'Panic disorder' is not the same thing as having a panic attack. Some research has suggested that panic attacks are a relatively common experience, where as many as one in every three people can have the experience of a panic attack in a year. So, many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry.
The key symptom of panic disorder is the persistent fear of having future panic attacks, especially if this effect is interrupting the everyday functioning of your life. If you suffer from repeated (four or more) panic attacks, and perhaps particularly if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional who specialises in panic or anxiety disorders.
The escalation of a few panic attacks into a 'panic disorder' can often occur during the teenage years or early adulthood, and while the exact causes are unclear, there does seem to be a connection with major life transitions that are potentially stressful: academic pressures, getting married, having a first child, and so on. In some circles, there is argument for a genetic predisposition. This point of view suggests that if a family member has suffered from panic disorder, you may have an increased risk of suffering from it yourself, especially during a time in your life that is particularly stressful.
Panic attacks - the hallmark of panic disorder
A panic attack is a sudden surge of overwhelming fear that can come without warning and may not be associated with any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience.
Symptoms of a panic attack can include:
Difficulty breathing, feeling as though you 'can't get enough air'
Terror that may be almost paralysing
Dizziness, lightheadedness or nausea
Trembling, sweating, shaking
Choking, chest pains
Hot flashes, or sudden chills
Tingling in fingers or toes ('pins and needles')
Fear that you're going to go crazy or are about to die.
You may recognise this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms can rise from out of nowhere. They may occur in seemingly harmless situations-and for some, the symptoms can appear during sleep.
In addition to the above symptoms, a panic attack is often marked by the following conditions:
It occurs suddenly, without any warning and without any way to stop it
The level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated
It passes in a few minutes (the body cannot sustain the 'fight or flight' response for longer than that).
However, repeated attacks can continue to recur for hours.
A panic attack is not dangerous. While we are not aware of anyone dying from a panic attack, the experience can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse and medical complications. Its effects can range from a social impairment to a total inability to face the outside world.
In fact, the most common phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack.
How to identify panic disorder
Panic is a commonly misdiagnosed array of symptoms. One American study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. That's why it's important to know what the symptoms are, and to make sure you get the right help.
For these reasons, the diagnosis of panic disorder needs to be made by a psychologist, psychiatrist or general practitioner with experience in this area.
Can people with panic disorder lead normal lives?
The answer to this is a resounding YES. Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective and, once treated, panic disorder does not usually lead to any permanent complications.
Side effects of panic disorder
Without treatment, panic disorder can have serious consequences.
The immediate danger with panic disorder is that it can often lead to a phobia. That's because once a panic attack has been experienced, the person may begin to avoid the types of situations they were in when the attack occurred.
Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, the person who has an attack while driving, may start to avoid driving until they develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia (fear of going outdoors) because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help.
The fear of an attack is so debilitating, they prefer to spend their lives locked inside their homes.
Even if extreme phobias do not develop, a person's quality of life can be severely damaged by an ongoing and untreated experience of panic.
A recent study showed that people who suffer from panic disorder:
Are more prone to alcohol and other drug abuse
Spend more time in hospital emergency rooms
Spend less time on hobbies, sports and other satisfying activities
Report feeling emotionally and physically less healthy than non-sufferers
Are afraid of driving more than a few miles away from home.
Importantly, panic disorder can be treated successfully, and sufferers can go on to lead full and satisfying lives.
Most specialists agree that a combination of cognitive, behavioural and relaxation therapies can contribute to providing the best outcomes in treating these symptoms. Hypnosis can also be a powerful tool in the healing process. Medication might also be helpful in some cases.
Often, the first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce or actually 'be' a heart attack.
Cognitive therapy can help the client identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.
The behavioural components of the therapy can consist of what one group of clinicians has termed 'interoceptive exposure.' This is similar to the systematic desensitization used to cure phobias, but what it focuses on is exposure to the actual physical sensations that someone experiences during a panic attack.
People with panic disorder are more afraid of the actual attack than they are of specific objects or events; for instance, their 'fear of flying' is not that the planes will crash but that they will have a panic attack in a place, like a plane, where they can't get to help. Others won't drink coffee or go to an overheated room because they're afraid that these might trigger the physical symptoms of a panic attack.
This type of exposure can help the sufferer go through the symptoms of an attack (elevated heart rate, hot flashes, sweating, and so on) in a controlled setting, and teach them that these symptoms need not develop into a full-blown attack. Behavioural therapy is also used to deal with the situational avoidance associated with panic attacks. One very effective treatment for phobias is in vivo exposure, which is in its simplest terms means breaking a fearful situation down into small manageable steps and doing them one at a time until the most difficult level is mastered.
Many of these interventions can also be made available through hypnosis, where the client can be assisted to experience themselves in a variety of 'vulnerable' situations in the safety of the consulting room, and learn various strategies to manage and discover more effective responses. Hypnosis can also be a very effective relaxation medium, and clients can learn a variety of self and post-hypnotic methods to address their symptoms.
Relaxation techniques can further help someone 'flow through' an attack. These techniques include breathing retraining for comforting the body and an understanding and expectation of physiological processes and sensations. Some experts have found that people with panic disorder tend to have slightly higher than average breathing rates, learning to slow this can help someone deal with a panic attack and can also prevent future attacks.
In some cases, medications may also be needed. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.
Length of treatment
Treatments periods vary greatly between individuals, ranging from some clients who can find almost immediate relief, to others who may need to continue practicing and evolving their strategies as their life becomes more manageable and unimpaired.
If you are suffering from regular panic attacks or panic disorder, you should be able to find help from a registered psychologist or psychiatrist in your area or nearby, who has experience in treating these symptoms.
If you suffer regular panic attacks or from panic disorder, these therapies can help you. But you can't do them on your own. All of these treatments need to be outlined, overseen and prescribed by a registered psychologist or psychiatrist, with your help.
Listed alphabetically, our approach to treating panic disorders includes: