What is Panic Disorder?
Panic disorder and panic attacks are two common issues in the realm of mental health. Firstly, it’s important to note that panic disorder isn’t the same as panic attacks; however, people with a panic disorder often experience unexpected panic attacks in a recurring manner. A panic attack is described in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as a sudden, intense surge of fear or discomfort that peaks within minutes. This is usually accompanied by four or more physical symptoms, such as a racing heart, sweating, shaking, difficulty breathing, feeling like you’re choking, chest pain, nausea, dizziness, chills or feeling hot, numbness or tingling, feeling detached from oneself or reality, fear of going mad, and fear of dying.
Panic attacks may occur as frequently as several times a day, or as infrequently as a few times a year. One of the main features of panic disorder is that these attacks occur without warning, and there is often no specific trigger. Someone dealing with these attacks may tend to feel a loss of control. But, panic attacks are not exclusive to panic disorder. They can also co-occur with other mental health conditions, including other anxiety disorders, mood disorders, psychotic disorders, and substance use disorders.
To accurately diagnose panic disorder, it’s necessary to differentiate it from isolated panic attacks. According to DSM 5, panic disorder is diagnosed when recurrent and unexpected panic attacks are followed by at least one month of constant worry about having further attacks, and a behavior change to avoid situations the individual connects with the panic attack.
Even though panic attacks can be caused by the direct effects of substance use, medication, or physical health conditions like an overactive thyroid or balance problems, they must not be solely derived from these. For instance, if panic attacks occur due to social anxiety disorder triggered by social situations like public speaking, it’s not considered as part of panic disorder. A key symptom of panic disorder is that the individuals experience their fear and anxiety in a physical way, rather than in their thoughts.
Panic disorder can greatly affect a person’s quality of life, leading to depression and inability to carry out daily activities. Individuals with panic disorder are also at a higher risk for alcoholism and substance abuse compared to others.
What Causes Panic Disorder?
There are several theories and ideas about what may cause panic disorder. Many highlight an imbalance of certain chemicals in the body as a major contributor. This includes abnormalities in gamma-aminobutyric acid, cortisol, and serotonin, which are all chemicals that help control feelings and body actions.
It is believed that a combination of genes and environmental factors come into play in the development of panic disorder. Some research shows that difficult experiences in childhood could lead to the disorder in adulthood.
Newer studies are highlighting that the wiring in our brains could have a big impact on panic disorder. Some people’s brains may be overly sensitive, making them at risk for developing the disorder.
Genes may also play a role in developing panic disorder. If someone in your family has been diagnosed with panic disorder, there is a 40% chance that other family members could develop it too. Additionally, people with panic disorder are at a higher risk of developing other mental health disorders.
Risk Factors and Frequency for Panic Disorder
Panic disorder is quite common, making it one of the most prevalent anxiety disorders, following only social anxiety disorder, posttraumatic stress disorder, and generalized anxiety disorder. Remarkably, individuals with panic disorder tend to have a higher rate of various health issues, including heart, respiratory, and digestive problems, compared to the rest of the population. It’s more frequently found in European Americans than in African Americans, Asian Americans or Latinos, and is more common in women than men. Panic disorder typically develops during adolescence or early adulthood. It’s rare in children under 14.
- Those with panic disorder often have other conditions, such as obsessive-compulsive disorder, social phobia, asthma, chronic obstructive pulmonary disease, irritable bowel syndrome, high blood pressure, and mitral valve prolapse.
- Pregnant women with panic disorder are more likely to have babies with low birth weights.
Signs and Symptoms of Panic Disorder
Panic disorder affects many people and triggers multiple symptoms that can be worrying. Often people suffer from chest pain, heart palpitations, or shortness of breath. Other symptoms could include sweating, shaking, feeling choked, experiencing nausea, chills, numbness or tingling, or feelings of detachment from reality.
Because these symptoms can be so physical, many people look for other causes apart from mental health issues, sometimes avoiding seeing mental health professionals. Instead, they turn to specialty doctors for assurances. It’s crucial to understand that some conditions such as irritable bowel syndrome, asthma, and vocal cord dysfunction have similar symptoms to panic disorder.
