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A panic disorder is a form of anxiety characterized by panic attacks that occur unexpectedly and repeatedly. The fear of panicking will lead the person affected to have avoidance behaviors which will modify everyday life.
- “Panic attacks” are an alarm signal raised by the body without a valid reason
- Panic disorder is one of the manifestations of “anxiety disorders”
- “Anticipatory anxiety” is the fear of experiencing a panic attack again, which leads to the development of “avoidance behaviors”
- “Agoraphobia” is the fear of being in places where it might be difficult to flee or to get help in the event of a panic attack
Panicking is the every-day anxiety we all feel, but one which doesn’t bring on serious physical symptoms as attacks do. When people have strong feelings of panic or panicking, their thoughts are similar to those experiencing attacks. We’ve all had moments where we feel a loss of control or overwhelming, irrational fear.
What is panic disorder?
One speaks of panic disorder when one lives in the anxiety of a new panic attack and this leads to modifying one’s behavior with “avoidance behaviors.” Panic disorder is one of the manifestations of “anxiety disorders.” Anxiety and panic attacks are not as serious as such, but they can be worrying, even traumatic, for both the person and those around them.
A panic attack is a very painful acute anxiety attack (“terror attack”) that appears suddenly and unexpectedly and lasts from a few minutes to a few hours. The person will experience intense fear (of dying, or going crazy, for example), a feeling of immediate danger with unpleasant physical perceptions (palpitations, sweating, tremors, chest pain …) which will be more or less spectacular and will aggravate the fear felt. The person has the impression of completely losing control.
Usually, when a panic fear is triggered in the presence of real danger, the reaction of terror can save the life of the person. But in a panic attack, the terror reaction occurs when there is no reason to raise an alarm. These panic attacks therefore often occur unexpectedly, and in a familiar setting or in a situation that presents no real danger. The fact remains that the feeling of terror is very real and associated with extreme physical and psychological manifestations.
Gradually, “anticipatory anxiety” sets in. The person lives in fear of a panic attack again. This fear of seeing it reappear anywhere and anytime can lead to “avoidance behavior” which occurs in all areas: professional (absenteeism), personal (fear of leaving home), family (conflict) and a significant drop in the person’s quality of life.
Panic disorder can sometimes be accompanied by “agoraphobia”, that is, the fear of being in places where it might be difficult to flee or to seek help in the event of a panic attack. Some agoraphobes circulate only within a limited perimeter or need to be accompanied by a trusted person for their least movement, which often affects family and friends.
The frequency of panic attacks varies from person to person. Some people will do only one or two over their entire life while others will have several a day.
What are the signs of panic disorder?
The main signs of the panic attack are psychic, physical and behavioral.
Often the signs come on suddenly, with no real trigger. They reach their maximum intensity in a few minutes and last on average half an hour. Unpleasant physical sensations increase anxiety and fear creating a vicious circle.
The physical signs vary from one person to another and from one panic attack to another and can lead to looking for other illnesses (infarction, asthma, etc.). These may be signs of heart disease as an acceleration of the heart rate may occur (“tachycardia”), even real palpitations, with pain or discomfort in the chest. There may also be a respiratory discomfort suggestive of lung disease with a feeling of suffocation, malaise, dizziness, or of an acute belly disease with pain in the belly, nausea, vomiting, or diarrhea.
Sometimes there are tremors, muscle twitches, blurred vision, ringing in the ears (“tinnitus”), sweating, chills, or hot flashes. Only after careful examination by the doctor will there be a determination of these as signs of anxiety (vs. a physical disease).
There can be a psychosomatic effect that can evoke asthma, cardiac disorders, digestive, etc. The psychic sensations are dominated by catastrophic thoughts and loss of control sensations associated with various fears: fear of illness or disease, choking, fainting, dying, having a heart attack, of going crazy.
In order to fight these fears, some people will quickly flee the place where they are by trying to hide the trying experience, others are flabbergasted, unable to move. In the most severe forms of a panic attack, an impression of depersonalization and/or derealization can exist with a loss of contact with reality.
Panic Disorder Causes
Panic disorder does not have a single cause; it results from the combination of several genetic, biological and psycho-social factors that researchers are trying to clarify.
According to some theories, it is an inappropriate or excessive reaction to stress. Thus, different situations of fear and anxiety (including that of not being able to breathe) can trigger hyperventilation, which can itself cause certain signs, in particular dizziness, numbness of the limbs, tremors and palpitations. In turn, these feelings worsen fear and anxiety. It is therefore a vicious circle that is self-sustaining through certain neurotransmitters in the brain.
