Panic disorder is a serious and debilitating mental health condition characterized by recurrent, unexpected panic attacks. This comprehensive guide provides an in-depth look at the causes, symptoms, diagnosis, and holistic treatment approaches for panic disorder.
What is Panic Disorder?
Panic disorder is an anxiety disorder distinguished by recurring panic attacks that strike suddenly and unexpectedly. According to the National Institute of Mental Health (NIMH), around 2.7% of U.S. adults experience panic disorder every year.
During a panic attack, a person experiences an abrupt surge of intense fear or discomfort that reaches a peak within minutes. Common symptoms include a racing heartbeat, shortness of breath, dizziness, trembling, sweating, nausea, and numbness or tingling. People having a panic attack may feel like they are losing control, going crazy, having a heart attack, or even dying.
While isolated panic attacks can happen to anyone in stressful situations, a diagnosis of panic disorder requires recurrent, unexpected attacks along with persistent worry about future attacks or changes in behavior related to the attacks. Without treatment, panic disorder can severely restrict a person’s quality of life.
Causes and Contributing Factors
Experts don’t know exactly what causes panic disorder, but research suggests that a combination of genetic, environmental, and biological factors are involved.
Genetics a probable cause for Panic Disorder
Panic disorder tends to run in families. Having a first-degree relative with the condition increases your risk. Genetic research has connected certain gene variations with the development of panic disorder. These genes may impact neurotransmitters like serotonin that influence mood and the body’s response to stress.
Environmental Stress induced Panic Disorder
High stress levels and traumatic life events, like divorce, death of a loved one, childhood trauma, or military combat, can trigger the onset of panic disorder. Stress impacts the body’s stress response system, which may malfunction and cause changes in brain activity linked to panic attacks.
Biological Causes may result in Panic Disorder
Imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine that regulate emotions may play a role in panic disorder. Other biological factors like inflammation, dysregulated blood sugar levels, and abnormal activity in parts of the brain involved in fear and anxiety have also been implicated.
Smoking, Drugs, and Medical Conditions influences Panic Disorder
Using stimulant drugs and withdrawal from certain substances can prompt panic attacks. Underlying medical conditions like thyroid abnormalities, heart arrhythmias, respiratory issues, and vestibular problems have also been associated with panic attacks and disorder.
Symptoms of Panic Disorder
During an unexpected panic attack, a person experiences a combination of intense physical and emotional symptoms that peak within minutes. Attacks tend to be highly distressing but are not dangerous or life-threatening. However, the symptoms often mimic serious medical emergencies like a heart attack or seizure.
Common symptoms of a panic attack include:
- Pounding heart, racing pulse, palpitations
- Sweating, chills, hot flashes
- Trembling, shaking
- Shortness of breath, feeling smothered
- Dizziness, lightheadedness, vertigo
- Nausea, stomach cramping
- Numbness or tingling sensations
- Feelings of unreality, derealization
- Fear of losing control or going crazy
- Fear of dying
- Chest tightness or pain
- Choking sensation
Panic attacks typically reach peak intensity within 10 minutes and then begin subsiding. Most attacks end within 20 to 30 minutes. Frequency of attacks varies greatly, from a few per week to a few per month. Many people experience anticipatory anxiety and worry about when their next attack will strike.
Those with panic disorder may avoid places, situations, or behaviors where previous attacks occurred. They may also display other anxiety disorder symptoms like excessive phobias or compulsive rituals. Recurrent panic attacks frequently cause significant life impairment and increased suicide risk.
Since panic disorder has physical and mental symptoms, getting an accurate diagnosis often requires examinations by both medical and mental health professionals. Your doctor will want to rule out underlying physical causes that could be prompting recurrent panic attacks.
