HEALTH WATCH
A panic attack is a sudden, intense experience of fear coupled with an overwhelming feeling of danger, accompanied by physical symptoms of anxiety, such as a pounding heart, sweating, and rapid breathing. A person with panic disorder may have repeated panic attacks (at least several a month) and feel severe anxiety about having another attack. While many people experience moments of anxiety, panic attacks are sudden and unprovoked, having little to do with real danger.
Panic disorder is a chronic, debilitating condition that can have a devastating impact on a person’s family, work, and social life. Typically, the first attack strikes without warning. A person might be walking down the street, driving a car, or riding an escalator when suddenly panic strikes. Pounding heart, sweating palms, and an overwhelming feeling of impending doom are common features. While the attack may last only seconds or minutes, the experience can be profoundly disturbing. A person who has had one panic attack typically worries that another one may occur at any time.
As the fear of future panic attacks deepens, the person begins to avoid situations in which panic occurred in the past. In severe cases of panic disorder, the victim refuses to leave the house for fear of having a panic attack. This fear of being in exposed places is often called agoraphobia. People with untreated panic disorder may have problems getting to work or staying on the job. As the person’s world narrows, untreated panic disorder can lead to depression, substance abuse, and in rare instances, suicide.
Causes and symptoms
Scientists are not sure what causes panic disorder, but they suspect the tendency to develop the condition can be inherited. Some experts think that people with panic disorder may have a hypersensitive nervous system that unnecessarily responds to nonexistent threats. Research suggests that people with panic disorder may not be able to make proper use of their body’s normal stress-reducing chemicals.
People with panic disorder usually have their first panic attack in their 20s. Four or more of the following symptoms during panic attacks would indicate panic disorder if no medical, drug-related, neurologic, or other psychiatric disorder is found:
- Pounding, skipping or palpitating heartbeat.
- Shortness of breath or the sensation of smothering.
- Chest pains or pressure.
- Choking sensation or a ‘lump in the throat’.
- Fear of dying.
- Feelings of unreality or being detached.
- Shaking and trembling.
- Fear of losing control or going crazy.
A panic attack is often accompanied by the urge to escape, together with a feeling of certainty that death is imminent. Others are convinced they are about to have a heart attack, suffocate, lose control, or “go crazy.” Once people experience a panic attack, they tend to worry so much about having another attack that they avoid the place or situation associated with the original episode.
Diagnosis
Because its physical symptoms are easily confused with other conditions, panic disorder often goes undiagnosed. A thorough physical examination is needed to rule out a medical condition. Because the physical symptoms are so pronounced and frightening, panic attacks can be mistaken for a heart problem. Some people experiencing a panic attack go to an emergency room and endure batteries of tests until a diagnosis is made.
Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic attack and panic disorder, taking into account not just the actual episodes, but how the patient feels about the attacks, and how they affect everyday life.
Most health insurance policies include some limited amount of mental health coverage, although few completely cover outpatient mental health care.
Treatment
Most patients with panic disorder respond best to a combination of cognitive-behavioral therapy and medication. Cognitive-behavioral therapy usually runs from 12–15 sessions. It teaches patients:
- How to identify and alter thought patterns so as not to misconstrue bodily sensations, events, or situations as catastrophic,
- How to prepare for the situations and physical symptoms that trigger a panic attack,
- How to identify and change unrealistic self-talk (such as “I’m going to die!”) that can worsen a panic attack,
- How to calm down and learn breathing exercises to counteract the physical symptoms of panic,
- How to gradually confront the frightening situation step by step until it becomes less terrifying,
- How to “desensitize” themselves to their own physical sensations, such as rapid heart rate. At the same time, many people find that medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. People with panic disorder usually notice whether or not the drug is effective within two months, but most people take medication for at least six months to a year. Several kinds of drugs can reduce or prevent panic attacks.
Alternative treatment
One approach used in several medical centers focuses on teaching patients how to accept their fear instead of dreading it. In this method, the therapist repeatedly stimulates a person’s body sensations (such as a pounding heartbeat) that can trigger fear. Eventually, the patient gets used to these sensations and learns not to be afraid of them. Patients who respond report almost complete absence of panic attacks. A variety of other atlernative therapies may be helpful in treating panic attacks. Neurolinguistic programming and hypnotherapy can be beneificial, since these techniques can help bring an awareness of the root cause of the attacks to the conscious mind.
Prognosis
While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very well to treatment; panic attacks decrease in up to 90% of people after 6-8 weeks of a combination of cognitive-behavioral therapy and medication. Unfortunately, many people with panic disorder never get the help they need. If untreated, panic disorder can last for years and may become so severe that a normal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, and jobs.
(Author is a registered medical practitioner and health columnist. Feedback:[email protected])
