Panic Disorder

Panic Disorder is a type of anxiety disorder that causes recurrent and unexpected panic attacks, which are sudden episodes of intense fear and physical symptoms that can feel overwhelming and terrifying. Panic disorder can affect anyone, but it is more common in women and often starts in late adolescence or early adulthood. In this article, I will explain what panic disorder is, what are its symptoms, causes, diagnosis, treatment, and coping strategies.

What is the diagnosis of Panic Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Diagnostic Criteria for Panic Disorder is as follows:

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense anxiety, fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or “going crazy”.
13. Fear of dying.

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
2. A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).

What are the symptoms of Panic Disorder?

The main symptom of panic disorder is having recurrent and unexpected panic attacks that cause significant distress and impairment. However, people with panic disorder may also experience other symptoms such as:

• Anticipatory anxiety: This is a constant feeling of nervousness or dread about when the next panic attack will occur or what will trigger it. Anticipatory anxiety can interfere with one’s concentration, sleep, appetite, mood, and motivation.
• Interoceptive sensitivity: This is a heightened awareness of one’s bodily sensations and changes, such as heart rate, breathing, muscle tension, etc. Interoceptive sensitivity can make one more prone to misinterpret normal bodily reactions as signs of an impending panic attack and trigger a vicious cycle of fear and anxiety.
• Phobic avoidance: This is a tendency to avoid places, situations, activities, or people that are associated with past panic attacks or that might trigger future ones. Phobic avoidance can range from mild to severe and can affect one’s personal, professional, and social life.
• Safety behaviours: These are actions or strategies that one uses to cope with or prevent panic attacks, such as carrying medication, seeking reassurance from others, distracting oneself, breathing deeply, etc. Safety behaviours may provide temporary relief but can also reinforce the belief that one cannot cope without them and maintain the fear of panic attacks.

What causes Panic Disorder?

The exact causes of panic disorder are not fully understood, but several factors may contribute to its development and maintenance. These include:

• Biological factors: Some studies suggest that genetic factors may play a role in predisposing some people to panic disorder. Other biological factors that may be involved include abnormalities in brain structures and functions related to fear and anxiety regulation (such as the amygdala), hormonal imbalances (such as low levels of serotonin), and sensitivity to physical stimuli (such as caffeine).
• Psychological factors: Some psychological factors that may increase the risk of developing panic disorder include having a history of trauma or abuse, experiencing stressful life events (such as loss, divorce, illness), having a negative self-image or low self-esteem, having an anxious temperament or personality style (such as perfectionism), having maladaptive beliefs or attitudes about oneself and the world (such as catastrophizing), and having poor coping skills or emotional regulation.
• Environmental factors: Some environmental factors that may trigger or worsen panic disorder include exposure to situations that elicit fear or anxiety (such as crowds, heights), lack of social support or positive feedback from others, having high expectations or demands from oneself or others (such as work pressure), and experiencing changes or transitions in life (such as moving to a new place).

How is Panic Disorder diagnosed?

To diagnose panic disorder, a mental health professional will conduct a comprehensive assessment that may include:

• A clinical interview: This is a conversation between the clinician and the client that aims to gather information about the client’s symptoms, history, functioning, and goals. The clinician will ask questions about the frequency, intensity, duration, and context of the panic attacks, as well as the client’s worries, fears, behaviours, and coping strategies related to them. The clinician will also inquire about the client’s medical history, family history, substance use, and other mental health issues that may affect or co-occur with panic disorder.
• A physical examination: This is a check-up by a medical doctor that aims to rule out any physical causes or conditions that may explain or mimic the symptoms of panic disorder. The doctor may perform tests such as blood tests, electrocardiogram (ECG), chest X-ray, etc. to assess the client’s general health and rule out any potential problems such as thyroid disorders, heart diseases, respiratory diseases, etc.
• A psychological test: This is a standardized measure that evaluates the client’s psychological functioning and symptoms. The clinician may administer one or more tests such as the Panic Disorder Severity Scale (PDSS), the Anxiety Sensitivity Index (ASI), the Agoraphobic Cognitions Questionnaire (ACQ), etc. to assess the severity and impact of the panic disorder and related factors such as anxiety sensitivity, phobic avoidance, and catastrophic thinking.

