Imagine being the victim of an illness that can bring on horrendous physical and mental symptoms that grip you with fear, for no apparent reason at any time without warning. Might you not be walking around on eggshells, just waiting for the next barrage to come? That is what happens to many Panic Disorder patients. The fear of fear becomes their biggest enemy. Brings a new application to FDR’s famous quote of “The only thing we have to fear is fear itself,” doesn’t it? Let’s see if we can learn to understand this condition a bit better.
What Is Panic Disorder?
Panic disorder is an illness associated with individuals who have repeated panic attacks, whereby they experience physical and emotional symptoms that are associated with fear and anxiety. These panic attacks initially appear for no apparent reason, and may be sudden and intense. Extreme symptoms such as profuse sweating and a pounding heart, along with an overwhelming sense of danger or impending doom, can be terribly upsetting to panic disorder victims. In fact, the greatest fear of many panic disorder sufferers is that of the next panic attack. Frequent panic attacks, more than several a month, are necessary in order for a diagnosis of panic disorder to be justified.
Panic attacks, especially the intitial one, can come at any time and under any circumstances. Patients have had them in public, at home alone, or even been awakened from a deep sleep by an attack. The attacks are rarely based on any rational fears. The severity of the symptoms is often mistaken for a heart attack, and many folks will end up in the emergency room seeking treatment for such. After the first attack, patients who go on to develop full blown panic disorder will get chronically worse, with repeated panic attacks that may even increase in intensity. The anxiety of another attack can actually become the fuel that triggers future attacks in some patients, so it can become a vicious cycle.
How common is panic disorder? Well, statistically speaking, it is relatively rare. About one of every 63 Americans is diagnosed with panic disorder on an annul basis. It is also more common amongst women than men. Most people experience their first attack in their twenties. Heredity seems to play a role as a risk factor for panic disorder as well. If it runs in your family, you are more likely to suffer from it than if it doesn’t.
What Are the Symptoms of Panic Disorder?
A typical panic attack will begin without warning, grow in intensity and peak in about 10 minutes, usually lasting for up to 30 minutes. But this is not always the case. Some folks will get panic attacks that only last for a few minutes, while others may experience attacks that last for hours or even up to a full day, on rare occasions. Many times a person will feel very drained and fatigued after an attack has passed. Panic attacks can produce a variety of symptoms. Besides the frequency of attacks, the occurrence of four or more of the following during a panic attack is also considered grounds for labeling the case as panic disorder. Common signs include:
- Racing, pounding heartbeat
- Heart palpitations (irregular, skipping heartbeat)
- Shortness of breath
- Sensation of smothering (inability to catch breath, suffocation)
- Hyperventilation
- Dryness of mouth
- Profuse sweating
- Trembling
- Flushed appearance
- Dizziness or lightheadedness
- Nausea or stomach pains
- Chest pain or pressure
- Difficulty swallowing
- Choking sensation
- Numbness or tingling
- Chills
- Hot flashes
- Persistent need to urinate or defecate
- Dreamlike feeling (sensation of being detached from reality)
- Fear of dying
- Fear of impending doom
- Fear of losing control, going “crazy”
- Needing to escape, run away
Needless to say, if some or all of these symptoms came on a person suddenly and without warning, they might easily think they were losing it mentally, or having a heart attack or some other potentially fatal experience. Panic attacks, especially when the fear of the next one has kicked in, are very unpleasant, and many victims will begin to adjust their behaviors as best they can to avoid places or circumstances that have been associated with an attack in the past with the hope of avoiding it. Add to this anxiety about how these attacks will affect your job, family, or other relationships, and you have the makings of a significant life-controlling problem.
Many folks who have panic disorder also suffer from insomnia, social life disruption, isolation, depression, and suicidal thoughts or behaviors. Seeking to self-medicate with prescription drugs, alcohol, or street drugs can also lead to chemical dependency problems.
What Are the Causes of Panic Disorder?
There are numerous theories regarding the causes of panic attacks and panic disorder. Many researchers believe the root cause of the disorder has something to do with the nervous system responding inappropriately to nonexistent threats. In a nutshell, the body kicks in to extreme “fight or flight” response mode, but the threat is not obvious and the response is exaggerated. This is thought to be a malfunction of a normal response that is built into our bodies to protect us from legitimate harm. If you were walking down the street and you suddenly saw a herd of elephants stampeding towards you, you would experience a lot of the same symptoms as a person in the grips of a panic attack does. Some research also indicates that those with panic disorder do not always process or make use of normal stress-reducing chemicals in the proper way.
