Panic Disorder & Attacks
Panic disorder is a psychiatric or anxiety disorder characterized by recurring, sudden panic attacks or even fear attacks. Having feelings of anxiety happens to everyone. But experiencing these feelings regularly without a clear reason often points to panic disorder (1). Symptoms of panic disorder include:
● Sudden and repeated panic attacks
● A fear of being out of control
● A fear of death during a panic attack
● An avoidance of places where panic attacks have occurred in the past (2)
Panic attacks can feel scary at times, but they are not actually dangerous, and it is unlikely to be admitted to a hospital after one. They usually last from 5-20 minutes, but a few have been reported as lasting up to an hour (1). Panic attacks often include intense physical and mental symptoms such as:
● Trembling
● Quickening of the heart rate (2)
● Nausea
● Choking sensations
● Feeling disconnected from the body
● Dry mouth
● Numbness (1)
Symptoms of panic attacks can mimic or act like symptoms of other health-related problems. This can lead to issues in people’s job performance, morale, and effectiveness in the workplace, as demonstrated by a study conducted with a sample of nurses who suffer from panic disorder (3). Panic disorder can sometimes run in families as a hereditary trait. Researchers have found that parts of the brain may play important roles in panic attacks. Panic attacks are likely the body’s “false alarm,” in which the body’s survival instincts are too active, leading to heightened fear or anxiety and panic attacks (2).
The exact cause of panic disorder is not fully understood yet. It is thought to be linked to things such as:
● A traumatic or stressful life experience
● Having a close family member with panic disorder
● An imbalance of neurotransmitters (chemical messengers) in the brain (1)
The science behind panic disorder is extremely complex. It contains aspects of acute fear, chronic anxiety, interoceptive sensation sensitivity (the self-perceived ability to sense internal physical sensations), and, in 30-50% of cases, agoraphobia (5). The shape of the amygdala in the brain, which is responsible for emotional responses in situations involving fear, anxiety, and rage, plays a relevant role in amygdala functioning in panic disorder.
Studies have found that the amygdala tends to be hyperactive in panic disorder in response to provocative stimuli, such as threats and challenges (5).
If severe panic disorder is left untreated, an individual can become more at risk for developing other mental health conditions, such as phobias or alcohol or drug problems.
Over the last 50 years, agoraphobia, or a syndrome where people avoid places or situations in which they fear feelings of embarrassment or being unable to escape, has been closely linked to panic disorder as a typical development or complication (4). Agoraphobia is highly prevalent with panic disorder in patients, but the conditions are often underrecognized and undertreated.
Treatment usually involves psychotherapy, medication, or both. The correct treatment path depends on the individual’s situation and a medical provider consultation. Cognitive behavioral therapy is commonly used to treat panic disorder. CBT teaches the person different ways of thinking, behaving, and reacting. Panic attacks can become much less frequent if a person learns to react differently to the feelings of anxiety and fear during a panic attack (2). Exposure therapy is a CBT method that focuses more on confronting the fears associated with panic disorder symptoms. Studies have found this method to be as effective in reducing panic symptoms as cognitive restructuring (6).
Antidepressant medication has proven to be effective in preventing panic attacks, especially since one of the major causes of these attacks is anxiety. High-potency benzodiazepines have also shown a rapid onset of anti-anxiety effect, making them effective and useful options for
short-term treatment to avoid or prevent panic attacks (4). Anti-epilepsy medication can also treat anxiety, but usually takes up to 8 weeks to work fully (1).
References
1. NHS. Panic disorder [Internet]. nhs.uk. NHS; 2021. Available from:
2. National Institute of Mental Health. Panic Disorder: When Fear Overwhelms [Internet]. National Institute of Mental Health. 2022. Available from:
https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms 3. Tompkins O. Panic Attacks. AAOHN Journal. 2010 Jun 1;58(6):268–8. 4. Perugi G, Frare F, Toni C. Diagnosis and Treatment of Agoraphobia with Panic Disorder. CNS Drugs. 2007;21(9):741–64.
5. Goddard AW. The neurobiology of panic: A chronic stress disorder. Chronic Stress. 2017 Jan;1(1):247054701773603.
6. Meuret AE, Wolitzky-Taylor KB, Twohig MP, Craske MG. Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. Behavior Therapy [Internet]. 2012 Jun;43(2):271–84. Available from:
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