Sanctuary for the Abused

Friday, March 29, 2013

Panic Disorder

What is a panic attack?
Panic attacks are marked by a sudden, very intense episode of fear or anxiety. There is often a feeling of impending disaster, such as dying. Panic attacks come on very suddenly and typically last only a relatively brief period of time. If the episode of anxiety gradually develops and/or peaks after more than 10 minutes, it is not called panic but rather extremely intense anxiety.

Accompanying a panic attack are several uncomfortable physical symptoms and a fearful state of mind. Included among the physical symptoms are:

palpitations, pounding heart or accelerated heart rate
trembling or shaking
shortness of breath
feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady,light-headed or faint
feelings of unreality or being detached from oneself
fear of losing control or going crazy
fear of dying
numbness or tingling sensations
chills or hot flushes

Several of these symptoms must occur all at once and the attack must reach a peak in ten minutes or less for the episode to be called a panic attack.

The fear that develops in people who have panic attacks is largely related to the physical symptoms experienced. These symptoms are often mistaken to indicate a serious illness or other pending disaster. Panickers often state that during an attack they fear they are going to die or have a heart attack.

Panic attacks are often accompanied by Agoraphobia. Agoraphobia is diagnosed when the person avoids situations or activities from which they cannot escape or in which help is not immediately available if a panic attack occurs. The person believes that by avoiding these situations they can avoid the panic attacks. Unfortunately, this avoidance has a tendency to grow and spread to more and more situations. In extreme cases the fearful and avoiding individual becomes totally housebound.

Causes of Panic Disorder 
Essentially, panic disorder results from a combinations of biological factors, psychological factors and current stress factors. The interaction of these factors is complex and typically it is not possible to fully know why any one person develops a panic disorder.

Some people have more excitable nerves than do others. Thus they tend to be more reactive and anxious than other people. In other people, the fight/flight response to stress is more easily triggered than in others. Some people hyperventilate chronically and others may have a disturbance in their sense of balance. These conditions all will increase the likelihood that a person will develop a panic disorder. However, it is important to note that there is no biological dysfunction that is responsible for all panics.

Psychological factors include our learning history. If we learn to associate physical symptoms with frightening situations, then over time whenever we have these physical symptoms, we tend to become fearful. Control issues are another psychological factor that can contribute to the development of a panic disorder. Panickers typically need to feel in control at all times and yet often feel out of control. Being out of control is associated in a panicker's mind with being is a highly threatening and fear producing situation.

Research into the onset of panic disorder indicates that in the majority of first panics, the person is experiencing a time of high stress. The stressful condition can be interpersonal such as a divorce, or may involve a situation in which the person feels overwhelmed by his or her own emotions. It is also possible for panic to result from the use of a medication or illegal substance.

Treatment of Panic Disorder
In the past, the psychological treatment of panic involved uncovering the psychological conflicts in the individual. These conflicts often dated back to childhood and were believed to be revealed in different symptoms including panic. Therapy was often long-term. Some people found this form of therapy helpful, others did not. More recently, instead of focusing on buried conflicts from childhood, psychotherapy has focused on what problems have been going on in the person's life that have not been handled well.

A more specific treatment for panic disorder has been developed as research has progressed in the area of panic disorder. Cognitive-behavioral therapy has been shown to be over 80% effective in people suffering from panic disorder without agoraphobia. The results are somewhat lower for panic disorder with agoraphobia. Cognitive-behavioral treatment of panic involves a great deal of homework on the part of the client. Thus, a person experiencing panic disorder must be willing to put in the effort to follow-through with the homework typically assigned in the course of cognitive-behavioral treatment of panic. While this many be daunting, the positive aspect is that it empowers the individual to help him or herself.

Medications have long been used in the treatment of panic, as well as other anxiety disorders. They do not cure the disorder but do often decrease the symptoms, which is helpful. However, the tranquilizers that are often used can produce physical and/or psychological dependence, making it difficult to stop their use. An additional problems is that with the use of the medications, the panicker becomes used to lower levels of anxiety. When taken off the medication, the panicker may find it difficult to adjust to the higher levels of anxiety. Research has indicated that people with panic disorder did better when treated with cognitive-behavioral therapy alone as compared to those treated with a combination of cognitive-behavioral therapy and medications.

The decision regarding what form of therapy is best in a particular case is certainly an individual one. This should be undertaken in consultation with professionals experienced in the treatment of panic.

Zuercher-White, E. Orvercoming Panic Disorder and Agoraphobia.Oakland, CA: New Harbinger Publications, 1999.

Cathy A. Chance, Ph.D

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