What is Panic Disorder?
Feelings of intense fear – and physical manifestations of that fear – are very common if someone is facing immediate danger or a perceived threat. In panic disorder, however, a person experiences recurrent unexpected panic attacks (abrupt surges of intense fear or discomfort accompanied by physical and cognitive symptoms) even when they are not in any danger.
Panic disorder causes a person to be persistently concerned or worried about having more panic attacks or causes them to change behavior because of the panic attacks. Panic attacks – which typically reach a peak within minutes – may occur in response to a known feared object or situation, or they may seem to appear out of the blue.
For panic disorder diagnosis, a person must have experienced recurrent, unexpected panic attacks and one month or more of persistent worry about additional panic attacks or a significant change in behavior related to the attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and can occur from a calm or anxious state, and includes at least four of the symptoms listed below. Common panic attack symptoms are listed below.
Panic Attack Symptoms
- 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
Panic Disorder Symptoms
- Persistent concern or worry about additional panic attacks or their consequences (like losing control or having a heart attack)
- A significant change in behavior related to the attacks (like avoiding unfamiliar situations)
In panic disorder, these symptoms are not attributable to the effects of drugs, alcohol, medication or another medical condition and are not better explained by another mental disorder.
The causes of panic attacks and panic disorder are unknown. Genetics, major stress (like the death or illness of a loved one), a negative temperament or increased sensitivity to stress, and functional changes in the brain are all thought to play a part.
Risk factors that could contribute to panic disorder include:
Traumatic history: Traumatic events like physical abuse, sexual assault or a serious accident may precipitate panic disorder.
Major life changes: Having a baby, getting a divorce, losing a job and other major changes may trigger panic attacks.
Habits: Smoking or excessive caffeine intake may contribute to panic disorder.
A panic disorder diagnosis requires thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for panic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.
The panic disorder criteria are:
- Frequent panic attacks over long periods of time
- At least one panic attack followed by a month of intense worry about future attacks or other forms of psychological discomfort
- The panic attacks are not rooted in another medical or psychiatric condition, or in behavioral issues such as drug or alcohol abuse.
Panic Disorder Diagnosis
Diagnostic tests for panic disorder include:
Physical examination: Your provider will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem, medication side effects or unhealthy behaviors (like drug use). To rule out medical conditions, he or she may order:
- Blood tests to check for thyroid and other conditions
- An electrocardiogram (ECG or EKG) to rule out a heart condition
Psychiatric evaluation: Your behavioral health provider will ask you questions about your symptoms, stressful situations in your life, fears or concerns, relationship problems and other issues to confirm a diagnosis and rule out other psychiatric conditions.
Panic Attack Diagnosis
An individual panic attack is diagnosed similarly to panic disorder, but without reference to the DSM-5 criteria noted above.
Panic Attack Treatment Vs. Panic Disorder Treatment
Individual panic attacks may not require treatment. Many people experience one or two episodes during their lifetime, without serious or ongoing consequences. For persons experiencing infrequent but debilitating panic attacks, treatment options are similar to those for panic disorder.
Panic disorder cannot be prevented. But there are some lifestyle adjustments and self-care strategies that may reduce the number of panic attacks or make them less severe.
Stick to your treatment plan: Therapy, counseling and/or medications prescribed by your physician are the best ways to manage your panic disorder symptoms.
Seek support: Joining a support group can help you connect with others facing similar issues and discuss helpful strategies. This activity can also be used as panic disorder treatment, if mixed with other treatment options outlined later in this article.
Stay away from caffeine, cigarettes, alcohol and drugs: These can all worsen panic disorder.
Try relaxation and stress-management techniques: Explore yoga, gentle exercise routines, meditation and other practices that encourage muscle relaxation, deep breathing, balance and positive thought.
Get enough sleep: Sleep deprivation can make you more sensitive to stress.
Panic disorders can be long-lasting and difficult to treat, but most people can get better with ongoing treatment and lifestyle adjustment. Alcohol or drug use, relationship or work problems, and avoidance of social situations can all make panic disorder harder to treat.
Most people with panic disorder benefit from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist, panic disorder specialist or other behavioral health professional.
You may need to try a few different medications, or medication combinations, before you find the one that’s right for you. Some medications take a few weeks before their full effect is obvious. Some cause side effects for certain patients. If you experience any side effects, it’s important to talk to your physician immediately but not to abruptly stop taking the medication, which could cause a worsening of symptoms.
Common medications prescribed for panic disorder treatment include:
- Selective serotonin reuptake inhibitors (SSRIs): These first-line antidepressants are recommended most for panic disorder, are considered safer than other types, and tend to cause fewer disruptive side effects. They increase levels of serotonin in the brain.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): These antidepressants block the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain.
- Benzodiazepines: These sedatives are central nervous system depressants, so they help quell panic symptoms. But, they may be habit-forming, especially when taken for a long time or in high doses, and can interact with other medications.
Also known as talk therapy or psychological therapy, this involves talking about your condition, symptoms, mental health history and life with a mental or behavioral health professional. A form of psychotherapy called cognitive behavioral therapy may help you learn through your own experience that panic symptoms are not dangerous. Your therapist will help you recreate in a safe environment the symptoms of a panic attack or situations that induce fear. When physical sensations of panic no longer feel threatening, attacks should begin to resolve.
The aforementioned therapies can serve as severe panic disorder treatment as well as mild. If you or a loved one is interested, request an appointment today at any of our 8 locations and speak with a Baptist Health professional.
When treating severe panic disorder and even mild cases, there are complications that can arise from suffering from this condition. Complications of panic disorder include:
- Alcohol or drug abuse in an effort to numb fear responses
- Avoidance of social situations
- Depression or other anxiety disorders
- Financial problems (if panic disorder affects your work or you pursue costly medical care)
- Frequent medical care and health concerns
- Increased chance of suicidal thoughts
- Problems at work or school
- Relationship difficulties
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