Panic Disorder

What is panic disorder?

Panic disorder is a type of anxiety disorder characterised by recurrent and unexpected panic attacks. A panic attack is a sudden episode of intense fear or discomfort that reaches its peak within minutes and includes a variety of physical and emotional symptoms. People with panic disorder often live in fear of having another panic attack, which can significantly affect their daily life and well-being.

While panic attacks can occur in anyone, panic disorder is diagnosed when these attacks are frequent and the person develops a persistent concern about having more attacks or the consequences of the attacks, such as embarrassment or physical harm.

Symptoms of panic disorder

Panic attacks are the hallmark of panic disorder, but there are other symptoms that people may experience, both during and between attacks.

Common symptoms of a panic attack include:

• Rapid heart rate (palpitations)
• Sweating
• Trembling or shaking
• Shortness of breath or a sensation of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizziness, light-headedness, or faintness
• Chills or hot flashes
• Numbness or tingling sensations
• Feelings of unreality or detachment
• Fear of losing control or "going crazy"
• Fear of dying

For someone with panic disorder, the fear of experiencing another attack can lead to additional problems such as:

• Avoidance behaviour: People may start avoiding situations or places where they previously had a panic attack or fear having one.
• Constant worry: Individuals with panic disorder may spend a lot of time worrying about when the next attack will occur.
• Agoraphobia: In severe cases, people with panic disorder may develop agoraphobia, which is the fear of being in situations where escape might be difficult or help unavailable during a panic attack (e.g., crowds, public places, or travelling).

Causes of panic disorder

The exact cause of panic disorder is not fully understood, but several factors are believed to contribute to its development:

• Genetics: Panic disorder can run in families, suggesting a genetic predisposition. If a person has a close family member with anxiety or panic disorder, they may be more likely to develop it themselves.
• Brain chemistry: Imbalances in certain neurotransmitters or irregularities in brain areas that control fear and anxiety may play a role in panic disorder.
• Stress and trauma: Major life stressors, such as the death of a loved one, abuse, or a serious illness, can trigger panic attacks or increase the risk of developing panic disorder.
• Medical conditions: Certain physical health issues, such as heart problems, thyroid disorders, or respiratory conditions, can sometimes cause symptoms similar to panic attacks, and in some cases, may contribute to panic disorder.
• Cognitive factors: People with panic disorder may have a tendency to catastrophise or misinterpret normal physical sensations as signs of something much more dangerous, leading to heightened anxiety and panic.
  

Diagnosis of panic disorder

A mental health professional can diagnose panic disorder based on a person’s symptoms and medical history.

The diagnosis is typically made if:

• The person experiences recurrent, unexpected panic attacks.
• At least one of the attacks is followed by a month (or more) of persistent worry about having more attacks, or significant behavioural changes due to the fear of having an attack (such as avoidance of certain situations or places).
• The panic attacks are not caused by a medical condition, substance use, or another mental health disorder, such as social anxiety or post-traumatic stress disorder (PTSD).

It’s important to seek a professional evaluation to rule out other potential causes of symptoms, such as medical conditions or other anxiety-related disorders.

Treatment of panic disorder

Panic disorder is highly treatable, and many people experience significant improvement or even complete recovery with the right treatment.

There are several evidence-based treatment options:

1. Cognitive Behavioural Therapy (CBT)

• Identify and challenge irrational fears and catastrophic thinking patterns.
• Learn relaxation techniques to reduce physical symptoms of anxiety, such as deep breathing exercises or progressive muscle relaxation.
• Gradual exposure to feared situations or places (a technique called exposure therapy) to reduce avoidance behaviour and decrease sensitivity to triggers.
• CBT can help individuals reframe their thoughts and gain greater control over their reactions, making it easier to manage panic attacks when they arise.

2. Medication

• Selective serotonin reuptake inhibitors (SSRIs): These antidepressants, such as sertraline (Zoloft) or fluoxetine (Prozac), are often prescribed as first-line treatment for panic disorder because they help balance serotonin levels in the brain, reducing anxiety.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These medications, such as venlafaxine (Effexor), work similarly to SSRIs but also affect norepinephrine, another neurotransmitter linked to mood and anxiety regulation.
• Benzodiazepines: These medications, such as diazepam (Valium) or lorazepam (Ativan), can provide quick relief of panic symptoms. However, they are typically prescribed for short-term use due to the risk of dependence or tolerance.
• Beta-blockers: These medications, such as propranolol, are sometimes used to reduce the physical symptoms of panic attacks (e.g., rapid heart rate, tremors) by blocking the effects of adrenaline.

3. Mindfulness and relaxation techniques

• Deep breathing: Slow, deep breaths can help calm the body’s fight-or-flight response during a panic attack, reducing the severity of symptoms.
• Progressive muscle relaxation: Tensing and then relaxing different muscle groups in the body can help reduce physical tension and anxiety.
• Mindfulness meditation: Mindfulness can help individuals become more aware of their thoughts and emotions without reacting to them, which can reduce the power of panic attacks.

4. Lifestyle changes

• Regular exercise: Physical activity helps regulate the body’s stress response and promotes relaxation.
• Healthy sleep habits: Poor sleep can increase anxiety, so it’s essential to establish a consistent sleep routine.
• Avoiding stimulants: Caffeine, nicotine, and recreational drugs can trigger panic attacks or make symptoms worse.
• Stress management: Developing healthy ways to cope with stress, such as through journaling, hobbies, or social support, can help reduce the overall anxiety level.

5. Support groups

• Joining a support group or talking to others who have panic disorder can provide comfort and reassurance. It helps individuals feel understood and less isolated, as they share coping strategies and experiences.

How to manage panic disorder

While professional treatment is important, there are steps individuals can take on their own to help manage panic disorder:

• Educate yourself: Understanding what panic disorder is and how it works can help reduce fear and anxiety surrounding the attacks.
• Challenge avoidance: Avoiding places or situations where panic attacks have occurred can increase fear over time. Gradual exposure, with the help of a therapist, can help reduce this avoidance and increase confidence.
• Accept the sensations: Recognising that the physical sensations during a panic attack are not life-threatening (even though they may feel overwhelming) can help reduce the fear that fuels the attack.
• Practice relaxation techniques: Regular practice of relaxation techniques can help calm the body and mind, making it easier to manage anxiety.

How we can help

If you or someone you care about is struggling with panic disorder, we are here to support you. Panic disorder is treatable, and with the right help, many people learn to manage their symptoms and live a full and fulfilling life. If you’re experiencing panic disorder, reach out today - recovery is possible, and you don’t have to face it alone.