Other theories indict certain substances as one of the causes of panic attacks. Studies have shown that some people with panic disorder can bring on or aggravate their attacks by using too much caffeine or other stimulants, or due to excessive levels of lactic acid (a byproduct of glucose when it breaks down in the presence of inadequate amounts of oxygen.)
Psychological factors also play a role. While most panic attacks, especially the initial ones, are seemingly without cause, it is known that some patients can identify stressful situations that have set off attacks in the past. Examples might include an important job interview or an automobile accident.
How is Panic Disorder Diagnosed?
Diagnosis is based mainly on the frequency of panic attacks and their corresponding symptoms. However, the danger does exist of mistaking panic attacks or disorder for another condition, or of labeling something else as panic disorder because of similar symptoms, and therefore misdiagnosing it. The two most common illnesses that have signs that are very similar to panic disorder are heart disease (heart attacks) and hyperthyroidism (an overactive thyroid gland).
The best course of action is to get a thorough physical exam by a trusted health care provider who knows you and the specifics of your health history and issues. You don’t want to miss heart or thyroid problems, and you don’t want to assume panic disorder either. Physical / emotional conditions such as panic disorder are often misdiagnosed and treated promiscuously with drugs. The mental health field is typically very “hit and miss” in their approach to diagnosing illnesses, many of which may not even exist except in a drug manufacturer’s mind. The last thing you want to do is take mind-numbing drugs just in case you have a vague condition that might actually be made worse by the wrong medications. Speaking of treatments…
What Treatments Are Available for Panic Disorder?
I would stay away from the psychotropic drugs that are often thrown at a condition like panic disorder for several good reasons. First, there are serious side effects associated with most of them, to one degree or another. Secondly, it is very difficult to find the right “cocktail” of drugs that is effective for a given individual. On top of that, the magic formula often stops working over time, and must be recalculated. That leaves many patients feeling like a guinea pig. Thirdly, there are much more effective and safer alternatives available. Some very good options for treating panic attacks or panic disorder include:
- Cognitive-behavioral therapy: During counseling with a therapist, which typically lasts 12-15 sessions, patients with panic disorder are taught about themselves and their illness, and are given practical ways to combat and manage panic attacks. Topics may include:
- Identifying and learning to replace negative or destructive thought patterns that may trigger or worsen panic attacks.
- How to prepare for possible situations that have been associated with attacks in the past, and may cause future attacks.
- How to recognize and change negative self-talk that can worsen or bring on a panic attack. Examples might be: “I’m going to die,” or “I can’t handle this situation, and I’m going to have a panic attack.”
- Learning how to conquer fears by gradually confronting them and disarming the power they have to cause panic attacks, including the fear of the attacks themselves.
- Relaxation techniques: There are many relaxation techniques that can be excellent tools for handling both physical and emotional stressors that are associated with panic attacks. Some of these include:
- Breathing exercises: Learning to breath deeply, in a slow and regular pattern, can do wonders in all kinds of stressful situations. It relaxes the mind and the muscles, as well as introducing more oxygen into your system and eliminating more toxins from your body.
- Progressive relaxation: This method involves tensing and relaxing your muscle groups one at a time. Tighten and hold your leg and buttock muscles, for example, for about five seconds, then focus on totally relaxing and letting go in the same area. Then move on other parts of the body, until all your muscles have been covered. Consistently doing these techniques is a preventative measure that can prepare you in advance to learn how to relax in the midst of a panic attack, or it can also be used during a crisis.
- Diet: We should all be careful what we put into our bodies, but especially if we are dealing with a condition such as panic disorder. Here are some suggestions:
- Caffeine: In some studies, patients who have eliminated caffeine and other stimulants from their diets have seen the panic attacks totally disappear. Some people seem to have a greater sensitivity to these drugs than others, and this is apparently often true with folks who suffer from panic disorder.
- Eliminate sugar, alcohol, or any foods that cause an allergic reaction.
- Increase the intake of foods that are high in calcium, magnesium, and B vitamins. Examples include leafy green vegetables, sea vegetables, legumes, whole grains, sesame, and some dairy products.
