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Panic disorder: signs, causes, and treatment

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Panic disorder is a condition where a person experiences recurrent, sudden panic attacks. It is classified as a type of anxiety disorder, and it has a major impact on a person’s quality of life. 

Signs of panic disorder include overwhelming anxiety and fear, impending doom, loss of control, avoidance of places where panic attacks have occurred in the past, and constant worry about future panic attacks. Besides these, a person with panic disorder experiences physical symptoms such as shaking or tremors, chest pain, pounding heart rate, sweating, chills, difficulty breathing, weakness, and others.

The causes of panic disorder are still quite unclear. Various factors may be involved. Some of the most significant causes of panic disorder are genetics or heredity, trauma, changes in the function of some brain areas, and a person’s temperament. A combination of different factors may also lead to the development of panic disorder.

While panic disorder causes symptoms that can be severe, it is a manageable condition. Treatment of panic disorder focuses on psychotherapy and medications, usually combined. The first-line treatment approach is psychotherapy i.e., cognitive-behavioral therapy. During therapy sessions, patients learn to identify and cope with the triggers of their panic attacks. The role of medications is to reduce the severity of symptoms that people experience.

Panic disorder definition.

What is panic disorder?

Panic disorder is a type of anxiety disorder indicated by sudden attacks of fear and panic. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) by the American Psychiatric Association defines panic disorder as an abrupt surge of intense fear or discomfort that reaches a peak within minutes. It’s been in DSM since the third edition (DSM-3), released back in 1980.

Panic attacks can be a frightening experience primarily because a person feels they’re losing control. Many people have panic attacks, but not all of them have panic disorders. In people with this disorder, panic attacks may occur frequently, and a person is constantly worried about them happening again.

Late teens or early adulthood is when panic disorder generally starts. It is an overreaction to the body’s natural survival instincts and behaviors. Most people get better with proper treatment for their panic attacks.

What are the signs of panic disorder?

Signs of panic disorder revolve around intense anxiety and physical sensations of fear. One way to determine the signs of a panic disorder is to observe how they occur. They usually appear, without warning, suddenly. A person with panic disorder may have multiple panic attacks and is constantly worried about having another. The symptoms usually go away within a few minutes. Once they go away, an affected individual feels fatigued and worn out. The most common signs of panic disorder are listed below:

  • Sense of impending doom or danger
  • Pounding, rapid heart rate
  • Fear of loss of control/fear of death
  • Intense worry about the next panic attack and when it’s going to happen
  • Sweating
  • Avoidance of places where previous panic attacks have occurred 
  • Shaking or trembling
  • Sense of choking or tightness in the throat
  • Shortness of breath
  • Overwhelming anxiety and fear
  • Nausea 
  • Abdominal pain
  • Hot flashes or chills
  • Dizziness or lightheadedness
  • Weakness
  • Chest pain
  • Feeling of detachment or unreality
  • Tingling sensation or numbness

What are the causes of panic disorder?

Woman having a a panic attack breathing into a paper bag.

The causes of panic disorder are still relatively unclear, but several factors could be involved. A combination of different causes could be the main culprit. The potential causes of panic disorder are listed below:

  • Genetics: even though more research is necessary about this subject, current evidence shows several genes may be involved in the development of panic disorder. Since panic disorder has a hereditary component, a person is more likely to develop it if their family members also have this condition.
  • Trauma or major stress: experiencing or witnessing a traumatic event or intense stress may pave the way to frequent panic attacks and full-blown panic disorder due to the inability to cope with trauma in a healthier manner. More precisely, a person’s environment and life experiences play a role in the development of this condition.
  • Brain function changes: certain areas of the brain become hyperactive during panic attacks, and these changes could contribute to panic disorder. This is particularly the case with the amygdala, the fear center of the brain. In other words, panic disorder has a neurological background. The changed activity in the amygdala and other areas, such as the temporal lobe, can lead to panic disorder in some people.
  • Temperament: some people are more sensitive to stress and have a temperament that is prone to negative emotions. This kind of temperament is one of the potential causes of panic disorder.

What are the possible effects of panic disorder?

Possible effects of panic disorder can be short- and long-term, but they are more pronounced when the condition is not managed properly. 

Short-term effects of panic disorder are mainly physical and revolve around higher blood pressure, sweating, shaking, heart palpitations, discomfort, and headache. A person also feels like they have no control over the specific situation and expect the worst to happen. 

Long-term effects affect physical and psychological well-being as well as social functioning. These include loss of social support, social withdrawal, poor work performance, higher risk of disability, and suicidal thoughts and tendencies.

Other long-term effects of panic disorder include a higher risk of specific phobias, depression, anxiety, financial problems, substance abuse, and problems with health.

How does panic disorder affect the quality of life?

Woman sitting in a black hoodie.

Panic disorder affects the quality of life in many ways. The symptoms can be so severe that a person misses school or work and falls behind due to low productivity. In order to manage their condition, people with this disorder go to many doctor visits. This takes a major toll on their everyday life and responsibilities. 

Avoidance of situations where people experience panic attacks is a hallmark symptom of this disorder. This can lead to people avoiding many social events and gatherings out of fear they may experience another panic attack. Social isolation may ensue as well as problems with family, friends, coworkers, and others. 