Much like other mental disorders (like anorexia for example), panic disorder usually appears in late adolescence or in young adults. The first crisis can occur after a period of great psychological stress, for example, the loss of a loved one, a separation, an illness, or an accident. Panic attacks, and especially their anticipation, persist even after the stressful situation has disappeared.
Case Study: Dan Harris Panic Attack
In 2004 Dan Harris had a panic attack on Good Morning America. He’s since said fear, then humiliation “rushed in”, after knowing he’d had it on live TV. It had been “building for years.”
Harris concluded “it’s the inner voice that can control us…We all spend time fixating on these self-defeating voices.” His inner voice was pushing him to succeed and he had doubts if he was good enough. So he became a workaholic. He slowed down after a long time in war zones, and that’s when the attack happened. Recreational drug use played a large part in panicking on live TV.
He found meditation, much of which was taken from Buddhism, was the best cure for panic attacks, this after many months speaking and working with “gurus” who claimed to have solutions.
10.6 million people viewed the ABC news broadcast where he had the attack on live TV.
How does panic disorder progress?
Without proper help, panic disorder can progress and cause even greater distress. The constant threat of not knowing when, or where, a new crisis will occur can cause “anticipatory anxiety “, that is, the constant fear that other panic attacks will occur. It is not enough to avoid feared situations or places to prevent this feeling of anxiety or fear.
Panic disorder most often develops chronically. Untreated, it often evolves with fluctuating phases of spontaneous remission but also phases of relapses which can span several months or several years.
Certain psychiatric disorders such as “agoraphobia” or depression can appear secondarily to the repetition of panic attacks. The fear of being invaded by a new attack in a public place without the possibility of being rescued can induce new fears such as the fear of going out, being in the presence of strangers or participating in various social or professional activities.
What are the complications of panic disorder?
Panic attacks, anticipatory anxiety and avoidance behaviors can have serious consequences if left untreated. The victims of this disorder are therefore at greater risk of depression than the general population, with the complications that this implies, in particular the risk of suicide.
In their desperate efforts to avoid panic attacks, some people abuse alcohol, recreational drugs (cannabis) or pharmaceutical drugs such as benzodiazepines.
Other psychiatric disorders are very frequently associated with panic disorder: social phobia, “generalized anxiety disorder,” obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD). Without proper care, they only worsen the signs inexorably.
When should you talk about a panic disorder?
Panic disorder usually appears in late adolescence or early adulthood.
It is very easy to confuse it with many other medical or psychiatric problems. People usually see several doctors before getting a diagnosis.
In the event of an intense and unexpected anxiety attack, with no real triggering factor, especially if avoidance behaviors develop, it is necessary to quickly consult a treating doctor because he alone will be able to make sense of the difference between an episode of acute anxiety and a disease with similar symptoms.
When should you consult a doctor?
As soon as the first panic attack occurs, it is important to consult a doctor.
The majority of panic disorders occur on healthy physical grounds and it is important that the doctor carefully examines and reassures the person who is particularly afraid of having an undetected organic disease. He can suggest listening and assessing the state of anxiety. Early consultation also generally helps to reduce apprehension about a new crisis.
In general, the earlier the support is implemented, the better the prognosis for the disease will be. It is important not to wait for the troubles to take on significant proportions in everyday life before acting. It is possible to consult your general practitioner or a psychiatrist to discuss an adapted and personalized care.
How to diagnose panic disorder?
Panic disorder is defined by at least one panic attack and then a significant period of apprehension over a period of more than a month. Panic attacks are a very distressing experience and leave traumatic imprints: the victim is constantly thinking about them and living in fear that other attacks will occur at any time. Anxiety of anticipation then sets in, corresponding to the fear of suffering from such a crisis again. The diagnosis of panic disorder is made when the anticipation of crises has lasted for more than a month and when it has a real impact on personal, family and professional daily life.
The frequency and intensity of panic attacks can vary greatly from one individual to another. It can last through one’s life or several times a day in a shorter period. Panic attacks are unexpected in panic disorder, that is, they are not directly triggered by exposure to feared objects or situations as in the case of phobias. Nor should they be triggered by the consumption of psychoactive substances such as alcohol, drugs or medication.
