Panic Disorder
Development and Course of Panic Disorder
Summary
- Panic attacks can happen to anyone.
- The fear of having another panic attack can be very intense.
- Panic disorder responds well to treatment.
Who is at risk?
Panic attacks can happen to anyone. They often start in the late teen and young adult years. For reasons not known, women are twice as likely to have them as men. Hormonal imbalances and genetics may play a part. There may be an overstimulation in the brain area that processes fear and anxiety. Alcohol, caffeine, and other drugs can cause attacks. Stress and lack of sleep may also be factors.
People with severe physical health issues appear to be at greater risk of panic attacks. The same is true for those with other mental health issues, such as depression. Having just one or two attacks does not mean a person has panic disorder. Panic disorder involves having recurring attacks, as well as a fear of having more.
Progression of panic attacks
Perhaps the scariest thing about panic attacks is that they seem to appear out of nowhere. Without any warning, a person can be struck with a nearly overwhelming terror. A sudden, racing heartbeat and gasping for breath can make the person feel like he is dying. The attack comes on quickly and in waves. There may be dizziness, sweating, chills, nausea, shaking, or numbness. The person may feel like he is choking or losing control.
A panic attack often lasts no longer than 10 minutes. Still, a person may feel nervous for many hours after an attack. The person may also develop a disabling fear of having the next attack.
Living in fear
The fear of having another attack can be strong. In some cases, it may be bad enough to start an attack. People with panic disorder will often stay away from places or situations where prior attacks occurred. This can cause problems at work, school, or other social settings. If left untreated, certain phobias may develop, such as the fear of flying or driving. Some people may even develop agoraphobia. This is a great fear of situations where the person might feel trapped. This can include being in crowds or lines, open or enclosed spaces, or using public transit. The person may avoid such settings for fear of having a panic attack. People with this issue are often afraid to leave their own home by themselves.
Getting help
Over the course of time, panic attack symptoms may get better or worsen. The first few times a person has a panic attack she might go to the emergency room. She is certain that something must be physically wrong with her. When nothing is found, she is quite surprised and frustrated. She may go from doctor to doctor, trying to find some medical reason for it. She may start to think she is losing her mind. She may start to withdraw from friends and loved ones. The fear and shame she feels can keep her from seeking care. She may turn to alcohol or drugs as a way of self-medicating. This will make matters worse. She can become sad and start having thoughts of suicide.
For some, one of the complications of panic disorder is depression. Symptoms may include changes in appetite, sleep, inability to enjoy activities previously enjoyed, lasting low mood or sadness, decreased energy, or thoughts of suicide. If a person gets help for depression, it is vital to tell the doctor about the panic attacks. Depression that follows or co-exists with panic disorder may help the doctor decide which drug or drugs may aid both issues at the same time. For example, some antidepressants are more helpful for panic attacks than other antidepressants as well as treating depression.
It is important to seek help as soon as possible. If a person thinks she is having attacks, she should talk to her doctor or have someone she trusts set up a visit for her. Panic disorder can be treated with talk therapy, medications, or both. Some people will do better on one versus the other. Sometimes a blend of the two works best. Don’t lose hope. Panic disorder responds well to treatment, and full recovery is possible.
Resources
American Psychological Association
National Alliance on Mental Illness
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8; National Alliance on Mental Illness, www.nami.org
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options
Helping a Loved One or Friend Get Through a Panic Attack
Summary
- Stay with the person.
- Use a distraction.
- Help the person to calm down.
A panic attack can be a very scary experience. This can be true not only for the person having the attack but also for bystanders. It can be especially difficult if it is happening to someone you know and love. You feel helpless. Yet, there are certain things you can do.
First things first
The first thing is to be sure it is a panic attack and not something else. Panic attack signs are very close to those of a heart attack, stroke, or respiratory issue. If you are not sure, call 911. Even if it is a panic attack, the operator can assist you.
Recognize the signs
It is helpful if you know the signs of a panic attack. This will put you in a better position to be supportive. In addition to extreme fear, panic attacks can produce any of the following symptoms:
- Racing or pounding heartbeat
- Trouble breathing
- Choking feeling
- Chest pains
- Dizziness
- Sweating
- Shaking or trembling
- Nausea
- Urge to have a bowel movement
- Hot flashes or chills
- Numbness or tingling
- “Out of body” feeling
- Feeling of losing control
- Feeling of dying
Stay with the person
A person having a panic attack will be afraid. Therefore, you should not leave the person alone. Reassure her that you are there to help in any way you can. Ask her if there is anything you can do to help her get through it.
