Panic Disorders

A panic disorder is a type of Anxiety Disorder. When a person has a panic disorder they often experience periods of intense anxiety or fear that may be referred to as Panic Attacks. These feelings of anxiety are usually accompanied by at least 5 of the following symptoms:

• Shortness of breath
• Dizziness or light-headedness
• Tightness or chest pain
• Trembling or shaking
• A sense of unreality
• Dry mouth
• Muscle tension
• Difficulty gathering thoughts or speaking
• Pounding/racing heart
• Tingling in the hands or feet
• Choking or smothering sensation
• Sweating
• Hot or cold flashes
• Urge to flee/escape
• Nausea or “butterflies” in stomach
• Blurred vision
• Fear of dying, losing control or going “crazy”

Panic attacks can range from mild to extremely severe. A panic attack may last anywhere from a few minutes to twenty minutes, with the peak of the attack usually occurring between the fifth and tenth minutes. In mild cases, the attacks are sporadic and do not greatly interfere with the person’s daily routine.

In very severe cases, panic attacks can occur over and over again during the day and/or night, so that the person may feel that he/she is in a constant state of panic. Usually, a panic attack is like a wave: it starts fairly low, then rises, peaks and then subsides. Panic attacks can be very frightening and disturbing. It is important to know that one panic attack does not mean someone has panic disorder. Only recurring panic attacks may lead to this diagnosis.

There are three common complications of panic disorder. The first complication is Anticipatory Anxiety. Because panic attacks are often very unpleasant and frightening, a person may develop an Anticipatory Anxiety. This means that they may feel anxious about the next panic attack, that may or may not come, during times when they do not experience a full blown attack. In other words, they become anxious because they anticipate that they will have to experience another panic attack.

The second possible complication of panic disorder is called Agoraphobia. The term comes from Latin and is actually a two-word expression: Agora means market place and Phobia mean fear. Thus, the word Agoraphobia means “a fear of the market place”. The condition involves a fear of crowded places or any place outside of the home. People who have experienced panic attacks may avoid situations that they believe may bring about an attack. For example, if the initial panic attack occurred in a mall or a supermarket, the person may avoid going to such places in the hope of avoiding a panic attack. Avoidance behavior may exacerbate the anxiety in the long run by feeding into it, and may also create a dependency on other people (see case example).

The third possible complication of panic disorder is Depression. When someone experiences recurrent panic attacks, their quality of life is adversely affected. People who have panic disorder may develop a negative view of themselves and their ability to cope. They may view themselves as weak in character and think of themselves as “crazy” or inherently flawed. These beliefs may result in feelings of self-loathing, helplessness and/or hopelessness, which, if remain untreated, may lead to Depression. All three possible complications highlight why it is extremely important for people with Panic Disorder to get treatment as soon as possible.

What causes panic disorder?

To date, researchers have not been able to identify a specific cause or causes of panic disorder. In the past, it was hoped that certain identifiable biological predispositions would explain the onset of this disorder, but research has failed to identify any predispositions that are unique to panic disorder. They found, however, that people with panic disorder usually have one or more members of their immediate family who have some type of an anxiety disorder.

For example, different siblings in a family may develop different types of anxiety disorders, such as panic disorder, generalized anxiety disorder or obsessive-compulsive disorder. Thus, we do not know of an exclusive biological cause of panic disorder, but we do know that a person may be at higher risk of developing this disorder, if one or more family members have some type of anxiety disorder. In recent years, research has focused on the contribution of stress to the development of panic disorder. It has been noted that people who perceive a lot of stress in their lives or who have experienced a major life event such as divorce, or death of a loved one, may develop this disorder.

As well, researchers have found that cognitions, i.e. thought patterns, may contribute to the occurrence of panic attacks. Specifically, if a person perceives or interprets a situation as dangerous, or if they perceive or anticipate loss of control in situations, they may develop panic attack. To summarize, there is no single cause of panic disorder. Rather, it may be a combination of biological predisposition for anxiety, stress, and cognitive processes.

Treatment options

The most commonly used treatments for panic disorder are cognitive-behavioral therapy, medication or a combination of the two. Cognitive-Behavioural Therapy (CBT) explores the relationships between behaviors, feelings, thoughts and the environment. Specifically, in cases of panic disorder the use of exposure to the threatening situation, breathing retraining, relaxation techniques and cognitive restructuring have been found very helpful.

In fact, CBT has been found to be as equally effective as medication in treating panic attacks. Therefore, CBT should be the first treatment of choice for panic disorder. Cognitive-behavioral therapy must be provided by a trained, licensed or registered health-care professional such as psychologist, marriage and family therapist, psychiatrist or registered counsellor. Medications have been successfully used to alleviate the symptoms of panic attacks.

There are four possible types of medication that have been commonly used to treat this disorder. These are they tricyclic antidepressants, the benzodiazepines, the beta-blockers and the monoamine oxidase inhibitors. Most medications can be prescribed by a family physician, while some medications can only be prescribed by a psychiatrist. The use of medication to treat panic disorder has its pros, such as quick relief of symptoms and cons, such as side effects, which should be discussed with the client before first taking them. Combination therapy means that both medication and cognitive-behavior therapy are being provided to the client at the same time. Combination therapy research has yielded mixed results, i.e. at present we cannot be sure that combining CBT with medication is superior to any of these treatments on their own.

However, some clinicians and clients alike have found that a combination of the two therapies works better than either one on its own. Treatment plans should be discussed by the therapist and the client, and should be evaluated throughout the process of treatment and recovery.

Further Readings

• Zuercher-White, E. (1997). Treating panic disorder and agoraphobia: A step-by-step clinical guide. Oakland, CA: New Harbinger Publications.
• Barlow, D. H. (2002). Anxiety and its disorders. Guilford. Ross, J. (1995). Triumph over fear. Bantam Books.
• Pace, A. (1996). Life isn’t just a panic. Baby Steps Press.
• Bassett, L. (1995). From panic to power: Proven techniques to calm your anxiety. HarperCollins. Anxiety Disorder Association of America Website: www.adaa.org