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Anxiety, Fears, and Phobias

Panic Disorder

Friday, March 16, 2012 - 15:38

Contributing Author: Guy Slowik FRCS

People with panic disorder have panic attacks, which can be devastating. Symptoms of a panic attack include frightening thoughts such as fear and dread, along with physical sensations such as heart palpitations and dizziness.

Panic attacks can come on suddenly. They usually reach their peak in about 10 minutes and are over in 20 minutes or less. However, in some cases, they may last as long as an hour.

If people have a panic attack in a specific situation, (for example, in a shopping mall) they may expect that panic will strike again the next time they are in that situation. As a result, they are likely to start avoiding that situation. When that happens, their condition is known as panic disorder with avoidance.

In severe cases, this pattern of avoidance is likely to develop into agoraphobia, the avoidance of open spaces and public areas. This is closely linked to panic disorder.

In some cases, however, panic attacks occur in no particular pattern. Avoiding specific situations doesn't help. That condition is called simple panic disorder.

Need To Know:

A panic attack usually involves several of these symptoms:

  • Shortness of breath or smothering sensations
  • Dizziness, unsteadiness, faintness
  • Palpitations, or a rapid heart rate
  • Trembling or shaking
  • Sweating
  • Choking
  • Nausea, upset stomach, abdominal distress
  • Feelings of disorientation, as if things around you are not real
  • Numbness or tingling sensations (pins and needles)
  • Hot flashes, cold chills
  • Pain or discomfort in the chest
  • Fear of disease or of dying
  • Fear of going crazy or losing control

A true panic attack involves at least four of these symptoms when no real outside threat (such as a mugger) is responsible for the fear.

How Panic Builds Up

Often fear of panic is as disabling as the panic attacks themselves. Or the fear itself can provoke attacks:

  • You experience a physical sensation, thought, or feeling that is threatening.
  • These threatening sensations, thoughts, or feelings lead to physical symptoms, such as rapid heartbeat, shortness of breath, etc.
  • The physical symptoms can make you feel even more frightened.
  • This can lead to greater fear that something terrible is going to happen to you.

However, the cycle can be broken.

The first panic attacks you experience can be terrifying because you don't know what is going on. But after you learn about panic, you will have one great advantage when an attack hits - you will understand what you are experiencing.

You will know that:

  • You are not going to have a heart attack.
  • You are not going to have a stroke.
  • You are not going to collapse or die. It's "only" panic, and it will go away soon.

Once you recognize that your symptoms are caused by panic, those symptoms may immediately become less severe. And your level of fear will go down.

How To Information:

Helping Yourself Through An Attack

It is helpful to follow these steps during a panic attack:

  • Breathe slowly and deeply.
  • Don't worry what other people are thinking. In general, people can't tell by looking at you that you are having a panic attack.
  • Tell yourself nothing serious will happen to you.
  • Let the attack peak and pass.

These measures may be enough to help some people cope with mild panic disorder.

Working With A Therapist

In recent years, psychiatristspsychologists, and others have developed excellent methods of dealing with panic. In fact, the great majority of people with panic can be treated successfully. They usually can return to a life free from fear, without having to take medication for long periods.

For some, however, panic is a chronic condition and may come back. But if you have learned to cope with it once, it is usually easier to deal with if it returns.

To overcome panic and phobia, it is important for both you and the therapist to understand how the condition started and how it affects you.

Among other things, the therapist will need to know:

  • When you first had a panic attack, and how it felt.
  • What makes you afraid now, and what situations (if any) you now avoid, as a result of this fear.
  • What physical symptoms you feel when you are afraid, or what symptoms you are afraid of feeling.
  • How your fears are affecting your social life, your career, your happiness, or your ability to carry out the daily routine.

There is a basic strategy that many therapists follow. They will aim to:

  • Reduce the frequency of you panic attacks with behavior therapy, relaxation, and medication.
  • Encourage personal wellness, advising you to get more sleep and exercise, less caffeine.
  • Help you develop coping skills. These may include learning to change how you think about panic, and learning to feel in control of panic attacks.

The therapist may ask you to:

  • Keep a diary so that you know when panic is most likely to occur. A panic attack that you expect is easier to take than one that hits out of the blue.
  • Plan how you will copy with panic attacks.
  • Learn to feel in control of the symptoms of panic. For example, if you deliberately speed up your heart by running in place, you may feel less threatened if your heart races during a panic attack.

Your therapist may remind you that there are two ways of "coping" that do not work:

  • Don't take alcohol or drugs to give yourself the courage to face difficult situations.
  • Don't simply avoid all the situations that might bring on panic.

Medication For Panic Disorder

Psychiatrists and other physicians may prescribe medicine as part of the treatment.

Medication can help speed the course of treatment. It can usually be stopped before the counseling sessions are over. But in some cases, drugs may be needed for a longer time to treat underlying conditions, such as depression, that may have been covered up by the panic disorder. Different types of medication may be used.

Antidepressants help patients with panic disorder even if they aren't depressed. Three different types may be helpful if taken regularly (not just as needed):

  • SSRIs (selective serotonin reuptake inhibitors), such as fluoxetine, paroxetine, sertraline
  • Tricyclics, such as imipramine, desipramine
  • MAOIs (which inhibit a brain chemical called monoamine oxidase), such as phenelzine, tranylcypromine
  • Benzodiazepines (a type of tranquilizer), such as alprazolam or clonazepam. (They may be addictive and must be used with care.)

Other medications may help:

  • Buspirone is a non-habit-forming medication to reduce anxiety. It usually takes a few weeks to be effective.
  • Beta-blockers may be used to reduce some effects of anxiety - for example, slowing a racing heart.

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