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Panic Disorder

Imagine you've just stepped into an elevator and suddenly your heart races, your chest aches, you break out in a cold sweat and feel as if the elevator is about to crash to the ground. What's happening?

Imagine you are driving home from the grocery store and suddenly things seem to be out of control. You feel hot flashes, things around you blur, you can't tell where you are, and you feel as if you're dying.

What's happening?


What's happening is a panic attack, an uncontrollable panic response to ordinary, nonthreatening situations. Panic attacks are often an indication that a person has panic disorder.


What is panic disorder?

A person who experiences four or more panic attacks in a four-week period is said to have panic disorder. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another panic attack.

Doctors often try to rule out every other possible alternative before diagnosing panic disorder. To be diagnosed as having panic disorder, a person must experience at least four of the following symptoms during a panic attack: sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of dying, losing control, or losing one's mind.

Panic attacks can occur in anyone. Chemical or hormonal imbalances, drugs or alcohol, stress, or other situational events can cause panic attacks, which are often mistaken for heart attacks, heart disease, or respiratory problems.

What are phobias?

Phobias are irrational, involuntary, and inappropriate fears of (or responses to) ordinary situations or things. People who have phobias can experience panic attacks when confronted with the situation or object about which they feel phobic. A category of symptoms called phobic disorder falls within the broader field of anxiety disorders.

Phobias are divided into three types:

Specific (simple) phobia: an unreasonable fear of specific circumstances or objects, such as traffic jams or snakes.

Social phobia: extreme fear of looking foolish or stupid or unacceptable in public that causes people to avoid public occasions or areas.

Agoraphobia: an intense fear of feeling trapped in a situation, especially in public places, combined with an overwhelming fear of having a panic attack in unfamiliar surroundings. This word means, literally (in Greek), "fear of the marketplace."

Phobias are usually chronic (long-term), distressing disorders that keep people from ordinary activities and places. They can lead to other serious problems, such as depression. In fact, at least half of those who suffer with phobias and panic disorders also have depression. Alcoholism, loss of productivity, secretiveness, and feelings of shame and low self-esteem also occur wit this illness. Some people are unable to go anywhere or do anything outside their homes without the help of others they trust.


What does it mean to "fear the fear"?

Many people with phobias or panic disorder "fear the fear," or worry about when the next attack is coming. The fear of more panic attacks can lead to a very limited life. People who have panic attacks often begin to avoid the things they think triggered the panic attack and then stop doing the things they used to do or the places they used to go.

Am I the only one?

It is estimated that 2 percent to 5 percent of Americans have panic disorder, so you are not alone if you, too have these symptoms. Usually panic disorder first strikes people in their early twenties. Severe stress, such as the death of a loved one, can bring on panic attacks.

A 1986 study by the National Institute of Mental Health showed that 5.1 percent to 12.5 percent of people surveyed had experienced phobias in the past six months. The study estimated that 24 million Americans will experience some phobias in their lifetimes.

Phobias are the leading psychiatric disorders among women of all ages. One survey showed that 4.9 percent of women and 1.8 percent of men have panic disorder, agoraphobia, or any other phobias.

What causes panic disorder?

No one really knows what causes panic disorder, but several ideas are being researched. Panic disorder seems to run in families, which suggests that it has at least some genetic basis. Some theories suggest that panic disorder is part of a more generalized anxiety in the people who have panic attacks or that severe separation anxiety can develop into panic disorder or phobias, most often agoraphobia.

Biological theories point to possible physical defects in a person's autonomic (or automatic) nervous system. General hypersensitivity in the nervous system, increased arousal, or a sudden chemical imbalance can trigger panic attacks. Caffeine, alcohol, and several other agents can also trigger these symptoms.

Researchers have found that sodium lactate, when injected into the bloodstream of some people who are predisposed to panic attacks, will induce such attacks. This suggests that people who experience panic attacks may have trouble metabolizing lactate, a substance usually produced by muscles during exercise.

Is panic disorder treatable?

Recovery from panic disorder appears to be most successful when a combination of treatments is used in fighting the disorder. Most often, medication is used to block panic attacks, and when it is used in combination with cognitive or behavioral therapy, it allows people to overcome their fears and return to normal, functional living.

On the other hand, even though 75 percent to 90 percent of the people treated have significant improvement, only about one-fourth of those who have this disorder ever seek appropriate treatment.

Cognitive therapy is used to help people think and behave appropriately. Patients learn to make the feared object or situation less threatening as they are exposed to, and slowly get used to, whatever is so frightening to them. Family members and friends help a great deal in this process when they are supportive and encouraging

Medication is most effective when it is used as part of an overall treatment plan that includes supportive therapy. Antidepressants and antianxiety medications are the most successful medications for this disorder, although beta blockers, which limit neuron activity in the brain, are helpful with social phobias. Ask your doctor about these medications or others that may help you.

Healthy living habits may also help people overcome panic disorder. Exercise, a proper and balanced diet, moderate use of caffeine and alcohol, and learning how to reduce stress are all important.

Peer support is a vital part of overcoming panic disorder. Family and friends can play a significant role in the treatment process and should be informed of the treatment plan and of the ways they can be most helpful.

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Resources
Anxiety Disorders Association of America 11900 Parklawn Drive, Suite 100, Rockville, MD 20852 phone: 301/231-9350 Web site: adaa.org
American Psychiatric Association 1400 K Street, N.W., Washington, DC 20005 phone: 202/ 682-6000 Web site: www.psych.org/public_info/panic.cfm
National Institute of Mental Health 6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD 20892-9663 phone: 301/443-4513 email: nimhinfo@nih.gov Web site: www.nimh.nih.gov/anxiety/anxiety/panic/index.htm
National Mental Health Association 1021 Prince Street, Alexandria, VA 22314-2971 phone: 703/684-7722 Web site: www.nmha.org/pbedu/anxiety/panic.cfm