Panic disorder

Panic Disorder

When a person suffers from recurring panic attacks or begins to live in fear because of the possible onset of an episode, he or she may have panic disorder.

Panic disorder is the repeated instances of anxiety attacks in which there are no obvious triggers. It limits the lives of the sufferers not only because of the episodes themselves but also because of their fear of another one starting.  A person with panic disorder will avoid places and situations that they associate with an attack in the past. They may also stay away from people that they don’t want to expose their condition to out of fear or shame.

What Is a Panic Attack?

During a panic attack, a person is gripped by intense anxiety without an obvious cause. The individual experiences unpleasant physical symptoms like a heavy chest, hyperventilation, sweating, tremors, and dizziness. At its worst, a person might even feel like he or she is dying. Sufferers are not always able to identify what might have triggered an episode, even later on. 

Patients often report feelings of helplessness or physical weakness during an episode. This is a direct contradiction to the condition of the body, which is actually at its strongest when in a state of panic because of a response known as ‘flight or fight’. 

In the presence of fear or danger, the body primes itself to either flee or engage the threat. The mind, which is in charge of making that decision, will choose whichever it perceives as the best chance of survival. For example, if you are cornered by dangerous looking men in a dark alley, your body reacts to the threat either by preparing to defend itself or to run like there’s no tomorrow.

As this automatic response kicks in, the sympathetic nervous system is triggered and the body is flooded with hormones like adrenaline and noradrenaline. This causes the heart and the lungs to go into overdrive. You start breathing faster to bring in more oxygen into the blood and your heart pumps rapidly to deliver the now oxygenated blood into the muscles, preparing you to sprint out of there or throw the biggest punch of your life.

This series of events happen in quick succession. When the danger is real, a person will hardly notice these changes in the body as they jump into action towards survival. However, for a person who is in the middle of a panic attack — where the threat is not seen but instead embedded deep in their subconscious — it’s all they feel. 

Is it a panic attack or an anxiety attack?

Don’t let the different terminologies confuse you. A panic attack and an anxiety attack are one and the same. The person is overwhelmed by the sudden onset of intense anxiety with no visible cause and exhibits physical symptoms like sweating, palpitations, shaking, dizziness, and can sometimes even lose consciousness.

Signs of a Panic Attack

An anxiety attack can manifest itself both in the mind and the body. An episode begins with an increased sense of anxiety, overwhelming dread, or fear followed by intense physical symptoms including:

  • Hyperventilation or rapid breathing
  • Shortness of breath
  • Palpitations or rapid/erratic heart rate
  • Nausea 
  • Tremors
  • Sweating
  • Rapid speech
  • Irritations in the hands or feet
  • Stomachache
  • Chest pains or pressure on the chest 

In addition, it is not uncommon for a person experiencing a panic attack to question their sanity or feel like they are dying.

Causes of Panic Attacks

Panic or anxiety attacks can be caused by a period of stress, a stress disorder, underlying diseases like cardiovascular issues and hypothyroidism, withdrawal from various substances, and addiction to stimulants including caffeine. Although the causes are not immediately visible, they can be uncovered after a further physical examination by a physician. On the other hand, a person with panic disorder suffers panic attacks without any of these underlying causes.

A person who is seeking help for a possible panic disorder should consult with a doctor to rule out these possible causes first.

Diagnosing Panic Disorder

Many people experience panic attacks once or twice throughout their lifetime as a result of extreme stress or a phobia. However, when a person suffers from multiple panic attacks over a period of time, or if they start living in fear of a possible attack, then they may have panic disorder.

The diagnosis of a panic disorder can be made by a mental health professional after other physical causes for the panic attacks have been ruled out by a physician. 

Symptoms of a Panic Disorder 

The first sign of panic disorder is repeated panic attacks in the course of a month for no obvious reasons. Other common symptoms of panic disorder include:

  • a heightened sense of anxiety on a daily basis
  • a growing fear of a possible attack 
  • agoraphobia or the fear of being in a situation that they can’t escape (this is mostly because they are afraid that they might have a panic attack in a public space)
  • avoiding people or places that they have come to associate with a panic attack that happened in the past

Complications

Living with panic disorder is not a hopeless situation. The condition can be treated but it’s important to seek proper medical help in a timely manner. If left untreated, the symptoms can worsen and become even more difficult to manage. 

People with panic disorder are also more likely to develop other mental health issues like phobias and even succumb to substance abuse.

A formal diagnosis of panic disorder may also take away your driving privileges as the Driver and Vehicle Licensing Agency (DVLA) requires drivers to report any medical condition that could affect their driving.

Treatment

Available treatments for panic disorder are designed to relieve the symptoms and ultimately, reduce or eliminate the episodes. 

To date, the primary course of treatment for panic disorder is therapy, specifically Cognitive Behavioral Therapy. CBT has shown promising results in treating a host of disorders including Post-Traumatic Stress Disorder (PTSD) successfully. Moreover, this type of therapy can be done online, which is beneficial for patients who refuse to leave their homes or for those with agoraphobia.

