Panic disorder is grouped under anxiety disorders in the DSM-5. It is characterised by an intense surge of fear response which may or may not be triggered due to anxiety. Common symptoms include shaking and trembling, sweating, breathlessness, pounding heart rate, chest pain and discomfort, nausea and abdominal distress, numbness and feelings of derealisation, feelings of losing control, etc.
Most people have one or two panic attacks in their entire lifetime. For some, it is a recurring phenomenon, causing imminent distress. People with panic disorder tend to avoid physical exertion or places that trigger their attacks.
Although the causes of panic disorder are known, risk factors include high negative affectivity proneness, stress, neurological reasons, etc. It is more common among females than males.
Common Signs and Symptoms of Panic Disorder
Panic disorder consists of recurrent panic attacks which have extreme physical symptoms such as:
- sweating, trembling, shaking, pounding heart rate, chest pain, shortness of breath, nausea and abdominal distress.
- Feelings of dizziness, unsteady or faint, chills or hot flashes, numbness and tingling sensations are also common.
Alongside these, there may be feelings of dying, derealisation, and fear of losing control. People who have panic disorder often worry about getting another attack which may cause more panic attacks. They may have anxiety accompanied with the attack or have no triggers whatsoever.
Often, people with panic disorder may find different maladaptive coping methods such as avoiding physical exertion, restricting usual daily activities or avoidance behaviours such as avoiding places that they think might trigger a panic attack, etc to manage their disorder.
Common risk factors include proneness to negative affect, which means that the person generally feels more negative feelings such as sadness, anxiety, etc. Genetic factors may also contribute to increasing risk of panic disorder.
Environmental factors such as stressful work or home environment, loss of a loved one, traumatic events affect the vulnerability for panic disorders. Habits such as smoking and excessive caffeine intake may also increase the risk for panic disorder.
To diagnose a person with panic disorder, following criteria must be met:
- Recurring panic attacks with surge in intensity within minutes’ time taking awhile for the patient to reach a stable state. At least four or more of the following symptoms must be present:
- Palpitations, pounding heart, or accelerated heart rate.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
Patients may present severe anxiety with regards to their next panic attack. They may even engage in behaviours that will help them avoid panic attacks such as avoiding exercise, climbing stairs, public spaces, etc.
These panic attacks may be expected (due to anxiety) or unexpected (no triggers at all). The panic attacks vary in frequency. Sometimes they may be regular, almost daily or once a week for a period of a couple of months. Other times they may be absent for a while and recur for a couple of months or weeks.
Panic attacks that happen in sleep and cause the person to wake up are termed as nocturnal attacks. However,they follow the same trajectory of a regular panic attack.
Psychologists are to mention if the panic is caused due to substance abuse or other mental health disorders.
Treatment for Panic Disorder
Treatment for panic disorder includes psychotherapy as well as medication in case of increasing severity. Talk therapy and Cognitive Behavioural Therapy are often recommended psychotherapies. Talk therapy helps in understanding the symptoms and the disorder.
In CBT, the practitioner recreates the symptoms of the panic disorder in a controlled setting, until the fear response towards the panic attack is sensitised. This helps in figuring out resolution options and eventually decreasing the risk of another panic attack.
As far as medication is concerned, Selective Serotonin Reuptake Inhibitors, Serotonin and norepinephrine reuptake inhibitors, and benzodiazepines are recommended as per the severity of the disorder.
1. Other specified anxiety disorder or unspecified anxiety disorder: Panic disorder should not be diagnosed if full-symptom panic attacks have never been experienced. If only limited panic attack symptoms are experienced, another specified anxiety disorder or unspecified anxiety disorder diagnosis should be considered.
2. Anxiety disorder due to another medical condition: Panic disorder is not diagnosed if the panic attacks are the physiological consequence of another medical condition. Appropriate laboratory tests may be helpful in determining the etiological role of another medical condition.
3. Substance/medication-induced anxiety disorder: Panic disorder is not diagnosed if the panic attacks are judged to be a direct physiological consequence of a substance. Intoxication with substances like cocaine, amphetamines, caffeine and alcohol can cause panic attacks. Panic disorder may precede substance use in some individuals and may be associated with increased substance use, even for calming during panic attacks. In this case, a diagnosis of panic disorder should be considered in addition to a diagnosis of substance use disorder.
4. Other mental disorders with panic attacks as an associated feature: Panic attacks that occur as a symptom of other anxiety disorders are expected and would not meet criteria for panic disorder. These disorders may include social anxiety disorder, specific phobias or agoraphobia, generalized anxiety disorder, separation anxiety disorder.
Anxiety disorders, agoraphobia, major depressive disorder, bipolar disorder and alcohol use disorder are found to be highly comorbid with panic disorder.
Panic disorder is significantly comorbid with numerous general medical symptoms and conditions, including, but not limited to, dizziness, cardiac arrhythmias, hyperthyroidism, asthma, COPD, irritable bowel syndrome, mitral valve prolapse and thyroid disease.
A clinical psychologist, CBT practitioner and psychiatrist work together to treat panic disorder.
There are times when everyone feels anxious or panicky. It’s a typical reaction to tense or risky circumstances. An anxiety illness known as panic disorder causes frequent, unexpected panic or dread attacks.
Panic disorder and panic attacks cannot be completely avoided. Early diagnosis and treatment, nevertheless, can be beneficial. To prevent panic attacks from getting worse or becoming more regular, it is crucial to get therapy as soon as possible.
Additionally, it is advised that you adhere to your treatment schedule to help stop relapses or the symptoms of panic attacks from getting worse. Regular physical activity may help to prevent anxiety.
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