What is Panic Disorder?
Panic Disorder occurs when an individual who has had recurrent and unexpected panic attacks worries about having future panic attacks or is afraid of what might happen if he or she has another panic attack.
Panic Disorder affects approximately 2% - 4% of the population. It can occur at any age but usually begins either in late adolescents or adulthood (mid 30s). Postpartum anxiety and panic attacks are also common. Panic disorder is more commonly diagnosed in women than in men.
What are Panic Attacks?
Panic attacks are discrete periods of intense fear or physical discomfort that are accompanied by a number of physical and/or cognitive symptoms.
Common panic symptoms include:
- racing heartbeat or palpitations
- sweating
- shaking or trembling
- shortness of breath or constricted breathing
- feeling of choking
- chest pain
- nausea or abdominal discomfort (e.g. stomach butterflies)
- dizziness or lightheadedness
- numbness or tingling
- chills or hot flashes
- feelings of unreality or being detached from oneself
- fear of losing control or going crazy
- fear of dying
Panic attacks are the body's natural reaction to feared or dangerous situations. However, sometime an attack occurs in error when there is no real danger. Some panic attacks occur when an individual is exposed to a certain situation or trigger (cued panic attacks), while others occur for no perceivable reason at all (uncued or unexpected panic attacks). While panic attacks are uncomfortable, they are not dangerous. People with panic disorder however, do not believe this and thus react to their panic attacks with fear and anxiety.
What is Agoraphobia?
Agoraphobia is a condition that is often associated with Panic Disorder. It is the fear of places or situations that a person feels would be hard to escape from or get help in if they felt panicky or had a panic attack. Not all people with panic disorder develop agoraphobia. However, those that do are often afraid of leaving their house alone, being in crowded areas, being trapped in a car, train or bus, or simply being in an unknown or "unsafe" area. Individuals with agoraphobia either avoid the situations or feel intense dread and discomfort in these situations. Sometimes, just being in these situations will cause a panic attack.
How is Panic Disorder (with or without Agoraphobia) treated?
The most effective psychological treatment for panic disorder is a combination of relaxation training, interoceptive exposure, and graduated exposure.
- Relaxation Training involves teaching the patient breathing, muscle relaxation, and visualization exercises to help them calm down and either avoid or cope with a panic attack.
- Interoceptive Exposure involves teaching the patient that the physical sensations that occur during a panic attack are not dangerous and can be tolerated. The patient is exposed to physical sensations that are experienced during a panic attack in a controlled way and taught how to cope with them without setting off a full blown panic attack.
- Graduated Exposure involves gradually exposing the patient to those feared and/or avoided situations that cause anxiety. By repeatedly exposing oneself to these situations, the patient learns that the situations are actually benign.
Treatment for Panic Disorder typically begins with education about the disorder and the treatment. Then the therapist teaches the patient relaxation techniques as an immediate way of coping with their anxiety. Interoceptive exposure is then used to teach the patient how to cope with the physical sensation that usually precede or occur during a panic attack. For example, this may include spinning in a chair to simulate dizziness or breathing into a bag to simulate hyperventilation. Cognitive therapy is used to challenge those beliefs that support the fear of the panic attacks.
For patients with agoraphobia, the patient and the therapist build an anxiety hierarchy, in which places and situations are identified and ranked from least to most anxiety provoking. With the therapist's support, and at a pace that is comfortable for the patient, the patient is gradually exposed to each situation on the anxiety hierarchy until that situation no longer provokes anxiety.
Medication is also used to treat panic disorder. Some medications depress the autonomic nervous system and stop panic attacks from happening. Others help reduce anxiety and curb panic attacks. However, once an individual stops taking medication there is a good chance that the panic symptoms will return. Therefore, medication is best used to help curb symptoms and decrease anxiety so that patients can more easily engage in therapy and successfully learn to combat their symptoms in a more permanent way.
Panic Disorder Links
American Psychologist Association Panic Disorder website - http://www.apa.org/pubinfo/panic.html
