1. What is Panic Disorder?
Panic Disorder is a type of anxiety disorder characterized by recurrent, unexpected panic attacks—intense surges of fear or discomfort that peak within minutes. Unlike GAD (chronic worry), panic disorder involves sudden, acute episodes followed by persistent fear of future attacks.
Key Features (DSM-5 Criteria)
- Recurrent unexpected panic attacks (not triggered by specific situations).
- At least one month of:
- Persistent concern about additional attacks.
- Significant maladaptive behavior (e.g., avoiding places where attacks occurred).
- Not caused by substances, medical conditions, or another mental disorder.
2. Symptoms of a Panic Attack
Panic attacks involve a combination of physical and cognitive symptoms, including:
Physical Symptoms
- Heart palpitations or racing heart
- Shortness of breath or hyperventilation
- Chest pain (often mistaken for a heart attack)
- Trembling or shaking
- Sweating or chills
- Dizziness or lightheadedness
- Nausea or stomach distress
- Numbness/tingling (paresthesia)
Cognitive & Emotional Symptoms
- Fear of losing control or “going crazy”
- Derealization (feeling detached from reality)
- Fear of dying (common during first attacks)
- Overwhelming urge to escape
Note: A panic attack typically peaks within 10 minutes and subsides within 20-30 minutes.
3. Causes & Risk Factors
A. Biological Factors
- Neurochemical imbalance (low serotonin, high norepinephrine, GABA dysfunction).
- Overactive amygdala (brain’s fear center).
- Genetic predisposition (family history of anxiety/panic disorders).
B. Psychological & Environmental Factors
- Major life stress (divorce, job loss, trauma).
- History of childhood anxiety or abuse.
- Hypervigilance to bodily sensations (misinterpreting normal changes as danger).
C. Triggers
- Caffeine, alcohol, or stimulant use.
- Hyperventilation (can induce panic-like symptoms).
- Situational avoidance (phobias, agoraphobia).
4. Diagnosis Process
A mental health professional (psychiatrist, psychologist) diagnoses panic disorder through:
A. Clinical Interview
- Frequency, intensity, and duration of panic attacks.
- Agoraphobia assessment (fear of places where escape might be hard).
- Rule out medical conditions (e.g., heart problems, thyroid issues).
B. Psychological Assessments
- Panic Disorder Severity Scale (PDSS).
- Anxiety Sensitivity Index (ASI).
C. Medical Evaluation
- EKG (to rule out heart conditions).
- Blood tests (thyroid, hypoglycemia, drug screening).
5. Treatment Options
A. Psychotherapy (First-Line Treatment)
- Cognitive Behavioral Therapy (CBT)
- Exposure therapy: Gradual exposure to feared sensations (e.g., rapid heartbeat) to reduce fear.
- Cognitive restructuring: Challenges catastrophic thoughts (“I’m having a heart attack”).
- Panic-Focused Psychodynamic Psychotherapy (PFPP)
- Explores unconscious emotional triggers.
B. Medications
| Medication Type | Examples | Notes |
|---|---|---|
| SSRIs | Sertraline (Zoloft), Paroxetine (Paxil) | First-line, takes 4-6 weeks to work |
| SNRIs | Venlafaxine (Effexor) | Also helps with depression |
| Benzodiazepines | Alprazolam (Xanax), Clonazepam (Klonopin) | Short-term use only (high addiction risk) |
| Beta-Blockers | Propranolol | Reduces physical symptoms (shaking, fast heart rate) |
C. Lifestyle & Self-Help Strategies
- Breathing techniques (diaphragmatic breathing to prevent hyperventilation).
- Regular exercise (reduces overall anxiety).
- Avoid caffeine, alcohol, and nicotine (can trigger attacks).
- Mindfulness/meditation (helps manage anticipatory anxiety).
6. Complications if Untreated
- Agoraphobia (fear of leaving home due to panic attacks).
- Depression (high comorbidity).
- Substance abuse (self-medicating with alcohol/sedatives).
- Social & occupational impairment (avoiding work, relationships).
7. When to Seek Help
- If panic attacks are frequent and distressing.
- If you start avoiding places or activities due to fear of attacks.
- If symptoms mimic heart problems (chest pain, palpitations)—rule out medical causes first.
Early treatment (CBT + medication) has a high success rate (~80% improvement).
Final Thoughts
Panic disorder is highly treatable with therapy and/or medication. If you experience recurrent panic attacks, consult a mental health professional—effective help is available.