I’m sure you’ve heard someone say or joke about “having a panic attack,” but panic
attacks are very real situations where someone has a sudden period of intense fear or discomfort
that something bad’s going to happen, and that there’s some imminent threat or danger.
These feelings are often so intense that they’re accompanied by physiological symptoms like
heart palpitations, dizziness, or shortness of breath.
These symptoms peak within the first 10-20 minutes, but some might last hours.
Sometimes patients having a panic attack might feel as though they’re having a heart attack
or some other life-threatening illness.
Panic attacks can happen even in familiar places where there are no real threats, and
therefore they’re unpredictable, which can further increase anxiety about when the next
panic attack is going to happen.
In order to be characterized as a panic attack, the Diagnostic and statistical manual for
mental disorders, the fifth edition, or DSM-V, says patients need to have an abrupt onset
of four of the following thirteen symptoms: pounding heart or fast heart rate, chest pain
or discomfort, , sweating, trembling, shortness of breath, nausea, dizziness, chills, numbness,
feelings of choking, feelings of being detached from oneself, fear of losing control, and
fears of dying.
Admittedly, some of these symptoms might naturally happen together, and so they can be very hard
to tease apart.
For example, it would be unusual for a person that is sweating, feeling dizzy, and feeling
chills, to also not be trembling.
It’s also important to note that some of these are physical symptoms whereas others
are specific thoughts/ideas.
Panic attacks can happen in the context of several mental disorders including depressive
disorders, posttraumatic stress disorder, and substance abuse disorders.
It can also, however, happen in the context of a panic disorder, which is basically defined
by the panic attacks being recurrent, meaning 2 or more, and unexpected.
In addition, the DSM-V says that for somebody to be diagnosed with a panic disorder, they
also need to have persistent worry or change in behavior because of their panic attacks.
Also, the panic attacks can’t be due to the effects of some substance, like an illicit
drug or medication.
Finally, the panic attacks aren’t better explained by some other anxiety disorder,
like agoraphobia or social anxiety disorder.
Patients with a panic disorder can’t predict where the panic attack will happen next, so
it’s important to get treated before patients develop something called avoidance, which
is when they actively avoid the places where one previously happened.
They might stop doing activities that they think might trigger the attacks, like going
to the park, riding in elevators, or driving.
Avoiding these situations might temporarily reduce symptoms of anxiety about having a
panic attack, but it makes daily life really tough, right?
And ultimately doesn’t stop the attacks from happening.
Sometimes patients get anxiety just thinking about the possibility of having a panic attack,
and this is called anticipatory anxiety.
Anticipatory can be particularly debilitating because it might cause the patient to be reclusive
and choose to endure the attacks alone instead of risking an attack in public—this situation
can actually lead to the development of agoraphobia, a fear of going into crowded spaces.
Panic disorder is twice as common among women as men, and it appears to have a genetic component
and run in families, although we don’t know exactly what causes it.
Treating someone with panic disorder usually involves psychotherapy, medication, or both.
Cognitive behavior therapy has been an effective type of psychotherapy for patients with panic
disorder, and this relies on five fundamental steps.
First, they just learn about panic disorder, and how to identify certain symptoms.
Second, they monitor their panic attacks using a diary.
Third, they work on breathing and relaxation techniques.
Fourth, they start rethinking and changing their beliefs about the severity of a panic
attack from totally catastrophic to a realistic level.
Fifth, they allow themselves to be exposed to situations that provoke fear and anxiety.
Now if medications are used, antidepressants like SSRIs are the most commonly prescribed,
which have sedative and relaxing effects.
Anti-anxiety medications might also be prescribed, like benzodiazepines, which also have a relaxing
effect, although the use of anti-anxiety medications can sometimes lead to unwanted side effects
like tolerance, dependence, and withdrawal.
If very severe, anti-seizure medications may sometimes be prescribed.
Overall though, between cognitive behavior therapy and medication, many patients can
be effectively treated for panic disorder.