Panic attack
A panic attack is a period of intense fear or psychological distress, typically of abrupt onset and lasting no more than thirty minutes. Symptoms may include trembling, shortness of breath, heart palpitations, sweating, nausea, dizziness, hyperventilation, paresthesias (tingling sensations), and sensations of choking or smothering. Repeated and apparently unprovoked panic attacks may be a sign of panic disorder, but panic attacks are associated with other anxiety disorders as well. For example, people who suffer from phobias may experience panic attacks upon exposure to certain triggers.
Introduction
Most sufferers of panic attacks report a fear of dying, "going crazy", or losing control of emotions or behavior. These feelings generally provoke a strong urge to escape or flee the place where the attack began ("fight or flight" reaction) and, when associated with chest pain or shortness of breath, a feeling of impending doom and/or tunnel vision, frequently result in the sufferer seeking medical attention.
The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks are often experienced by sufferers of anxiety disorders and other psychological conditions involving anxiety, though panic attacks are not always indicative of a mental disorder, nor are they uncommon. Up to 10 percent of otherwise healthy people experience an isolated panic attack per year, and 1 in 60 people in the U.S. will suffer from a panic disorder at some point in their lifetime.
People with phobias will often experience panic attacks as a direct result of exposure to their trigger. These panic attacks are usually short-lived and self-limiting, as they will subside once the trigger no longer present.
In conditions of chronic anxiety, one panic attack can roll into another, leading to nervous exhaustion over a period of days.
Symptoms
The symptoms of a panic attack appear suddenly, without any apparent cause. They may include:
Racing or pounding heartbeat or palpitations
Sweating
Chest pain/PVCs
Dizziness, lightheadedness, nausea
Difficulty breathing (dyspnea)
Tingling or numbness in the hands, face, feet or mouth
A sudden feeling that everything around the person represents a threat. This can cause a person to either behave extremely defensively (perhaps even assuming the fetal position), or to become enraged and lash out violently.
The loss of the ability to react logically to oncoming stimuli, and the loss of cognitive ability in general. One suffering from a panic attack will often only feel the attack and will be unable to assess why they are feeling the attack or what they can do to stop the sensation.
Flushed face and chest
Chills
Dream-like sensation or perceptual distortion (derealization)
Dissociation, or the perception that one is not connected to the body or is disconnected from space and time (depersonalization)
Terror, or a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
Vomiting
Tunnel vision
Fear of losing control and doing something embarrassing or going crazy
Fear of dying
Feeling of impending doom
Trembling or "shivering"
Crying
Heightened senses
Loud internal dialogue
Exhaustion
Vertigo
A panic attack typically lasts from 2 to 8 minutes. More severe panic attacks may form a series of episodes waxing and waning every few minutes, only to be ended by physical exhaustion and sleep.
The various symptoms of a panic attack can be understood as follows. First, there is the sudden onset of fear with little or no provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response where the person’s body prepares for major physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH which can in turn lead to many other symptoms, such as tingling or numbness, dizziness, and lightheadedness. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood.
Hyperventilation alone can bring about some of the symptoms of a panic attack. However, the person experiencing the panic attack often does not realize this and sees these symptoms as further evidence of how serious their condition is. An ensuing positive feedback loop of adrenaline release fuels worsening physical symptoms and psychological distress.
While the symptoms and the seriousness of panic disorder are very real, the feelings of panic or impending death that accompany many attacks are exaggerated. Many physicians tell panic disorder sufferers that while their body is affected by the attack, they are not in any risk of fatality (except due to auxiliary reactions such as crashing a car, running into traffic, committing suicide, etc). If a sufferer can anticipate an attack and find a safe place to release, there is little immediate risk.
Mnemonic
The symptoms of a panic attack can be remembered with the mnemonic: STUDENTS FEAR the 3 C’s: Sweating, Trembling, Unsteadiness/dizziness, Derealization/depersonalization, Elevated heart rate (tachycardia), Nausea, Tingling, Shortness of breath, FEAR of dying, FEAR of losing control, FEAR of going crazy, 3 C’s – Choking, Chest pain, Chills.
Induced phobias
People who have had a panic attack in certain situations, for example, while driving, shopping in a crowded store, or riding in an elevator — may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place.
Panic Disorder
People who have repeated attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked. An episode is often categorized as a positive feedback loop where the mental symptoms increase the physical symptoms, which increase the mental symptoms, and so on.