In addition to the therapy, a psychologist may also prescribe antidepressants at the beginning of the sessions, especially if a patient struggles to begin the process. Prescription antidepressants are also sometimes used on their own to treat panic disorder, depending on its severity or possible causes.

When searching for the best treatment, it is vital to provide the doctor with thorough information. Mental health professionals are trained to help an individual process any emotions that surround their condition including fear, anger, or shame. It is also important that the patient fully understands that while panic disorder is largely unpleasant, it is harmless and can be treated.

Panic Disorder and Therapy

Cognitive Behaviour Therapy is often described as the rewiring of the brain. This type of therapy teaches people with panic disorder how to change their thoughts toward specific situations and eventually, change the behaviour that follows these thoughts.

CBT is a two-fold treatment that allows patients to approach the problem from two fronts. The therapy begins by making patients understand how their thoughts lead to a reaction of panic. The psychologist helps them unpack experiences and emotions so they can learn to identify the thought patterns that lead to a panic attack. Next, the patient is taught how to challenge the thoughts that dictate the very behaviours that they are trying to eliminate.

It’s important to understand that treatment will be different for every individual. But at its very core, the therapy will expose the person to their triggers so they can work on changing how they think and respond to these situations. If you want to learn more about Cognitive Behaviour Therapy, you can read about it here.

Panic Disorder and Medication

In most cases, medication is used as an aid to therapy although there are instances when they work on their own. The kind of medication prescribed to a patient depends on several factors including their ability to begin therapy and how well they are doing in the sessions. 

Selective Serotonin Reuptake Inhibitors (SSRIs), is a type of antidepressant usually prescribed to people with panic disorder. Currently, health professionals in the UK can prescribe either of these medicines: citalopram, dapoxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine.

If SSRI is not suitable for a patient, tricyclic antidepressants are prescribed instead. In severe cases, anti-seizure or anti-epilepsy medication like pregabalin are given to the patient.

A short course of sedatives like diazepam or clonazepam is also an option but this has to be closely monitored by the doctor as they can be addicted. 

What to Do During a Panic Attack

Panic attacks feel terrifying but they are not causing any real harm to your body. There’s also a lot that you can do to ease the symptoms during an episode. If you feel an anxiety attack coming, try to do the following things:

  • If possible, walk away to a quiet place and stand firmly to feel the ground underneath your feet. 
  • Next, focus on your breathing and place a hand on your stomach so you can feel your body inhale and exhale. 
  • As you regulate your breaths, let your thoughts flow through you. The idea is to let the thoughts be present but not let them control you.
  • Try to determine what might have caused the episode. 
  • Counter negative thoughts like “I cannot move” or “This is terrible” by describing objectively what is happening in your body.
  • Resist the urge to push away any unpleasant thoughts and emotions as this can backfire. Understand that these thoughts are caused by panic and cannot be trusted.

If you are suffering from panic disorder or experience anxiety attacks occasionally, these thoughts can help you improve your response to the onset of an episode.

  • A panic attack is not dangerous. You are not losing your sanity, slipping out of control, or dying. 
  • The unpleasant symptoms that you feeling are simply a result of your body’s natural flight-or-fight response, which was activated by mistake.
  • There is no real danger around you, even if it feels that way.
  • A typical anxiety attack lasts about 45 minutes, but the absolute peak of fear is only a few minutes long. Your ordeal will come to an end sooner than you think or feel. 

Anxiety Attack and Sleep

One aspect of life that anxiety affects deeply is sleep. Patients with anxiety or panic disorder report having difficulty falling and staying asleep. Some patients are even jolted awake by the onset of symptoms like sweating, shortness of breath, and chest pain among others.

Nocturnal panic attacks or anxiety attacks that occur during sleep are observed in about 50% of panic disorder patients. Fortunately, these nighttime episodes seldom happen and comprise only about 10% of a patient’s total number of episodes. In the past, there was a conjecture that nocturnal attacks were caused by dreams. However, studies reveal that these attacks begin in the lightest stage of sleep, which eliminates dreams as the cause.

If you wake up in the middle of the night with an anxiety attack, you may feel disoriented and less in control than you typically would if the attack happened during the daytime. You are also likely to be alone and unable to ask anyone for help. When this happens, stay calm, relax your breathing, and know that the attack will end. When you are unable to fall asleep again, it is best to get up to do something else.

When to Get Help

If you or someone you know is experiencing panic attacks multiple times in the course of a month, set an appointment with a general physician or a psychologist right away. The sooner you can get a proper diagnosis, the better your chances are for a quick and full recovery.

Talking About Panic Disorder

It’s never easy to start talking about your mental health but it helps to know that there are other people who are fighting the same battle. As part of our campaign about breaking the stigmas surrounding mental health, we have collected a number of personal stories from people living with panic disorder. You can read about their experiences below.