Panic Disorder

Definition

Panic disorder is an anxiety disorder characterized by recurrent and unexpected

panic attacks that are not caused by drugs, alcohol, or certain

medical conditions like asthma. It can be a disabling condition, causing

people to quit jobs or social activities, avoid going outside their home,

or give up exercising. It also commonly leads to frequent and unnecessary

visits to hospital emergency rooms.

Description

The most noticeable symptom of panic disorder is a panic attack, which

is defined as a period of intense fear that comes on suddenly and builds

to a peak within a few minutes (usually about ten minutes). The attack

is often accompanied by a general feeling of doom and an urge to leave

or escape from the setting in which the attack occurs. There may or may

not be a pattern to a person

or two a week over a period of time, while others may have several attacks

close together and then go for months or years before another attack.

Although panic attacks are a symptom of panic disorder, the two are

not the same thing. It is possible for a person to have panic attacks without

being diagnosed with panic disorder. To meet the official criteria for a

diagnosis of panic disorder, a person must have recurrent and unexpected

panic attacks followed by at least one month of

worry about having another panic attack. In addition,

the official criteria specify that a person

must have at least four of the following thirteen

symptoms that characterize panic attacks:

•

Heart palpitations or fast heartbeat

•

Sweating

•

Trembling or shaking

•

Shortness of breath

•

Choking sensations

•

Chest pain

•

Nausea or pain in the abdomen

•

Dizziness or lightheadedness

•

Tingling sensations

•

Chills or hot flushes

•

unreal) or derealization (a feeling that the

external environment is unreal)

Depersonalization (a feeling that the self is

•

Fear of losing control (“going crazy”)

•

There are two subtypes of panic disorder: panic disorder with agoraphobia

and panic disorder without agoraphobia. Agoraphobia is an unrealistic

fear of going outside the safety of the home, particularly to use

public transportation or visit large public places (shopping malls, sports

arenas, or even parks or recreational facilities). About a third of Americans

diagnosed with panic disorder have panic disorder with agoraphobia.

Panic disorder with agoraphobia develops when the person

panic attacks takes the form of avoiding places from which a quick

exit or escape might be difficult or embarrassing (such as airplanes, trains,

or buses; crowded stores; worship or other group activities, etc.). This

form of panic disorder can interfere significantly with people

complete their education, go to work, or meet friends outside the home.

Fear of dying’s fear of recurrent’s ability to

Demographics

According to the National Institute of Mental Health (NIMH), between

1 and 4 percent of the American population suffers from panic disorder,

most of them adolescents or young adults. About 6 percent of the population

will have a panic attack at some point in their lives. The average

age of patients with panic disorder is twenty-four. It is unusual for people

over forty-five to develop panic disorder for the first time.

Women are between two and three times more likely than men to

develop panic disorder. With regard to race and ethnicity, researchers disagree.

Some studies suggest that African Americans have a slightly higher

rate of panic disorder than either Caucasian or Asian Americans, while

other researchers think that these findings point to problems in the

screening interviews used to detect panic disorder rather than the actual

rates of occurrence.

People with certain medical conditions, such as hypertension (high

blood pressure), migraine headaches, and irritable bowel syndrome,

appear to have an increased risk of developing panic disorder.

Causes and Symptoms

The causes of panic disorder are not completely understood. Some possible

causes that researchers are studying include:

•

a person with panic disorder is eight times as likely to develop it as

a person in the general population.

Genetic factors. A first-degree relative (parent, child, or sibling) of

•

think that differences in body chemistry cause some people to

overreact to noises, lights, or other stimuli in the environment.

Biochemical imbalances in the central nervous system. Some doctors

•

appear to trigger panic attacks in some people.

Consuming large amounts of coffee, tea, or alcohol. These substances

•

A tendency to convert anxious thoughts into physical symptoms.

•

symptoms of a full-blown panic attack. For example, a man whose

heartbeat speeds up when he is angry may worry when he notices

the change in heart rate. He then experiences the resulting anxiety

as the chest pain of a panic attack.

A tendency to intensify minor physical sensations into the physical

Diagnosis

The diagnosis of panic disorder is usually a diagnosis of exclusion, which

means that the doctor arrives at the diagnosis by ruling out other possibilities

rather than by positively identifying the disorder on the basis of

tests. There are no laboratory tests or imaging studies for panic disorder.

The doctor will examine the patient for such medical conditions as disorders

of the thyroid gland; asthma or other breathing disorders; or substance

abuse. Men in particular are likely to drink alcohol in order to

cope with panic attacks. The doctor will want to make sure that the

patient is not abusing alcohol or prescription drugs.

