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What is panic? What
is anxiety? And when is it a disorder?
The definition of Panic
Attacks is a discrete period in which there is the sudden onset of the
intense apprehension, fearfulness, or terror, often associated with feelings of
impending doom. During these
attacks, symptoms such as shortness of breath, palpitations, chest pain or
discomfort, choking or smothering sensations, and fear of "going
crazy" or losing control are present.
Anxiety Disorders, which are often associated with Panic Attacks, are
characterized by a severe increase in the level of stress or anxiety. This
increase can be related to the presence of particular events or items (triggers)
and can also exists without being prompted by any known triggers. Contrary to
the popular misconceptions about Anxiety Disorders today, Anxiety Disorder is
not a purely biochemical or medical disorder. Currently there are three main
schools of thought regarding the etiology of Anxiety Disorders: The Biological
Theory, (includes the genetic predisposition in panic disorder and presupposes a
chemical imbalance in the brain), The Psychodynamic Theory (looks at childhood
issues as being the cause), and the Behavioral Theory (sees the cause as learned
behavior, including our negative thought patterns).
Anxiety Disorders include the
following specific disorders: Anxiety Disorder with or without Agoraphobia,
Agoraphobia without History of Panic Disorder, Specific Phobia, Social Phobia,
Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress
Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due To a General
Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not
Otherwise Specified. Of this list there are five major Anxiety Disorders, which
are; Panic Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder,
Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder. Panic Attacks
and Agoraphobia, or "Avoidant Personality Disorder" are of the most
prevalent, occurring in the context of several of these disorders.
Description of
Categories and Types of Panic Attacks
Diagnostic And Statistical Manual
of Mental Disorders, 4th edition recognizes three different types of Panic
Attacks:
1) Un-cued (spontaneous) Panic Attacks (relates to Panic Disorder).
2) Cued (specific) Panic Attacks (relates to Social Anxiety Disorder,
Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder).
3) Situational predisposed Panic Attacks (may occur on exposure to the
situational cue or trigger, but do not necessarily occur immediately after the
exposure).
Panic Disorder is defined as the recurrent experience of "un-cued"
spontaneous panic attacks, which is often intensified by the resulting fear of
the next impending attack.
The fear itself of having a spontaneous panic attack often leads to Panic
Disorder. The spontaneous panic attack is generally NOT prompted by a
"trigger", and is now recognized as not being associated with specific
situations and places. The intensity of the attack can be extremely severe;
resulting in the feeling of having a heart attack along with intense feelings
that one is going to die.
Criteria for Panic Attack is
defined as a discrete period of intense fear or discomfort, in which 4 (or more)
of the following symptoms developed abruptly and reached a peak within 10
minutes.
List of symptoms are as follows:
- Palpitations, pounding
heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of
breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling Dizzy, unsteady
lightheaded, or faint
- De-realization (feelings of
unreality) or
depersonalization (being detached from oneself)
- Fear of losing control or
going crazy
- Fear of dying
- Parenthesis (numbness or
tingling sensations)
- Chills or hot flashes
Attacks that have
fewer than 4 symptoms are referred to as "limited symptom attacks".
Panic Attacks
suddenly overtake the person with a sense of imminent doom, death or
destruction. They normally strike outside the home, and the person feels they
are in a life-threatening situation from which escape is necessary. This
life-threatening situation may be medical (heart attack) or natural
(earthquake) or an act of war (a nuclear explosion). Although the timing of
the Panic Attacks is unpredictable, there may be situational stressors that
set them off on a regular basis. These are called situational panic attacks.
Situational Panic Attacks are indicative of social and specific phobias. Panic
Attacks that appear without any specific cues are more likely to be indicative
of Panic Disorder. Panic Disorder is defined as having recurrent panic attacks
with no situational key, and persistent worry about future attacks, change in
behavior related to the attacks, or a worry about the implication of the
attacks. There is also the possibility of having Panic Disorder with
Agoraphobia, which means that the client has a fear of being in places from
which escape is difficult, and situations such as travel are restricted. Panic
Attacks affect 2.6% of people over their lifetime, with 2 - 3 times more women
than men, and it is most common between the ages of 16 and 40. It may be
genetically bound, as there is a 20% risk of having Panic Attacks if a 1st
degree relative has panic attacks. Physically, the heart begins to pound, the
victim may scream. Most feel as if they are not getting enough air and gasp,
hyperventilate, feel dizzy and lightheaded. Most attacks last 3 to 10 minutes,
with 30 minutes being the general longest they may last. Each person will have
their own set of symptoms, and they usually remain the same. Additionally,
depression affects up to 50% of those with Panic Attacks. Panic Attacks are
caused by a number of different items in the environment: drugs, caffeine, and
postpartum period. Caffeine can cause Panic Attacks, as does marijuana,
cocaine, and amphetamines. Women with thyroid disorder may experience their
first panic attack in the immediate postpartum period after delivering a
child. Treatment of Panic Attacks is through psychosocial treatment and
explanation of how the attacks occur, and reassurance that the attacks are not
life threatening, and not a precursor to insanity. Pharmacologically, some
antidepressants can be utilized, such as Tofranil and Prozac for long-term
treatment, and Benzodiazepines such as Xanax and Ativan for short-term use in
acute attacks.
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attacks utilizing Clinical Hypnotherapy.
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