Psych Central

Anxiety

Panic Disorder

By Steve Bressert, Ph.D.
Jan 19 2005

Table of Contents

More than three million Americans will experience panic disorder during their lifetime, and there is no typical victim. According to the American Academy of Child and Adolescent Psychiatry, panic disorder can begin during childhood or before age 25.

While it is not clear what causes the disorder, there is a strong suggestion that the tendency is inherited and runs in families. At one time, researchers believed panic disorder was due primarily to psychological problems. Experts now believe that genetic factors or changes in body chemistry, in combination with stressful circumstances or events, play a pivotal role.

According to the American Psychological Association, each panic attack peaks within about 10 minutes. Sometimes attacks repeat in clusters for up to an hour after the initial attack, with associated fear over the possibility of another attack. Subsequent attacks may occur days and even weeks later.

This element of fearfulness is called anticipatory anxiety. People fear having another attack while performing the same activity or being in the same situation as when a previous attack occurred. Anticipatory anxiety can be so extreme that people turn away from the outside world for fear that another attack will be set off.

For example, if an attack occurred while driving on the freeway, a person may fear that repeating this type of driving will cause panic again. He will, then, limit himself to driving only on secondary roads. If panic was experienced while sleeping in bed in the dark, a person might sleep on the couch with the light on to try to prevent another attack.

If an attack was experienced outside while walking through a park or shopping at a mall, a fear of having a future attack in public can occur. This can lead to complete avoidance of any outside activity, which can result in a condition called agoraphobia-the inability to go beyond known and safe surroundings because of intense fear and anxiety.

While a great deal of research has been conducted on panic disorder, the exact cause is unclear. Research does suggest that panic disorder is more prevalent in women than in men.

According to the National Institute of Mental Health (NIMH), panic disorder can also happen with other disorders. Depression and substance abuse commonly occur simultaneously with panic disorder. About 30 percent of people with panic disorder abuse alcohol and 17 percent abuse drugs, such as cocaine and marijuana. This drug abuse can be attributed to unsuccessful attempts by a person with panic disorder to alleviate the anguish and distress caused by his condition.

Major advances have been made through research funded by the NIMH to produce effective treatments to help people with panic disorder. Treatment includes medication and a type of psychotherapy known as cognitive-behavioral therapy.

Appropriate treatment by an experienced professional can reduce or prevent attacks in 70 to 90 percent of people with panic disorder. Most people show significant progress after a few weeks of treatment. Relapses can occur, but they can often be treated effectively.

Symptoms of Panic Disorder

There are more than a dozen physical or emotional sensations that a person can experience during a panic attack. Not everyone experiences all of them, and people with panic disorder may report different feelings when having an attack.

If not recognized and treated, panic disorder can be devastating because it can interfere with relationships, schoolwork, employment and normal development. It is not uncommon for a person with panic disorder to experience an anxious feeling even between attacks. People with panic disorder will begin to avoid situations where they fear an attack may occur or situations where help might not be available. This happens with both adults and children with panic disorder.

For example, a child may be reluctant to go to school or be separated from her parents. Not all children who express separation anxiety do so because they have panic disorder, and it can be very difficult to diagnose. But when properly evaluated and treated with a combination of medication and cognitive-behavioral therapy, children with panic disorder usually respond well. It is recommended that a family physician or pediatrician first evaluate children and adolescents with suspected panic. If no other physical illness or condition is found as a cause for symptoms, a comprehensive evaluation by a child and adolescent psychiatrist should be obtained.

Brain scans and blood tests are not effective in diagnosing panic disorder.

Questions formulated by The Anxiety Disorders Association of America can help an individual determine whether he is experiencing panic disorder. These include:

  1. Are you troubled by repeated and unexpected “attacks” of intense fear or discomfort for no apparent reason?

  2. During such attacks, do you experience at least four of the following symptoms?
    • pounding heart
    • sweating
    • trembling or shaking
    • shortness of breath
    • choking
    • chest pain
    • nausea or abdominal discomfort
    • “jelly” legs
    • dizziness
    • a feeling of unreality or being detached from yourself
    • fear of losing control
    • going crazy
    • fear of dying
    • numbness or tingling sensations or chills or hot flashes
  3. Do you have a fear of places or situations where escape or getting help might be difficult, such as a crowded room or traffic jam?
  4. Do you have a fear of being unable to travel without a companion?
  5. For at least one month following an attack, have you felt persistent:
    • concern about having another attack?
    • worry about going crazy?
    • need to change your behavior to accommodate the attack?

In summary, panic disorder results from having panic attacks. Panic attacks are episodes that come “out of the blue.” They peak within a few minutes and cause feelings of terror and alarming physical symptoms.

People often are convinced during the attack that they are dying and describe a panic attack as the most distressing experience that they have ever had. As a natural response, people dread the next attack and often avoid places or situations where they have had panic attacks.

» Next in Series: Social Phobia/Anxiety Disorder

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Last reviewed: By John M. Grohol, Psy.D. on 26 May 2013
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