Panic Attacks

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Mental Health
Panic Attack

About Panic Attacks

The most essential thing to learn about panic is the experience of panic itself. Once it happens, a person's life changes dramatically. A panic attack brings on the fastest and most complex changes known in the human body. It is experienced as overwhelming, uncontrollable dread, as if one is terribly ill, about to die or lose one's mind. It drastically changes the the functioning of major glands, heart, lungs, stomach, intestines, pancreas, kidneys, bladder, eyes, and the largest muscle groups. Even violent poisons or traumatic injuries have less effect. A cascade of stimulants and hormones - adrenaline, epinephrine, glycogen, among others - flood all the cells of the body via the bloodstream. The impulse is to run, get out, or hide. The immediate cause is believing one is trapped and helpless, by some overwhelming threat.

While panic can happen as a consequence of crime or disaster, it doesn't matter whether the threat is real. Often, panic happens after several weeks or months of stress. It happens more often with persons who are very worried, perfectionist, socially avoidant, or who have had abuse in childhood. Heredity may play some part. What keeps panic going, and getting more intense and frequent, is worrying excessively about it and avoiding situations that appear to bring panic.

Panic masquerades as a variety of medical disorders. Panic mimics some medical conditions almost completely, causing years of misdiagnosis. These are hypoglycemia, complex partial seizures, drug effects, heart arrhythmia and hyperventilation syndrome. Panic partly mimics others: angina, asthma, irritable bowel, colitis, vertigo, heart attack, post concussion syndrome, hypertension, postural hypotension, and hiatal hernia.

Almost everyone who panics believes they have a serious physical illness, and go from doctor to doctor for several years as symptoms shift. Yet panic is easily diagnosed by professionals experienced in panic. About 7.2% of all adults, or 1 in 15, have a panic disorder which is a primary part of their disorder, (NIH, 1993). In any given year, about 1/3 of American adults have at least one panic attack; most of these adults never develop repeated attacks. This startling data means that a phobia/panic disorder is the most common emotional disorder, more common than alcohol abuse or depression (phobias are an irrational fear of something, spiders, heights etc.).

Phobia/panic disorder also has the lowest rates for seeking help and finding it, about 22%. Phobia is the most common and the most hidden condition at the same time. After a few months of panic, about 10% of people become housebound and unable to leave home alone. After a few years, about 30% of panic sufferers have a loss of job, pay or job responsibilities. Some 17% are at risk for alcoholism and about 40% risk a chronic depression as life opportunities are cut off. A majority have marital problems and much reduced travel and social life.

For most, panic closes life off like a prison. If you are agoraphobic (fear of crowds, fear of leaving your home alone), there's a 40% chance you had near relatives who were phobic. You may have suffered early abuse. In addition, there may have been a lot of instability in your home, such as repeated moves or foster care. You may have had your first panic as part of a school phobia.

Your phobia most likely started with a panic attack about age 23, as if "out of the blue". After a while you saw that only certain situations brought it on, those in which you were trapped in some way. Just before the first attack, you were likely to have been under unusual stress, responsibility, or loss of security. Then you soon started to avoid those panic situations and to worry and dread going back to them. Very soon you began multiple consultations with several physicians to check out your alarming symptoms, which shifted from year to year. By the end of the first year you were already avoiding crowds, stores, transportation, and closed in spaces. There was a 10% chance you became housebound. After 8 to 10 years of mostly misdirected treatment, you found that periods of panic would be followed by 1 or 2 years of some relief, only to return stronger than before.

Because you still didn't know your condition, you began to feel a bit alien and became good at hiding your condition. You slowly began to give up on friendships, social life, travel, work ambition and other life plans. If male, you began a period of heavier drinking, as a way of self-medication. A kind of chronic, low grade depression set in along with lowered expectations in life. You started to get resigned to your prison. After 20 or more years of having agoraphobia, you found you could get by in safe areas or with a safe friend, but your life became narrow and limited. You became very dependent on your partner to travel. In fact, your relationship got strained as your partner felt increasingly helpless and distant. There was less sexual desire. There was a good chance you had some loss of your work role and impaired work performance. Amazingly, you have not learned what to call your condition. It has become a way of life, the way your life has turned out. While panic is always part of agoraphobia. social phobia, or any phobia, it also turns up some of the time in other anxiety disorders.

About 30% of people with obsessive-compulsive tendencies experience panic, particularly around the need to stop the rituals of washing, checking, or cleaning. A good estimate is that about 40% of those of who have post-traumatic stress disorder (PTSD) panic at least occasionally, and sometimes regularly. Those with PTSD have undergone a major trauma such as rape, assault, a natural disaster, combat, major surgery, or early childhood abuse. Sometimes panic disorder exists by itself, but is much more common with the above conditions.

Treatment

Treatment for panic attacks and panic disorder is very effective. The outlook is good if you seek help, and most people are able to resume everyday activities. Be willing to admit that this is something that you need help with. It is not something that will get better with time. In fact, left untreated, it is likely to get worse over the years. Call your family Dr. S/he can give you referrals to therapy groups, specialists, and can get your treatment started.

Treatment may involve:
  1. Medications. Your doctor may prescribe an antidepressant medication, such as one of the SSRI group (such as Zoloft, Paxil, Effexor, Lexapro). Antidepressant medications are usually effective in preventing future attacks. In some cases, doctors prescribe a medication to relieve anxiety, such as Klonopin or Xanax. The effectiveness of these drugs often varies. Be very aware that anti anxiety drugs such as Xanax and Klonopin are very habit forming and should not be taken long term. Unlike antidepressants, anti-anxiety medications are likely to cause drowsiness and lethargy. They are designed to reduce the immediate stressor and do not prevent symptoms long term as do the anti depressants. The duration of treatment depends on the severity of your disorder and your response to treatment.
  2. Cognitive behavior therapy. During sessions with your psychiatrist or psychologist, you learn to better understand your panic attacks and how to deal with them. In the cognitive part of your treatment you will learn to recognize those things that trigger your panic attacks or make them worse. The behavioral part of the therapy involves learning ways of coping with anxiety, such as using breathing and relaxation techniques, journaling, learning to express anger appropriately, learning to recognize your feelings and to express them without fear and to recognize your red flags, those life situations which trigger anxiety for you. You will learn how to curb your anxiety before it escalates into a panic attack and you will learn better ways to cope with daily anxiety. If you're avoiding common situations because of fear of panic attacks, behavior therapy can help you overcome this avoidance, which may be limiting the quality of your life. Most people need only eight to 10 sessions. Long-term psychotherapy usually isn't necessary to get panic attacks under control. However because it is common for panic disorder to to develop in people who have had a significant childhood loss (death of a parent, divorce or a traumatic event), longer term therapy may be indicated to work through those emotional triggers for your panic episodes.
  3. Therapy/support groups specifically for those with panic disorders are often the best way to learn how to deal with a panic disorder, especially for those who do not have an underlying mental illness. Groups help the individual realize that they are not alone. And the unthreatening environment is often helpful to reduce the anxiety than can accompany beginning treatment.

    Some people do well with either antidepressant medications or therapy. But the combination of the two have been shown to create the best long term healing.

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