How is Panic Disorder treated?

Panic disorder can be effectively treated with a combination of psychotherapy and medication. The most common and evidence-based treatments for panic disorder are:

• Cognitive-behavioural therapy (CBT): This is a type of psychotherapy that focuses on identifying and challenging the negative thoughts and beliefs that contribute to panic disorder and replacing them with more realistic and adaptive ones. CBT also teaches the client skills and techniques to cope with and reduce anxiety and panic symptoms, such as relaxation, breathing exercises, exposure therapy, etc. CBT can help the client understand the nature and causes of panic disorder, reduce the fear of panic attacks and their consequences, increase the sense of control and confidence, and prevent relapse.
• Medication: This is a type of treatment that involves taking prescribed drugs that affect the brain chemicals involved in fear and anxiety regulation. The most common types of medication used for panic disorder are antidepressants (such as selective serotonin reuptake inhibitors or SSRIs) and anti-anxiety drugs (such as benzodiazepines). Medication can help reduce the frequency and intensity of panic attacks, lower the general level of anxiety, improve mood and sleep quality, and enhance the effects of psychotherapy. However, medication can also have side effects such as nausea, drowsiness, weight gain, sexual dysfunction, etc. and can be addictive or cause withdrawal symptoms if stopped abruptly. Therefore, medication should always be used under close supervision by a doctor who can monitor its dosage, effectiveness, and safety.

How can I cope with Panic Disorder?

In addition to seeking professional help for panic disorder, there are some self-help strategies that can help you cope with it better. These include:

• Educating yourself: Learning more about panic disorder can help you understand what is happening to you and why, reduce your fear, stigma and confusion, increase your motivation to seek help and follow treatment recommendations, and find sources of support and information.
• Practicing relaxation: Engaging in activities that promote relaxation can help you calm your body and mind, lower your stress levels, improve your mood and sleep quality, and prevent or reduce panic attacks. Some examples of relaxation activities are meditation, yoga, progressive muscle relaxation, guided imagery, listening to music, reading a book, etc.
• Exercising regularly: Physical activity can have many benefits for your physical and mental health. It can help you release tension and negative emotions, improve your cardiovascular fitness and immune system, enhance your self-esteem and body image, and stimulate the production of endorphins (natural painkillers and mood boosters). Aim for at least 30 minutes of moderate exercise three times a week.
• Eating healthy: What you eat can affect how you feel. Eating a balanced diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats can provide you with the nutrients you need for optimal functioning. Avoid or limit foods that can worsen your anxiety or panic symptoms such as caffeine, alcohol, sugar, processed foods, etc.
• Seeking support: Having people who care about you and understand what you are going through can make a big difference in your recovery process. Seek support from your family, friends, partner, or other people who have experienced or are experiencing panic disorder. You can also join a support group, online forum, or helpline where you can share your feelings, experiences, and coping strategies with others who can relate to you. Mental health matters and you need to prioritize it.
• Challenging yourself: Facing your fears can be scary but also empowering, as you learn to overcome your fears and gain confidence in yourself. Some examples of challenging yourself are:
• • Gradually exposing yourself to situations that trigger your panic attacks, such as driving, flying, shopping, etc. Start with the least scary situation and work your way up to the most scary one, while using your coping skills and challenging your negative thoughts. Ideally, you should work with a mental health professional who can help you navigate this process.
  • Practicing interoceptive exposure, which is deliberately inducing or simulating the physical sensations of a panic attack, such as hyperventilating, spinning, holding your breath, etc. This can help you get used to these sensations and reduce your fear of them.
  • Setting realistic and achievable goals for yourself and rewarding yourself for your progress. For example, you can set a goal to go to the grocery store by yourself and buy one item, and then reward yourself with a treat or a compliment.

Conclusion

Panic disorder is a common and treatable condition that causes recurrent and unexpected panic attacks that can interfere with one’s daily life. However, with proper diagnosis, treatment, and coping strategies, one can learn to manage panic disorder and live a fulfilling and productive life. If you think you have panic disorder or are experiencing panic attacks, please seek professional help from a mental health provider who can offer you the best care and support for your needs. Remember that you are not alone and that there is hope for recovery.