Panic disorder

Overview
Panic disorder is a type of anxiety disorder characterized by unexpected and recurrent panic attacks and anxiety about possibly having another panic attack. A panic attack is a distinct period of intense fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Symptoms may include heart palpitations or accelerated heart rate, sweating, shaking, shortness of breath, fear of dying or a belief that one is dying, fear of losing control or going crazy, and chills or hot flashes.
More than one-third of Americans experience panic attacks in a given year. An unexpected panic attack, one that occurs without warning or trigger, can occur spontaneously. A situationally bound panic attack, on the other hand, occurs in anticipation of or upon exposure to a particular cue or trigger associated with prior panic attacks. The usual cue or trigger may not always lead to an attack, however. For example, although driving a car may be a trigger for a certain person, the same person may not always have a panic attack while driving.

When a person has an anxiety disorder, panic attacks usually develop in situations related to the core features of the disorder. For example, a person who has a phobia of snakes may experience a panic attack when exposed to snakes. With panic disorder, a less common condition, panic attacks often occur spontaneously and unexpectedly. Panic attacks may also develop in a condition called panic disorder with agoraphobia. This condition occurs when a person is fearful of or avoids situations in which panic attacks might occur, such as situations when help may not be readily available, where escape may be difficult, or when a panic attack may be particularly embarrassing.

Panic disorder typically appears between late adolescence and a person's early 30s. Women are diagnosed with panic disorder more often than men. It can become a chronic condition, although it waxes and wanes.

Only a small number of children are diagnosed with panic disorder. For older adults, several medical disorders and drugs may cause anxiety or symptoms that may be misinterpreted as an anxiety disorder. For example, a person who has delirium, dementia or hyperthyroidism may have anxiety-type symptoms. A thorough physical exam is crucial for an accurate diagnosis and treatment.

Some studies suggest a genetic factor in the development of panic disorder. People who have panic disorder tend to have abnormalities in certain areas of the brain, as well as irregularities with neurotransmitters in the brain. Sensitivity to anxiety and inhibited, introverted or neurotic behavior have also been associated with panic disorder.

Medical conditions that may accompany or be confused with panic disorders include gastrointestinal conditions, irritable bowel syndrome, hyperthyroidism and mitral valve prolapse (when the tissues that make up the mitral valve -- the heart valve that connects the atrium, the left upper chamber of the heart, to the ventricle, the left lower chamber of the heart -- bulge out of place).


Characteristics
During the first wave of a panic attack, you may experience physical sensations such as rapid or shallow breathing, heart palpitations, chest pain or shortness of breath. Hot and cold flashes, sweating or dizziness are common. You may feel faint and have impaired coordination or movement. During the second wave, you may have psychological symptoms. You may be afraid and tell yourself you can't handle the attack. You may have difficulty concentrating or obsessive thoughts. You may feel self-conscious or be afraid of losing control or that you're going crazy.
If you experience panic attacks, you may avoid new experiences for fear of having an attack, or avoid situations where panic attacks have occurred before. Some people who have panic disorder heavily use medical services for panic attack symptoms. Others choose not to take their medications.

As with all physical symptoms, consult your medical health care provider to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
It's important to have symptoms of panic disorder assessed and diagnosed by a health professional in order to rule out or diagnose any medical conditions with similar symptoms. Various types of counseling can often effectively treat panic disorder. For example, through cognitive behavioral therapy, you can learn to understand and manage unhealthy thoughts and behaviors. Through exposure therapy, you will be gradually exposed to the feared object or situation while in a safe and supportive environment.
Relaxation exercises such as meditation or visualization can be helpful. Learning controlled breathing or practicing deep-breathing exercises can be particularly helpful, since shallow, rapid breathing can heighten anxiety. To learn about meditation and other relaxation exercises, you may want to check out books in your local library or bookstore. In some cases, medications such as benzodiazepines or antidepressants may be prescribed to help you cope with anxiety.

To further cope with panic, consider the following suggestions.

Face the symptoms rather than running from them. Accept what your body is doing without fighting against it.

Pay attention to your body's state of physiological arousal without reacting to it with more fear and anxiety. It may help to float with the "wave" of the panic attack and simply allow time to pass. Remember that panic is caused by a sudden surge of adrenaline, much of which will metabolize and be reabsorbed into your bloodstream within three to five minutes.

Leave the situation temporarily with the intent of returning.

Have someone talk you through a panic attack.

Engage in simple repetitive activitiesor those that require focused concentration. Physical activity can help dissipate the extra energy or adrenaline created during the physical phase of a panic attack.

Consider a technique known as thought stopping. To do this, say "stop" aloud or silently. Then, replace the anxious thoughts with calm, positive, supportive statements.