If people go to the emergency room complaining of chest pain, the

doctors there will commonly ask two simple questions to screen for panic

disorder: 1) Have they had a spell or attack in the past six months when

all of a sudden they felt anxious, frightened, or very uneasy? 2) In the past

six months, have they ever had a spell in which they felt their heart race,

could not catch their breath, or felt faint? A

is considered a positive screen for panic disorder.

“yes” answer to either question

Treatment

Panic disorder is highly treatable. Most patients are given a combination

of medications and psychotherapy. The two forms of psychotherapy that

are most useful in treating people with panic disorder are exposure

therapy (for those with agoraphobia) and cognitive behavioral therapy.

In exposure therapy, patients are introduced to their feared situation in

gradual stages until they feel comfortable with it. For example, someone

who is afraid to go shopping for groceries might start by just opening the

front door, then walking down the front path to the sidewalk. Next, the

person walks a few blocks, then goes to the store itself and purchases only

one item, and so on. Some people recovering from agoraphobia refer to

exposure therapy as the

recover, and repeat.

In cognitive behavioral therapy (CBT), patients are given some education

about anxiety and are taught to recognize and control their reactions

to panic attacks. In CBT sessions, people learn to recognize

things that trigger panic attacks or make them worse, such as specific

thoughts or situations. They also learn to modify behavior so that it is

more useful than simply avoiding the feared place or situation.

Doctors may prescribe medications in addition to psychotherapy,

particularly if the patients

The medications prescribed for adults are usually antidepressants

or tranquilizers. It may take several weeks for the medications to take

effect. The doctor may need to try more than one medication before

finding the drug that works best for the specific patient, but most

patients with panic disorder are helped by these drugs.

Complementary and alternative therapies that are effective in

treating panic disorder include yoga, meditation, relaxation techniques,

guided imagery, and hypnosis.

Prognosis

Most people do very well when treated for panic disorder provided they

stick with their treatment plan. In addition, people who have been

treated with psychotherapy can usually make arrangements for

sessions

groups and online communities for people with panic disorder.

“booster” if they feel the need for further help. There are also many support

Prevention

There is no known way to prevent panic disorder because its causes are

not yet fully understood. People can, however, lower their risk of panic

attacks by avoiding the use of recreational drugs and learning stress management

or relaxation techniques.

The Future

Panic disorder is likely to continue to be a disabling condition for many

people, particularly those who do not know that it is treatable. It is

possible that further research will help doctors learn more about the

causes of the disorder and develop even more effective treatments.

SEE ALSO

Alcoholism; Hypertension; Irritable bowel syndrome

For more information

BOOKS

Campbell, Nancy M.

National Institute of Mental Health (NIMH).

No. 06-3879. Bethesda, MD: NIMH, 2006.

Panic Disorder. Mankato, MN: LifeMatters, 2002.Anxiety Disorders. NIH Publication

WEB SITES

Anxiety Disorders Association of America (ADAA).

Available online in PDF format at http://www.adaa.org/bookstore/

Brochures/panic_adaa.pdf (accessed May 5, 2008). This four-page brochure

includes a self-test for panic disorder.

National Alliance on Mental Illness (NAMI).

Available online at http://www.nami.org/Template.cfm?Section=

By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=

54&ContentID=23050 (updated May 2003; accessed May 5, 2008).

National Institute of Mental Health (NIMH).

Available in PDF format at http://www.nimh.nih.gov/health/publications/

panic-disorder-a-real-illness/complete.pdf (updated October 2005; accessed

May 5, 2008).

WORDS TO KNOW
Agoraphobia: An irrational fear of venturing outside
the home or into open spaces, so strong
that a large number of activities outside the
home are limited or avoided altogether. Agoraphobia
is often associated with panic attacks.
Cognitive: Pertaining to thinking, learning, or
memory.
Diagnosis of exclusion: A diagnosis that the
doctor arrives at by ruling out other diseases one
by one rather than making the diagnosis on the
basis of laboratory tests or imaging studies, or
other test results.
Panic attack: An episode of intense fear that lasts
for several minutes and is accompanied by
physical symptoms or temporary disturbances of
thinking.
Phobia: An unfounded or morbid dread of a specific
object or situation that arouses feelings of
panic.Panic Disorder.About Mental Illness: Panic Disorder.Panic Disorder—A Real Illness.“five Rs,” which stand for react, retreat, relax,’ panic attacks are keeping them virtually housebound.’s panic attacks. Some people may have one

Panic Disorder