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Overview

Panic disorder is an anxiety disorder which is characterized by unexpected and repeated episodes of intense fear accompanied by a variety of physical symptoms. Because of this fear and the fact that panic disorder usually appears with many physical symptoms it is a common reason for people to go a hospital emergency room. An estimated 2 million Canadians suffer from panic disorder. It typically begins in a person's late teen years or early twenties. Women are affected twice as often as men.

It is common for people with panic disorder to go through a process of investigations (e.g. for an overactive thyroid or an electrocardiogram) to rule out other "physical" causes for their symptoms and when these investigations come up empty they feel confused and somewhat abandoned. It is critical to understand that panic disorder is in fact a very physical disease and that there are effective therapies but they tend to work better if there is understanding and acceptance of a panic disorder diagnosis.

Causes

The exact cause or causes of panic disorder are unknown. Heredity other biological factors stressful life events and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role.

Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear which underlie 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 structure deep inside the brain called the amygdala. Research suggests that anxiety disorders may be associated with abnormal activity in this area of the brain.

Symptoms

People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. During a panic attack your heart pounds and you may feel sweaty weak faint or dizzy. Your hands may tingle or feel numb and you might feel flushed or chilled. You may have nausea chest pain or smothering sensations a sense of unreality or fear of impending doom or loss of control.

Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred such as in supermarkets or other everyday situations. As the frequency of panic attacks increases the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia an inability to go beyond known and safe surroundings because of intense fear and anxiety.

Treatment

Panic disorder is highly treatable with a variety of therapies and drugs that include:

Medications. Your doctor may prescribe an antidepressant medication which usually is effective in preventing future attacks. Just like aspirin works not only for pain but also to prevent heart disease antidepressants also work for anxiety. In some cases an anti-anxiety drug is also recommended especially at the beginning of treatment. The duration of treatment depends on the severity of your disorder and your response to treatment.

Cognitive behavior therapy. With a panic attack people tend to feel a symptom such as a palpitation (the sensation of an unusual heartbeat) then automatically think of the worst thing it could be ("I am gong to have a heart attack!") which in turn increases their heart rate and makes them over-vigilant for any other sensations. This cycle repeats itself but can be broken with awareness of automatic thoughts and more realistic interpretation of symptoms. You learn to recognize things that trigger your panic attacks or make them worse and learn how to cope with anxiety through breathing and relaxation techniques. Most people need eight to 10 sessions with a counselor for an effective outcome.

The College of Family Physicians of Canada offers these additional suggestions for coping with panic disorder:

Control your worry. Pick a place and time to do your worrying. Make it the same time in the same place every day. Spend 30 minutes thinking about your concerns and what you can do about them. Try not to dwell on what "might" happen. Focus more on what's really happening instead of what might happen.

Relax. You may learn techniques to help you relax. These may include muscle relaxation yoga biofeedback and deep breathing. Muscle relaxation is simple. Start by choosing a muscle and holding tight for a few seconds. Relax the muscle after a few seconds. Do this with all of your muscles. Try starting with your feet and working up your body.

Steps to deep breathing

1. Lie down on a flat surface.

2. Place one hand on your stomach just above your navel. Place the other hand on your chest.

3. Breathe in slowly and try to make your stomach rise a little.

4. Hold your breath for a second.

5. Breathe out slowly and let your stomach go back down.

Confront the things that have made you anxious in the past. Begin by just picturing yourself confronting these things. By doing this you can begin to get used to the idea of confronting the things that make you anxious before you actually do it. After you begin to feel more comfortable picturing yourself confronting these things you can begin to actually face them.

You might find it helpful to make a list of things that cause you to feel anxious. Begin by confronting the thing that causes you the least anxiety and work your way up the list.

If you feel yourself getting anxious practice one of your relaxation techniques or focus on a simple task such as counting backward.

Although the feelings of anxiety are scary they won't hurt you. Label the level of your fear from zero to 10 and watch it go up and down. Notice that it doesn't stay at a very high level for more that a few seconds. When the fear comes accept it. Wait and give it time to pass without running away from it.

Don't be surprised if you have bouts of anxiety even after it begins to go away. This is normal.

Additional Resources

Canadian Mental Health Association