To receive a panic disorder diagnosis, you must have:
- Recurrent unexpected panic attacks
- Persistent concern or worry about future attacks
- Significant changes in behavior related to the attacks
The attacks cannot be due to substance use, medical conditions, or other disorders. Your doctor or mental health provider will perform a comprehensive evaluation involving:
- Physical exam and medical history review
- Discussion of your symptoms, daily functioning, thoughts, and behaviors
- Screening for conditions that mimic or co-occur with panic disorder
- Questionnaires to assess severity of panic disorder symptoms
Sometimes monitoring physiological symptoms during an attack helps with diagnosis. Common co-occurring conditions screened for include other anxiety disorders, depression, bipolar disorder, sleep disorders, PTSD, and substance abuse problems.
Panic disorder is highly treatable through a holistic approach addressing mind, body, and lifestyle factors. Cognitive behavioral therapy and anti-anxiety medications are effective first-line treatments. Relaxation practices, dietary changes, exercise, and stress management also help manage symptoms.
Cognitive behavioral therapy (CBT) helps people identify and change negative thought patterns and behaviors that fuel panic symptoms. Exposure therapy slowly exposes you to feared situations so you can build confidence in managing anxiety. Acceptance commitment therapy (ACT) focuses on acceptance rather than control of anxiety. Psychodynamic and family therapy can also provide insight into root causes.
Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines are often prescribed for panic disorder. SSRIs like Zoloft, Lexapro, Prozac, and Paxil regulate serotonin to control symptoms. Benzodiazepines like Klonopin provide rapid relief during acute attacks. Tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and beta blockers may also be effective.
Relaxation practices like deep breathing, meditation, yoga, tai chi, and progressive muscle relaxation inhibit the stress response. This calms the body and controls anxiety. Mindfulness-based practices help reduce reactivity to fearful thoughts and physical sensations. Regular relaxation sessions can help prevent panic episodes.
Eliminating stimulants like caffeine, alcohol, sugar, and refined carbs can stabilize blood sugar and energy levels to reduce anxiety and symptoms. Anti-inflammatory diets high in Omega-3s from fatty fish, veggies, and fruit may improve mood. Vitamin B, magnesium, and vitamin D supplements can also help balance brain chemistry.
Exercise and Lifestyle Routines
Regular cardio exercise boosts feel-good endorphins and neurotransmitters to relieve anxiety. Maintaining consistent sleep, meal, work, and socialization routines also minimizes symptoms. Limiting stress through tasks like journaling, deep breathing, and gratitude practice further dampens the stress response.
When to Seek Emergency Care
While incredibly frightening, panic attacks themselves are not physically harmful or dangerous in most cases. However, their symptoms often perfectly mimic life-threatening medical emergencies.
Seek immediate emergency care if your panic attack is accompanied by:
- Chest pain that radiates down the arm or up to the jaw
- Sudden severe headache
- Weakness or numbness on one side of the body
- Difficulty speaking
- Vision changes
- Loss of consciousness
These could indicate a serious medical issue like stroke or heart attack that requires urgent treatment. Call 911 or go to the nearest ER if you experience any of these symptoms along with chest pain during an intense panic attack.
Supporting a Loved One with Panic Disorder
If your friend or family member has panic disorder, you can provide invaluable social support by:
- Remaining patient, compassionate, and nonjudgmental
- Learning about the condition so you understand their experience
- Asking how you can best assist during and after attacks
- Helping identify and avoid triggers
- Practicing relaxation techniques together
- Going with them to therapy or doctor’s visits
- Encouraging but not forcing them to face fears
- Not taking their anxiety or avoidance personally
- Checking in regularly and monitoring for suicidal thoughts
- Taking care of your own mental health and setting boundaries when needed
With compassion, professional treatment, lifestyle changes, and social support, those living with panic disorder can take back control and rebuild fulfilling lives.
Panic disorder is a challenging condition, but various evidenced-based treatment approaches can effectively manage symptoms. Combining psychotherapy, medications as needed, lifestyle changes, relaxation practices, and social support allows those with panic disorder to minimize attacks and improve quality of life. Seeking help from both medical and mental health professionals is key for accurate diagnosis and customized treatment planning.