Panic disorder

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Panic attacks are feelings of severe anxiety that start and finish quite suddenly. They are sometimes called anxiety attacks.

If you have a panic attack, the feelings may be so scary that you feel that you are about to die, collapse or lose control of your mind. You may feel that you have to immediately escape or find help.

Such an extreme reaction would be normal in a situation where your life really was in danger, for example, if you were in the sea and a shark was swimming towards you. This is called the flight or fight response and is good!

But panic attacks happen when there is no real danger. They may start for no obvious reason. Often they happen in an everyday situation you have become anxious about, like being in a supermarket.  Panic attacks are so unpleasant that people are frightened of having another one. They often remember their first attack for the rest of their lives.

Panic disorder is when you have frequent panic attacks, once a month or more.

Other factors that may mean you have panic disorder rather than panic attacks are when your life is seriously affected either by fear of having attacks, or if you avoid certain places in case you have an attack.

Although most of the symptoms and treatments are the same, panic disorder is a more serious and life-disrupting form of panic attacks.

Experiencing panic attacks often makes people feel generally unwell. They may sleep badly and feel anxious and exhausted, have trouble concentrating, and find it hard to relax and enjoy themselves. People who are severely affected find it difficult to go out alone, even to do everyday activities like shopping or collecting children from school. Travel to new places may be impossible.

In severe cases this means you cannot work or have a social life outside the home. You may lose touch with your friends.

If you have panic attacks it is important to seek help and information, as panic attacks themselves are fairly easy to treat. Early treatment can help to avoid later complications and the development of panic disorder. 

What causes panic attacks?

There are many causes of panic. Most people experiencing panic disorder will have several of the following factors that contribute to an attack:

Panic runs in families, so if either parent has panic attacks, it may make you more susceptible.

Personality may play a part. Some people are more nervous and ‘highly strung’ than others. This may be good in some circumstances because they are more sensitive and cautious. But the down side is that they will be slightly more likely to have anxiety problems, including panic. Again this is not always the case. Some anxious people never experience sudden panics and some people who are very calm and confident by nature will develop panic attacks.

Events and situations in your life can put you under stress and make you more vulnerable to panic. Typically, events that make you feel unsafe or insecure or anxious may be causes. General stresses like poverty or relatives dying could make you vulnerable. Panic can also occur as part of another mental illness. It commonly occurs with depression.

Some common substances can cause panic. Caffeine, found in coffee and many soft drinks, is the most common. Tea has a similar but weaker effect. People who have panic attacks and panic disorder may be very sensitive to caffeine and even small amounts can be harmful. Alcohol does not directly cause attacks, but as its effects wear off, you are more likely to have a panic attack. Cannabis is another drug that some people are sensitive to, and for them, it can start panic attacks. The effects of cannabis are long-lasting as the body takes weeks to get rid of it.

Over-breathing, also called hyperventilation, is a problem for the majority of people with panic disorder. Anxiety makes you breathe too much. Over-breathing can directly cause physical symptoms like dizziness and tingling in your hands and feet, which makes you feel even more anxious. Strangely, when you are over-breathing, you may feel as if you are not getting enough air and breathe even harder. This makes you feel worse and you get caught in a vicious cycle.

For some people panic seems to start out of the blue. They may just have a strong inherited tendency to panic. For others there seem to be obvious stresses in their life. There are often some symptoms of general anxiety or depression, or other phobias, in the months before panic starts.

Note, if panic attacks follow an experience that really was extremely dangerous or horrific, like being assaulted or being in an accident, then it is usually part of a different condition known as post-traumatic stress disorder or PTSD.[LINK]

It's important to remember that it’s not your fault if you are experiencing anxiety or panic.

Signs to look for (symptoms)

The most obvious symptoms are the panic attacks themselves. These start suddenly, often in a few seconds, sometimes over five or ten minutes. Panic attacks normally last for 10 or 20 minutes but people can feel anxious or shaken up for some hours after.

As well as feelings of great anxiety, fear or terror, people may also have many other symptoms, most of which are physical. In an attack you may feel several of the following:

  • shaking or trembling
  • sweating
  • choking feelings
  • racing or pounding heart
  • chest pain or tightness
  • nausea, stomach pain or diarrhoea
  • hot and cold feelings
  • shortness of breath or feeling smothered
  • dizziness or light-headedness
  • tingling, often in the fingers
  • feeling cut off from reality
  • fear of losing control or going crazy.