The impact on life is particularly severe in people who have panic disorder in addition to agoraphobia.

Many people with panic disorder aren’t aware their symptoms are manageable. They tend to believe no treatment will help them and are, therefore, reluctant to seek help. Not just that, but they don’t discuss the symptoms with their family, friends, and doctors even. This leads to suffering in silence, which further affects the quality of life.

How common is panic disorder?

Panic disorder is not uncommon. According to the National Institute of Mental Health, 2.7% of U.S. adults and 2.3% of adolescents had a panic disorder in the past year. The disorder is more common in women than men, with a prevalence of 3.8% and 1.6%, respectively. 

The same happens in female adolescents; they are more likely to have panic disorders than males. The prevalence of panic disorder in adolescent females is 2.6% as opposed to 2.0% prevalence in males.

The same report shows that around 4.7% of adults in the United States have a panic disorder at some point in their lifetime.

Of adults with panic disorder, 44.8% experienced a serious impairment, 29.5% had a moderate impairment, and 25.7% experienced mild impairment. 

How is panic disorder diagnosed?

Scared man looking at papers with a laptop on his lap.

Panic disorder is diagnosed after a thorough evaluation process. Based on the symptoms described, a doctor may suspect a person has a panic disorder. 

In order to diagnose the condition, they need to eliminate other potential causes of the symptoms. For that reason, a patient may need a physical exam. A doctor may order lab tests to rule out other health problems. 

Once these tests show a person doesn’t have a physical condition that would induce their symptoms, a healthcare provider refers them to a psychiatrist. The psychiatric evaluation involves talking about symptoms, stressful situations, fears, and concerns, as well as family history.

It’s important to keep in mind that not everyone who experiences panic attacks has panic disorder. 

The psychiatric assessment gives a psychiatrist a detailed insight into the intensity and duration of symptoms. It also provides other information important for diagnostic purposes. 

The psychiatrist will refer to DSM-5 to see whether the patient’s symptoms meet diagnostic criteria before they diagnose panic disorder. In order to be diagnosed with panic disorder, a person must be experiencing unexpected and recurrent panic attacks. Generally speaking, they need to have four or more panic attacks and fear the next one, according to Johns Hopkins Medicine. They also need to experience four or more symptoms of panic disorder.

How to prevent having a panic disorder?

In order to prevent having a panic disorder, it’s useful to follow the tips listed below:

  • Identify triggers that lead to panic attacks in order to learn to manage them properly (this is usually done during therapy)
  • Reduce caffeine intake
  • Manage stress
  • Eat a healthy, well-balanced diet
  • Practice deep breathing
  • Exercise regularly 
  • Consult a doctor about over-the-counter medications and herbal supplements that promote calmness and reduce anxiety
  • Practice mindfulness meditation 
  • Adhere to the panic disorder treatment
  • Get enough sleep 
  • Find a relaxing hobby 
  • Socialize 

What are the possible treatments for panic disorder?

Woman with hand on her chest.

Possible treatments for panic disorder depend on the severity of the symptoms and how they affect a person. They are listed below:

  • Medications
  • Psychotherapy

Medications

The main purpose of medications is to lower the severity of symptoms and aid the management of other problems, such as depression. The healthcare professional prescribes the most suitable medications based on the patient’s condition. These usually include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Benzodiazepines as central nervous system depressants are a short-term pharmacotherapy approach because they are habit-forming, Mayo Clinic reports. They can be effective in quickly reducing symptoms of panic attacks.

Antidepressants help with depression and symptoms of panic disorder. They’re not fast-acting, meaning it may take a few weeks to experience the effects.

Sometimes, a healthcare provider may also prescribe beta-blockers to patients with panic disorder. Beta-blockers address some physical symptoms of panic disorder, such as sweating, tremors, and rapid heart rate.

If, by any chance, a specific medication doesn’t work for a patient, the doctor may recommend another option or combine certain medications to increase their effectiveness. 

Psychotherapy

Psychotherapy is the first line of treatment for panic disorder. The main goal is to help a patient understand their panic attacks, identify the trigger, and learn to cope with them. 

The most common approach is cognitive behavioral therapy (CBT), which helps patients learn through their experience that panic symptoms aren’t dangerous. The main premise of CBT is that irrational or negative thoughts or beliefs lead to negative emotions and behaviors. Identifying these thoughts or triggers could help improve emotions and lead to more positive behavior patterns. 

During CBT sessions, the therapist helps a patient gradually re-create symptoms of a panic attack in a safe manner. Just like in panic disorder, these attacks are repetitive. The goal is to achieve the point where the physical sensations of a panic attack don’t seem threatening anymore. That is when the attacks start resolving.

The number of CBT sessions varies from one patient to another, but a paper from CNS Spectrums reports 12 to 15 sessions are usually enough. Studies confirm that CBT can be used, by other individuals or in the group, as a first-line treatment for panic disorder, and it is particularly beneficial for patients who don’t respond to other treatments.

The process of CBT includes recognizing and replacing negative thoughts, followed by skill-building and behavioral changes. Patients may receive homework for practicing skills they learned during the session.

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