Occurrence
Panic disorder is a serious health problem in the United States. It is estimated that 1.7 percent of the adult American population has panic disorder. It typically strikes in young adulthood; roughly half of all people who have panic disorder develop the condition before age 24, though some sources say that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop panic disorder.
Panic disorder can continue for months or years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where the person’s life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. It does not usually go away unless the person receives treatments designed specifically to help people with panic disorder.
For people who seek active treatment early in development, the majority of symptoms can disappear within a few weeks, with no permanent negative effects once treatment is completed.
Treatment
Panic disorder is real and potentially disabling, but it can be controlled. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for heart disease or some other life-threatening medical illness. This misconception often aggravates or triggers future attacks. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions, thus creating further anxiety.
Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people about the nature of panic attacks, the cycles of negative thoughts, and demonstrates ways to interrupt the panic process.
Medications can be used to break the psychological connection between a specific phobia and panic attacks. Medications can include antidepressants (SSRI’s, MAOI’s, etc.) taken every day, or anti-anxiety drugs (benzodiazepines, e.g. — Valium, Ativan, Xanax, etc.) during or in anticipation of panic attacks. Exposure to the phobia trigger multiple times without a resulting panic attack (due to medication) can often break the phobia-panic pattern, allowing people to function around their phobia without the help of medications. However, minor phobias that develop as a result of the panic attack can often be eliminated without medication through monitored cognitive-behavioral therapy or simply by exposure. The decision to participate in this therapy personally or through a registered practitioner should always be made in conjunction with a medical professional.
Often, a combination of psychotherapy and medications produces good results. Some improvement may be noticed in a fairly short period of time–about 6 to 8 weeks. Thus appropriate treatment by an experienced professional can prevent panic attacks or at least substantially reduce their severity and frequency–bringing significant relief to 70 to 90 percent of people with panic disorder. [2] Relapses may occur, but they can often be effectively treated just like the initial episode.
In addition, people with panic disorder may need treatment for other emotional problems. Clinical depression has often been associated with panic disorder, as have alcoholism and drug addiction. About 30% of people with panic disorder use alcohol and 17% use drugs such as cocaine or marijuana to alleviate the anguish and distress caused by their condition. Research has also suggested that suicide attempts are more frequent in people with panic disorder, although this research remains controversial.
As with many disorders, having a support structure of family and friends who understand the condition can help increase the rate of recovery. During an attack, it is not uncommon for the sufferer to develop irrational, immediate fear, which can often be dispelled by a supporter who is familiar with the condition. For more serious or active treatment, there are support groups for anxiety sufferers which can help people understand and deal with the disorder.
Other forms of treatment include journalling, in which a patient records their day-to-day activities and emotions in a log to find and deal with their personal stresses, and breathing exercises, such as diaphragmatic breathing. In some cases, a therapist may use a procedure called interoceptive exposure, in which the symptoms of a panic attack (such as hyperventilation) are induced in order to promote coping skills and show the patient that no harm can come from a panic attack. Stress-relieving activities such as tai-chi, yoga, and physical exercise can also help ameliorate the causes of panic disorder. Many physicians will recommend stress-management, time-management, and emotion-balancing classes and seminars to help patients avoid anxiety in the future.
Causes
Panic disorder has been found to run in families, and this may mean that inheritance plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it.
Other biological factors, stressful life events, environment, and thinking in a way that exaggerates relatively normal bodily reactions are also believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, major stress, or certain medications. People who tend to take on excessive responsibilities may develop a tendency to suffer panic attacks. PTSD patients also show a much higher rate of panic disorder than the general population. The exact causes of panic disorder are unknown at this point.
Studies in animals and humans have focused on pinpointing the specific brain areas involved in anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body’s fear response is coordinated by a small but complicated structure deep inside the brain called the amygdala. Eating disorders have also been linked to have caused panic attacks in several people.
Hypoglycemia may also cause panic attacks. In this condition the receptors for insulin do not respond properly to insulin, interfering with the transport of glucose across the membranes of cells. The brain depends on a steady supply of glucose — its only source of energy. When there is a sudden fall in blood sugar levels the brain sends a hormonal signal to the adrenal glands to produce adrenaline. This hormone functions to raise blood sugar levels by converting glycogen into glucose, thus preventing brain starvation, but it is also a panic hormone that is responsible for attacks of fear. The non-drug treatment for this is the adoption of the hypoglycemic diet.