- Chest pain
- Heart palpitations
- Shortness of breath
- Sweating
- Shaking
- Feeling of choking
- Nausea
- Chills
- Numbness or tingling
- Feelings of detachment from reality
Testing for Panic Disorder
To diagnose panic disorder, doctors usually don’t require specific lab tests, X-rays, or other similar examinations. Instead, they use a set of guidelines called the DSM 5 criteria, which were mentioned earlier. Aside from these guidelines, doctors also use rating scales to measure the severity of panic attacks.
However, it’s crucial for healthcare providers to thoroughly examine the patient to exclude other potential causes of the symptoms. This is because panic disorder is only diagnosed when the symptoms can’t be better explained by other medical or mental health conditions.
Treatment Options for Panic Disorder
Panic disorder is typically treated using both psychological and medication-based methods. Psychological treatments often involve cognitive-behavioral therapy, a type of therapy that works to change negative thought patterns that can lead to anxiety and panic.
Interestingly, these treatments can also positively affect other health conditions that a patient may have. For example, breathing training, which involves using biofeedback to reduce instances of over-breathing or hyperventilation, can help manage panic symptoms. Not only that, but this technique can also benefit patients with conditions like asthma and high blood pressure. Methods for reducing over-breathing can also be helpful for individuals with heart disease. Moreover, techniques that lower anxiety and stress levels can reduce the negative impacts on heart health by calming the body’s response to stress.
Two types of medications, antidepressants and benzodiazepines, are commonly used to treat panic disorder. Of the various types of antidepressants, a group called selective serotonin reuptake inhibitors (SSRIs) are typically suggested over others. SSRIs are often the first choice for treating patients with panic disorder. If a patient has other health conditions, or if their panic symptoms are very severe, a type of benzodiazepine, such as alprazolam, may be used until the antidepressants start to work. For patients who have panic disorder and also struggle with substance use, gabapentin and mirtazapine might be used.
Keep in mind, there’s a risk of suicide associated with panic disorder, and some patients may need to be watched closely in a hospital setting until their symptoms lessen.
What else can Panic Disorder be?
Possible health conditions that can be associated with panic attacks include:
- Angina (chest pain)
- Asthma
- Congestive heart failure
- Mitral valve prolapse (a heart disorder)
- Pulmonary embolism (a blockage in the lungs)
- Substance use disorder
- Other mental health disorders
What to expect with Panic Disorder
The outlook for recovery from panic disorder can be uncertain. It’s rare for someone to have panic disorder without other mental health issues. Most people also experience a return of symptoms even after they’ve been symptom-free for a while. Staying on track with treatment is a major factor in managing this, but many people have their symptoms come back. In fact, only about 60% of patients are symptom-free within six months.
Certain factors can make it harder to recover. These include having another long-term illness, being highly sensitive to interpersonal interactions, not being married, low socioeconomic status, and living alone. Besides the risk of heart problems, it’s also important to know that people with panic disorder are at a higher risk of suicide.
Possible Complications When Diagnosed with Panic Disorder
Panic disorder can increase the likelihood of suicidal thoughts. It also has negative effects on quality of life since it affects a person’s ability to function properly in their social and family circles. Additionally, it comes with an increased risk of other co-existing medical conditions and a higher chance of smoking.
Possible Risks and Consequences:
- Increased risk of suicidal thoughts
- Decreased quality of life due to trouble functioning in social and family situations
- Higher chance of other medical conditions occurring at the same time
- Increased likelihood of smoking
Preventing Panic Disorder
It’s crucial that doctors explain to the patient the symptoms that might occur if they are diagnosed with a certain disorder. If a patient doesn’t understand these symptoms, they may become more fearful of their condition, which could potentially trigger more frequent episodes. Doctors should also talk about two different treatment options: medication therapy and cognitive-behavioral therapy. Understanding these options can help patients better cope with the condition they have.