These are all symptoms of severe anxiety. Because many of them are physical sensations, people with panic attacks often think that there is something wrong with their body. They may think they are having a heart attack or stroke or that they are dying. They may call an ambulance and be rushed to an emergency medical service. People do not die of panic attacks, even though they may feel that way during an attack.

Panic attacks are common. Many people will have at least one attack during their lifetime. Panic disorder is also quite common. Women are affected twice as often as men. The problem usually starts between the late teenage years and the age of 35. Usually it causes problems for a few months and then lessens.

Unfortunately, panic attacks often come back again after a few months or years and a person's avoidance of places or situations for fear of a panic attack may get worse.

One third of people with panic attacks avoid places where they might panic. This is called agoraphobia. Most people who have not been treated for panic will still have some symptoms 10 years later. By then they may have become depressed or have started to overuse alcohol or other drugs because of repeated panic attacks and the restriction in their lives caused by panic.

If depression becomes severe they may feel suicidal.

If you fear you might harm or kill yourself it is vital that you seek help immediately.

How the doctor determines if you have panic attacks or panic disorder (diagnosis)

Many people with panic attacks, sooner or later, go to see their doctor or a counsellor. When you see your doctor it’s important to tell them as much as you can about how you are feeling and what you are going through, especially if you experience any of the feelings listed above.

The doctor may do some tests to make sure there are no underlying medical conditions that are causing your symptoms. They may also refer you to a mental health professional if they suspect you have panic disorder.

Treatment Options

The most effective treatment for panic related problems is a combination of psychological therapy and medication. Common treatment types include:

Medicines

Antidepressant or tranquilliser medication in conjunction with therapy has proven effective in improving the symptoms of panic disorder. 

You should be told what effects you should  notice from any medication, receive clear instructions about how you should take them and what precautions are necessary. 

If you are pregnant or breast feeding no medication is entirely safe.

Talking therapies and counselling

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, usually talking therapies, to assess and help you understand what has happened, and to help you make positive changes in your life.

Cognitive-behavioural therapy (CBT) − a psychological therapy which largely focuses on overcoming unhelpful beliefs, has been proven to work well with panic disorders.

Education

Education can be extremely important to help you, your family/whānau and supporters to understand this disorder and help in the recovery. Your doctor or mental health professional will give you information about the disorder, suggest different ways to handle it, and discusses any complications which may occur.

There are also numerous books available in the shops that some people find to be really useful. They can teach you about some of the ways of dealing with panic attacks and they can also get you used to reading about or discussing problems that you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have experienced panic attacks.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Important strategies to support recovery

For people who have panic attacks or a panic disorder, the following strategies have been found to be important and useful.

  • Tell family/whānau or friends about your concerns. If you find it difficult to let others understand how it feels for you it may be helpful to find an article or book which explains panic attacks and ask them to read it. You will feel more comfortable if they know that you might have to stop to wait out an attack or that you might have to leave a place or situation. Because panic is so common, most people know someone who has had it, even if they have not experienced it themselves.
  • Avoid substances that aggravate panic including caffeine, alcohol and cannabis. You might want to experiment to see if alcohol and caffeine do affect you, but the safest plan is to stop. Do this gradually if you are taking them regularly.
  • Make sure you eat good food, exercise and having a regular daily routine. These will help you feel better and more in control of your health. But they are not likely to be enough to cure you of panic.
  • Relax regularly. If you need to, learn a relaxation technique or find something to do with your family/whānau or friends that is relaxing and enjoyable. Exercise and sport is good as it helps you relax and helps you feel in control of yourself. Sleep is the most important relaxation, so do not stay up late unnecessarily. If you are in a sexual relationship, remember that [wild] sex is a good antidote to anxiety.

Try to remember that it’s your thoughts/anxiety that causes the feelings you have during an attack. If you do nothing the attack will do you no harm and it will pass.

If you find yourself thinking catastrophic thoughts like: "I am dying," remind yourself that this is not true. Remember that you have survived previous attacks. If you can, you should resist leaving places or situations because of attacks. This is because if you leave or avoid places you will find it increasingly hard to return there.

Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: September, 2014.