Panic Disorder
Imagine you've just stepped into an elevator and suddenly your heart races, your chest aches, you break out into a cold sweat and feel as if the elevator is about to crash to the ground. What is happening?
What is happening is a panic attack, an uncontrollable panic response to ordinary, non-threatening situations. Panic attacks are often an indication that a person has panic disorder. A person who experiences four or more panic attacks in a four week period is said to have panic disorder. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another attack.
Panic attacks can occur in anyone. Chemical or hormonal imbalances, drugs or alcohol, stress, or other situational events can cause panic attacks, which are often mistaken for heart attacks, heart disease or respiratory problems.
Symptoms/Causes
Doctors often try to rule out every other possible alternative before diagnosing panic disorder. To be diagnosed as having panic disorder, a person must experience at least four of the following symptoms during a panic attack: sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; feelings of dying, losing control, or losing one's mind.
Phobias are irrational, involuntary, and inappropriate fears of (or responses to) ordinary situations or things. People who have phobias can experience panic attacks when confronted with the situation or object about which they feel phobic. A category of symptoms called phobic disorder falls within the broader field of anxiety disorders. Many people with phobias or panic disorder "fear the fear," or worry about when the next attack is coming on.
Phobias are divided into three types:
- Specific (simple) phobia: an unreasonable fear of specific circumstances or objects, such as traffic jams or snakes.
- Social phobia: extreme fear of looking foolish or stupid or unacceptable in public, that causes people to avoid public occasions or areas.
- Agoraphobia: an intense fear of feeling trapped in a situation, especially in public places, combined with an overwhelming fear of having a panic attack in unfamiliar surroundings. This word means, in the original Greek, "fear of the marketplace."
Prognosis
No one really knows what causes panic disorder, but several ideas are being researched. Panic disorder seems to run in families, which suggests that it has some genetic basis. Some theories suggest that panic disorder is part of a more generalized anxiety in people who have panic attacks or that severe separation anxiety can develop into panic disorder or phobias, most often agoraphobia.
Biological theories point to possible defects in a person's autonomic (or automatic) nervous system. General hypersensitivity in the nervous system, incresed arousal, or a sudden chemical imbalance can trigger panic attacks. Caffeine, alcohol, and several other agents can also trigger symptoms.
Researchers have found that sodium lactate, when injected into the bloodstream of some people who are predisposed to panic attacks, will induce such attacks. This suggests that people who experience panic attacks may have trouble metaboliizing lactate, a substance usually produced by muscles during exercise.
Recovery from panic disorder appears to be most successful when a combination of treatments is used in fighting the disorder. Most often, medication is used to block panic attacks, and when it is used in combination with cognitive or behavioral therapy, it allows people to overcome their fears and return to normal, functional living.
About 75 to 90 percent of the people treated have a significant improvement, but only about one-fourth of those who have this disorder ever seek treament.
Treatment
Cognitive therapy is used to help people think and behave appropriately. Patients learn to make the feared object or situation less threatening as they are exposed to, and slowly get used to, whatever is so frightening to them. Family members and friends help a great deal in this process when they are supportive and encouraging.
Medication is most effective when it is used as part of an overall treatment plan that includes supportive therapy. Antidepressants and antianxiety medications are the most successful medications for this disorder, although beta blockers, which limit neuron activity in the brain, are helpful with social phobias. Ask your doctor about these medications or others that may help you.
Exercise, a balanced diet, moderate use of caffeine and alcohol, and learning how to reduce stress are all also important.