’s important to seek treatment.

How to Identify Panic Disorder

Please remember that only a licensed therapist can diagnose a panic disorder. There are certain signs you may already be aware of, though.

One study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. That's why it's important to know what the symptoms are, and to make sure you get the right help.

Many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry. The key symptom of panic disorder is the persistent fear of having future panic attacks. If you suffer from repeated (four or more) panic attacks, and especially if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional 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 panic disorder or some other emotional disorder such as depression. Studies with twins have confirmed the possibility of 'genetic inheritance' 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 unknown reasons, women are twice as likely to get the disorder as men. 

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack.

Both: Physical and psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack. For example, if a person with panic disorder experiences a racing heartbeat caused by drinking coffee, exercising, or taking a certain medication, they might interpret this as a symptom of an attack and , because of their anxiety, actually bring on the attack. On the other hand, coffee, exercise, and certain medications sometimes do, in fact cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack. That's why the right therapy for panic disorder focuses on all aspects (physical, psychological, and physiological aspects) of the disorder.

Hence this disorder is rightly understood by “Bio-psycho-social model” as propounded by George Engel in 1977, which stressed an integrated approach to human behaviour and disease. Engel postulated by his experiments that each of biological, psychological and social systems affects and is affected by the others.

Can People with Panic Disorder lead normal lives?

The answer to this is a loud YES - if they receive treatment. 

THE FIRST STEP TO OBTAINING HELP IS TO ACCEPT THAT GETTING HELP IS THE RIGHT THING TO DO!

Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective, and most people who have successfully completed treatment can continue to experience situational avoidance or anxiety, and further treatment might be necessary in those cases. Once treated, panic disorder doesn't lead to any permanent complications. 
 

Side Effects of Panic Disorder

Without treatment, panic disorder can have very serious consequences.

The immediate danger with panic disorder is that it can often lead to a phobia. That's because once you've suffered a panic attack, you may start to avoid situations like the one you were in when the attack occurred.

Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, you might have an attack while driving, and start to avoid driving until you develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia - fear of going outdoors -because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help. The fear of an attack is so debilitating, they prefer to spend their lives locked inside their homes.

Even if you don't develop these extreme phobias, your quality of life can be severely damaged by untreated panic disorder. A recent 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 satisfying activities
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, a recent study cited the case of a woman who gave up a $40,000 a year job that required travel for one close to home that only paid $14,000 a year. Other sufferers have reported losing their jobs and having to rely on public assistance or family members.

None of this needs to happen. Panic disorder can be treated successfully, and sufferers can go on to lead full and satisfying lives. 

How Is Panic Disorder Treated?

Studies have shown that proper treatment-a type of psychotherapy called cognitive-behavioral therapy, medications, or possibly a combination of the two-helps 70% to 90% of people with panic disorder. Significant improvement is usually seen within 6 to 8 weeks. 

Cognitive-behavioral approaches teach patients how to view the panic situations differently and demonstrate ways to reduce anxiety (e.g., using breathing exercises or techniques to refocus attention). 

Exposure therapy, a technique used in cognitive-behavioral therapy, often helps to alleviate the phobias that may result from panic disorder. In exposure therapy, people are very slowly exposed to the fearful situation until they become desensitized to it. 

Some people find the greatest relief from panic disorder symptoms when they take certain prescription medications. Such medications, like cognitive-behavioral therapy, can help to prevent panic attacks or reduce their frequency and severity. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place 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 must be outlined and prescribed by a registered mental health professional.

How Long Does Treatment Take?

Much of the success of treatment depends on your willingness to carefully follow the outlined treatment plan. This is often multifaceted, and it won't work overnight, but if you stick with it, you should start to have noticeable improvement within about 10 to 20 weekly sessions. If you continue to follow the program, within one year you will notice a tremendous improvement.

Keep in mind, though, that panic disorder, like any other emotional disorder, isn't something you can either diagnose or cure by yourself. An experienced mental health professional is the most qualified person to make this diagnosis, just as he or she is the most qualified to treat this disorder. 

Message: This article is designed to answer your basic questions about panic disorder; a qualified mental health professional will be able to give you more complete information.

Panic disorder does not need to disrupt your life in any way!

Correspondence: Dr. Nirmal Lamichhane

MBBS, MD

Neuropsychiatrist

Office: Western Regional Hospital, Pokhara.

Clinic: Fishtail Hospital and Research Centre Pvt. Ltd

Gairapatan, Pokhara

E-mail: drnrmlam@yahoo.com
 

References

Carlat D.J.(editor). The Psychiatrid Interview A Practical Guide (2nd ed). Lippincott Williams & Wilkins 2005.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision DSM-IV-TR (text revision). American psychiatric association 2000.
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Clinical descriptions and diagnostic guidelines (ICD-10). World Health Organization. Geneva: A.I.T.B.S. Publishers and Distributors (Regd.) Delhi-51 2002
Sadock B. J and Sadock V. A (eds). Comprehensive textbook of psychiatry (8th ed).New York: Lippincott Williams and Wilkins; 2005.
Semple D, Smyth R, Burns J, Darjee R and Mclntosh A (eds). Oxford Handbook of Psychiatry (Indian edition). Oxford University Press 2005.