Panic Disorder

Definition and usual symptoms of Panic Disorder

Panic disorder is a condition in which the individual experiences recurrent and unexpected episodes of extreme anxiety. During these episodes which are called panic attacks, a variety of terrifying physiological symptoms can occur such a pounding heart, shortness of breath, dizziness, or trembling.

Emotionally the person may experience extreme anxiety and dread. Cognitively the person may think that they are losing control, that something terrible is going to happen, or even that they are going to die.

Between panic attacks, the person may also experience a persistent dread that a panic attack will occur at any time. This fear can lead to significant deficits in normal functioning.

Very detailed criteria for defining panic attack are provided in the Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Society (DSM-IV). Some of the symptoms listed there are:

  • Pounding heart or accelerated heart rate
  • Sweating
  • Trembling
  • Sensations of shortness of breath
  • Feeling of choking
  • Chest pain
  • Feeling dizzy
  • Derealisation (Feelings of unreality, or being detached from self
  • Nausea or abdominal distress
  • Fear of losing control
  • Fear of dying
  • Numbness or tingling
  • Chills or hot flushes

The DSM-IV requires that the following conditions be met for a panic disorder to exist:

  • Recurrent unexpected panic attacks
  • At least one of the attacks has been followed by 1 month or more of one (or more) of the following:
    • Persistent concern about having another attack
    • Worries about the possible implications of the attack e.g. losing control, having a heart attack
    • A significant and detrimental change in behaviour due to the attacks
  • The condition significantly affects some aspects of everyday functioning e.g. work, social life.

Lifetime prevalence of Panic Disorder

A large epidemiological study conducted in the United States found the lifetime prevalence of panic disorder to be 4.7%, which is much less than the lifetime prevalence rate of 12.5% for specific phobia but higher than the 1.4% for agoraphobia (Kessler et al, 2005).

A report one year later and based on this same United States sample found that the lifetime prevalence for panic disorder without agoraphobia was 3.7% while it was only 1.1% for panic disorder with agoraphobia (Kessler et al, 2006).

Treatments for Panic Disorder

There are a wide variety of treatment approaches for panic disorder and these have been reviewed recently (Cloos 2005; Sánchez-Meca et al 2010). They include the following approaches:

  • Cognitive Behavioural Treatment (CBT). This is the most researched and systematic treatment and often involves consideration of cognitions.

    For example the person with panic disorder may use self-defeating self statements when stressed such as “This is way too much for me to handle. It will kill me”.

    The clinician can then use cognitive restructuring with the aim of helping the client to replace this statement with a more adaptive one such as “I am competent to cope with this. I will handle it well and get through it”.

    Also diaries or logs of irrational thoughts accompanying panic attacks are maintained by the client. Later, often with the assistance of the CBT therapist, they develop a set of adaptive comments to counter each negative thought in the log.
  • Stress management training is also part of most CBT programs for panic disorder. The reason is that both depression and anxiety can be considered stress responses and both are often found in persons with panic disorder. It is also to be noted that persons who are under a great deal of stress and who lack stress management skills are at risk for developing panic disorder.
  • Meditation, breathing and stretching exercises designed to increase awareness and control over the mind-body system. This can be extremely important in some cases where the person with panic disorder is no longer “listening” to their body. Relaxation methods of all kinds including exercise, self hypnosis (body scan), use of relaxation tapes, and Yoga can also be of great therapeutic value.
  • Social support can be a useful and important recovery tool for those with panic disorder. Social support can be provided by:
    • Therapist
    • Family
    • Support group. This can be a powerful element in managing panic disorder.
  • Reduction or elimination of caffeine, alcohol or other non-prescribed drugs.
  • Medication: In some cases clients can be helped by medication particularly during the initial phases of their recovery program medication in conjunction with other treatment approaches (Smits, O'Cleirigh,& Otto, 2006).

    However medication only reduces symptoms. It does not teach the person skills for coping with a panic attack. Also some of the medications routinely used in the short term treatment of panic disorder have the potential for abuse and dependence.
  • Psychoeducation about panic disorder and the various explanations for its causes and treatment.
  • Increase self-confidence and self-esteem and self-respect. It may be necessary to have the client increase their valuing of themselves. This is necessary since persons with panic disorder often feel humiliated and ashamed at the many limitations the condition has imposed on their functioning.
  • Family of origin issues: Often childhood stress plays a role in the development of panic disorder.
  • Holistic approach attempts to cover the complete life of the individual and all the stressors they have and their coping strategies including social support and emotional self-regulation.

Concluding remarks for readers with panic disorder

Panic disorder can be very manageable with the appropriate professional treatment. The result of treatment is that usually the frequency of attacks is greatly reduced and the client is able to moderate the intensity of the remaining attacks, or learn how to accept them.

Most panic disorder clients who work diligently on their recovery regain their former level of functioning. The majority of clients regain an active and unrestricted life.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., text rev.) Washington, DC: Author.

Cloos, J.-M. (2005). The treatment of panic disorder. Current Opinion in Psychiatry, 18(1), 45-50.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication. Archives of General Psychiatry, 63(4), 415-424.

Sánchez-Meca, J., Rosa-Alcázar, A. I., Marín-Martínez, F., & Gómez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clinical Psychology Review, 30(1), 37-50.

Smits, J. A. J., O'Cleirigh, C. M., & Otto, M. W. (2006). Combining cognitive-behavioral therapy and pharmacotherapy for the treatment of panic disorder. Journal of Cognitive Psychotherapy, 20(1), 75-84.


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