Panic disorder has a concrete impact on the functioning of affected people. All of life is reorganized around the fear of reliving a new crisis. The search for new avoidance strategies likely to reduce the risk of their occurrence takes precedence over all aspects of life: personal, family, professional.
Confusing panic disorder with other psychological disorders
Panic attacks can also be present in other related anxiety disorders, such as “social phobia” or “specific phobia” (seeing a spider, for example). They can be confused with anxiety disorders due to other psychiatric pathologies such as depression and schizophrenia.
Many diseases of the body can cause identical signs to panic attacks. It would be unreasonable to say that breathing difficulties or tetany problems are always synonymous with anxiety attacks. It is important to consult your doctor in all cases to get the correct diagnosis.
Apart from situations of fear or normal anxiety, it is also possible to confuse panic disorder with anxiety induced by a substance (cocaine, amphetamines, cannabis) or alcohol withdrawal.
The most difficult situation is to differentiate panic attacks from anxious manifestations due to certain medical diseases: prolapse of the mitral valve, high blood pressure, asthma, temporal epilepsy, duodenal ulcer, migraine, and others.
What is the value of psychotherapy in panic disorder?
The effectiveness of psychotherapy to treat panic disorder has been scientifically demonstrated. It is even the treatment of preference in many cases, before resorting to medication.
Cognitive-behavioural therapy (CBT) is the standard psychotherapy in the treatment of panic disorder. If a panic attack occurs, the person learns to recognize the signs as soon as they appear, to not make misinterpretations and to remain in the situation rather than to flee. The person learns to reduce his fears and thus acquires a better grip on the situation. Therapy aims to change thought patterns, helping people analyze their feelings. It helps the person to distinguish realistic and unrealistic thoughts.
It can sometimes be interesting to combine it with other types of psychotherapy (analytical, systemic therapy, etc.) to develop assertiveness in order to improve emotional control and develop new behaviors adapted to react to situations deemed to be distressing.
The analytic psychotherapy (psychoanalysis) can be used when there are conflicting elements underlying related to the personal history of the person.
Panic disorder medications
Among the drug treatments, several classes have been proven to reduce the frequency of acute anxiety attacks. Antidepressants are the first choice because they help treat panic disorder over the long term. “Selective serotonin reuptake inhibitors” (SSRIs) and “tricyclic antidepressants” are the most used. The antidepressant treatment is first prescribed for a period of 12 weeks, then a reassessment is made to decide whether to continue the treatment or to change it.
The anxiolytics such as benzodiazepines are prescribed if the anxiety and agitation are important. They must, however, be used in the short term because of their side effects and the risks of addiction. Therefore, anxiolytics are preferred because they don’t have drawbacks found with antihistamines (hydroxyzine) or a beta-blocker (propranolol).
How to prevent panic disorder
There is no real “common sense” method to prevent panic attacks, especially since they usually occur unpredictably. An appropriate management, both pharmacological and non-pharmacological, may include learning to manage stress and prevent crises from becoming too frequent or too debilitating.
In order to prevent the occurrence of new panic attacks, a healthy lifestyle is essential to reduce anxiety and to bring it back to a tolerable level.
- Good work/rest/ leisure balance
- A balanced diet, low in sugars, low consumption of caffeine, alcohol and nicotine
- Restful and sufficient sleep
- Regular physical exercise
- Relaxation activities (meditation, relaxation, yoga)
Certain factors can trigger panic attacks. These vary enormously from one person to another, and in many cases, there is no clearly identified trigger.
Several studies have shown that the influence of traumatic events experienced during childhood, especially in connection with separation anxiety (fear of separating from one’s parents) is a common thread with those suffering from panic attacks.
Among other factors which are often found, we can cite the following stressful factors: a context of relationship difficulties such as divorce or dismissal; bereavement or illness; the consumption of alcohol, cannabis, or illicit drugs; certain anxiety-provoking situations such as public transport, planes and crowds; and abrupt taking or stopping of certain medications, in particular certain antidepressants.
How to live with a panic disorder?
Healing can take several months, especially if there are other illnesses to consider (depression, phobia, alcohol or drug abuse).
Consultation and diagnosis is an important step towards the cure of the disease. Recognition in itself helps relieve anxiety around symptoms.
The support of family and good adherence to treatment (psychotherapy and/or medication) are essential to promote healing in the long term.
Healthy living, relaxation activities and a balance between professional, personal and family life help prevent crises and anticipate them. Little by little, it is possible to free yourself from your avoidance behaviors and find freedom on a daily basis.