Panic Attacks and Panic Disorder
Panic is acute, short-lived, extreme anxiety with accompanying physical symptoms.
Panic attacks may occur in any anxiety disorder, usually in response to a specific situation tied to the main characteristic of the disorder. For example, a person with a phobia of snakes may panic when encountering a snake. However, these situational panic attacks differ from the spontaneous, unprovoked ones that define a person's problem as panic disorder.
Panic attacks are common, occurring in more than one third of adults each year. Women are 2 to 3 times more likely than men to have panic attacks and panic disorder. Most people recover from panic attacks without treatment; a few develop panic disorder. Panic disorder is present in 2% of the population during any 12-month period. Panic disorder usually begins in late adolescence or early adulthood.
A panic attack involves the sudden appearance of at least four of the following symptoms:
- Chest pain or discomfort
- Choking
- Dizziness, unsteadiness, or faintness
- Fear of dying
- Fear of "going crazy" or of losing control
- Feelings of unreality, strangeness, or detachment from the environment
- Flushes or chills
- Nausea, stomachache, or diarrhea
- Numbness or tingling sensations
- Palpitations or accelerated heart rate
- Shortness of breath or sense of being smothered
- Sweating
- Trembling or shaking.
Symptoms peak within 10 minutes and usually dissipate within minutes, leaving little for a doctor to observe except the person's fear of another terrifying attack. Since panic attacks sometimes are unexpected or occur for no apparent reason, especially when people experience them as part of panic disorder, people who have them frequently anticipate and worry about another attack--a condition called anticipatory anxiety--and try to avoid places where they have previously panicked.
Because symptoms of a panic attack involve many vital organs, people often worry that they have a dangerous medical problem involving the heart, lungs, or brain and seek help from a doctor or hospital emergency department. However, the correct diagnosis may not be made, leading to the additional worry that the medical problem is going untreated. Although panic attacks are uncomfortable--at times extremely so--they are not dangerous.
A diagnosis of panic disorder is made when a person experiences at least two unprovoked and unexpected panic attacks, which are followed by at least 1 month of fear that another attack will occur. The frequency of attacks can vary greatly; some people have weekly or even daily attacks that occur for months, whereas others have several daily attacks followed by weeks or months of remission.
Treatment
People who experience panic attacks as part of an anxiety disorder other than panic disorder and some people with panic disorder who have recurring panic attacks, anticipatory anxiety, and avoidance recover without formal treatment. For others, panic disorder follows a waxing and waning course over years.
People with panic disorder are more receptive to treatment if they understand that the disorder involves both physical and psychologic processes and that treatment must address both. Drug therapy and behavior therapy can generally control the symptoms.
Drugs that are used to treat panic disorder include antidepressants and antianxiety drugs such as benzodiazepines. Most types of antidepressants--tricyclics, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs)--are effective (see Section 7, Chapter 101). Benzodiazepines work faster than antidepressants but can cause drug dependence (see Section 7, Chapter 108) and are probably more likely to cause sleepiness, impaired coordination, and slowed reaction time. SSRIs are preferred to other antidepressants and benzodiazepines because they are equally effective but have fewer side effects, especially considerably less sleepiness, and do not cause drug dependence.
When a drug is effective, it prevents or greatly reduces the number of panic attacks. A drug may have to be taken for a long time, because panic attacks often return once the drug is discontinued.
Exposure therapy, a type of behavior therapy in which the person is exposed repeatedly to whatever triggers a panic attack, often helps to diminish the fear. Exposure therapy is practiced until the person develops a high level of comfort with the anxiety-provoking situation. In addition, people who are afraid that they will faint during a panic attack can practice an exercise in which they spin in a chair or breathe quickly (hyperventilate) until they feel faint. This exercise teaches them that they will not actually faint during a panic attack. Practicing slow, shallow breathing (respiratory control) helps many people who tend to hyperventilate.
Supportive psychotherapy, which includes education and counseling, is beneficial because a therapist can provide general information about the disorder, its treatment, realistic hope for improvement, and the support that comes from a trusting relationship with a doctor.
 See the sidebar What Is Exposure Therapy?
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