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Panic disorder is a specific anxiety disorder which is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms.

These symptoms may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. This disorder is significantly different from other types of anxiety disorders because the panic attacks are very sudden, appear to be unprovoked, and are often disabling. Research has proven that  panic attacks are often experienced by people who suffer from some other types of anxiety disorders such as agoraphobia though panic attacks are not always indicative of a mental disorder. People with certain phobias will also experience panic attacks as a direct result of exposure to their trigger but these panic attacks are usually short-lived and rapidly relieved once the trigger is removed. On the other hand, anxiety is a normal reaction to stress. It helps one deal with a tense situation. However, it could be a part of a bigger disorder called anxiety disorder!

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The five major types of anxiety disorders are:

  1. Generalized Anxiety Disorder
  2. Obsessive-Compulsive Disorder (OCD)
  3. Panic Disorder
  4. Post-Traumatic Stress Disorder (PTSD)
  5. Social Phobia (or Social Anxiety Disorder)

Incidence of the condition

Most people are not aware that panic attacks represent a serious health problem in the United States. It is estimated that 1.7 percent of the adult American population has panic disorder. About 5% of the population will experience panic attacks during their lifetimes. Women are twice as likely as men to develop panic disorder. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by the attempts to avoid or conceal them. The good thing is that for people who seek active treatment early on, the majority of symptoms can disappear within a few weeks.
Symptoms of panic attacks

Some of the most common symptoms of a classic panic attack are:

  • A sudden feeling that everything around the person represents a threat
  • The loss of the ability to react logically to oncoming stimuli
  • Racing or pounding heartbeat or palpitations
  • Sweating
  • Chest pains
  • Dizziness, lightheadedness, nausea
  • Difficulty breathing (dyspnea)
  • Tingling or numbness in the hands, face, feet or mouth
  • Flushes to the face and chest or chills
  • Dream-like sensations or perceptual distortions
  • Dissociation, the perception that one is not connected to the body or even disconnected from space and time (depersonalization)
  • Terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
  • Vomiting
  • unnel vision
  • Fear of losing control and doing something embarrassing or of going crazy
  • Fear of dying
  • Feeling of impending doom
  • Trembling or shivering
  • Crying
  • Heightened senses
  • Loud internal dialogue
  • Exhaustion
  • Vertigo

Possible causes of panic attacks

The experts still don’t know what causes panic attacks. Research has shown that heredity, stress and certain biochemical factors may play a role. Many experts in this field think that the body's natural fight-or-flight response to danger is similar to a panic attack but reactions which occur in a panic attack are sometimes not triggered by an obvious stressor.

A recent research has shown that low blood sugar may also cause panic attacks. In this condition the insulin receptors do not respond properly to it, interfering with the transport of glucose across the membranes of cells. Adrenalin should raise blood sugar levels by converting glycogen into glucose, thus preventing brain starvation, but it is also a panic hormone that is responsible for attacks of fear.
Pathophysiological mechanism of a panic attack

A classical panic attack typically lasts from 2 to 8 minutes.

There is almost the same path of symptoms in every person that suffers from this disorder.

   1. The sudden onset of fear with little or no provoking stimulus.
   2. Release of adrenaline which cause the so-called fight-or-flight response where the person's body prepares for major physical activity
   3. Increased heart rate, rapid breathing, and sweating.
   4. Hyperventilation leads to carbon dioxide levels lowering in the lungs and then the blood.
   5. This leads to shifts in blood pH which can in turn lead to many other symptoms, such as tingling or numbness, dizziness, and lightheadedness.

While the symptoms and the seriousness of panic disorder are very real, the feelings of panic or dying that accompany many attacks are significantly exaggerated. 

Generalized anxiety disorder

Generalized anxiety disorder is a specific chronic disorder that affects twice as many women as men and can lead to considerable impairment. It is characterized by long-lasting anxiety that is not focused on any particular object or situation.  People with this disorder feel afraid of something but are unable to name the specific fear. They fret constantly and have a hard time controlling their worries. This constant fear may lead to developing of headaches, heart palpitations, dizziness, and insomnia. 

What exactly is a phobia?

This is a specific mental disorder characterized by a strong, irrational fear and avoidance of an object or situation. A phobic disorders differs from generalized anxiety disorders and panic disorders because there is a specific stimulus or situation that elicits a strong fear response.

The most common phobias are fears of knives, rats or spiders, closed space, dark etc. There is also one other category of phobias known as social phobias. Individuals with this disorder experience intense fear of being negatively characterized by others or of being publicly embarrassed because of impulsive acts. People with social phobias become so anxious that performance is out of the question.

Diagnosis of panic attacks


Patient’s history

The doctor should ask a patient to describe signs and symptoms, how often they occur and in what situations they occur.

Complete physical examination

The patient will probably undergo a complete physical exam so that doctor can determine whether health conditions other than panic attacks are the cause of symptoms. These other health conditions might include:

  • heart disease
  • overactive thyroid

Complications if left untreated

Unfortunately panic disorder can become debilitating and destructive if left untreated. The fear of the recurrent attacks can lead to behavior characterized by avoiding what most people consider to be normal situations. In children, panic attacks can interfere with normal development, disrupting the child's social life and schoolwork. Not only that, it is proven that having panic disorder also increases a person’s risk of depression, suicide, and abuse of alcohol and other drugs.
Treatment of panic attacks

Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for heart disease or some other life-threatening medical illness. That’s why differential diagnosis could be very important. Treatment for panic attacks and panic disorder is very effective and it may involve:

Medications

The most commonly used medications in the treatment of panic attacks are antidepressants such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac, Sarafem).

They improve or eliminate the symptoms of panic attacks. Medications called tranquilizators could also be used. Benzodiazepines such as Clonazepam (Klonopin) or alprazolam (Xanax), belong to this group.

Cognitive behavior therapy

Sessions with mental health provider could be extremely important. During these sessions with psychiatrist, the patient should learn to understand his panic attacks and how to deal with them. In the cognitive part of the therapy, the patient should learn to recognize things that trigger his panic attacks or make them worse



Family support

As with many disorders, having a support from family and friends who understand the condition can significantly increase the success of recovery. During the attack, it is not uncommon for the patient to develop an irrational fear, which can often be dispelled by a supporter who is familiar with the condition. 

Other treatment options

Other interesting forms of treatment include journalling, in which a patient records his day-to-day activities and emotions to find and deal with his personal stresses, and breathing exercises, such as diaphragmatic breathing. Research has proven that stress-relieving activities such as tai-chi, yoga, and other physical exercise can also help relieving the causes of panic disorder. 

Stress-relieving tips

  • Proper diet - reduction in consumption of caffeine, sugar, and generally an improvement of eating habits.
  • Exercise is thought to relieve stress.
  • Laughing
  • Breathing techniques and proper breathing
  • Proper sleep.
  • Meditation
  • Relaxation techniques