Help the person to calm down
One thing you can do to help her relax is to take deep breaths with her. Count slowly to three as you both breathe in and out. Help her to visualize a peaceful scene like a beach or a waterfall. Do not tell her to simply calm down or to “snap out of it.” She is probably well aware that the fear she is feeling is not rational. Asking her to stop will only add more pressure and anxiety. Remember, your job is to help her get through it, not over it.
Use a distraction
Sometimes it is helpful to distract the person. Remind her of a fun time you had together. Share a pleasant memory of eating at a favorite restaurant or seeing a funny movie. Show her silly pictures on your phone. Softly sing the words to a familiar song. Whatever you try, make sure it is distracting without being overwhelming.
After the attack
Panic attacks come on quickly and generally go away within about 10 minutes. On rare occasions, they may last for up to an hour. Panic attacks are marked by an intense fear. This fear can be so great that it lingers for several hours after an attack. For this reason, it is a good idea to remain with the person until the fear totally subsides. It may be helpful to follow up with the person later that day or the next day to see how she is feeling.
Help the person to get help
Some people will have only one or two panic attacks in their lifetime and no more. Others will have recurrent attacks. Those who have repeated attacks and are afraid of having more should consider seeking treatment.
A mental health doctor or licensed therapist can determine if they have panic disorder. People with this disorder respond very well to treatment. However, your friend or loved one may be too afraid or ashamed to get help.
This is where you can show your support. Offer to call a doctor and set up an appointment for the person. Then offer to drive and stay with the person during the appointment. Make it known that you will be there to support her through the recovery process.
Resources
National Health Service United Kingdom
National Institute of Mental Health
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Health Service United Kingdom, www.nhs.uk/Conditions/Panic-disorder/Pages/self%20help.aspx; National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options
How Do I Know If I Have Panic Disorder?
Summary
- Panic attacks can happen to anyone, anywhere.
- Seek help if you are afraid of having another attack.
- Panic disorder responds very well to treatment.
You don’t know what just happened. All of a sudden, your heart was pounding and you could hardly breathe. Your body started to sweat and shake. The pain in your chest made you think you were having a heart attack. It scared you and, in fact, you thought you were about to die!
By the time you reach the emergency room, though, your symptoms have subsided. You feel relieved but also confused. Your heart is no longer racing but your mind is. What was that? What is the matter with you? After a lot of questions and tests, the results come back. The doctor can find no physical reason for the attack. Now you are really confused, and scared.
You may have had a panic attack. Panic attacks can happen to anyone, anywhere. They can strike without warning and for no apparent reason. They are very similar to a person’s natural “fight-or-flight” response to danger. The difference is panic attacks can occur even when there is no threat of danger.
Symptoms of panic attacks
Panic attacks come on quickly and generally subside within about 10 minutes. On rare occasions, they may last for up to an hour. Panic attacks are marked by an intense fear. This fear can be so great that it lingers for several hours after an attack. In addition to extreme fear, panic attacks can produce any of the following symptoms:
- Racing or pounding heartbeat
- Trouble breathing
- Choking feeling
- Chest pains
- Dizziness
- Sweating
- Shaking or trembling
- Nausea
- Urge to have a bowel movement
- Hot flashes or chills
- Numbness or tingling
- “Out of body” feeling
- Feeling of losing control
- Feeling of dying
Panic attack symptoms can be similar to those of heart attacks or respiratory issues. For this reason, a person should be tested to rule out these or other medical conditions. Sometimes a person will have to see several different doctors before being properly diagnosed.
Having one panic attack does not mean you have panic disorder. Many people will have one or two attacks in their lives and no more. People with panic disorder have recurring panic attacks and often live in fear of the next one.
The fear of fear
As scary as panic attacks are, they are not considered dangerous. The greater danger is from the overwhelming fear they can create. You might become convinced that you have a serious physical illness. You may go from doctor to doctor, trying to find a medical explanation. The fear can be so restricting it prevents you from leading a normal life. You may start to avoid places or situations where you had an attack. You may start to withdraw from friends and loved ones. You may stop doing many of the things you used to enjoy.
If left untreated, you can start to develop certain phobias. You might become afraid to go the grocery store or to drive or to fly, for instance. You may develop a condition known as agoraphobia. This is an extreme fear of situations where the person might feel trapped. This can include being in crowds or lines, open or enclosed spaces, or using public transportation. The person will avoid such settings for fear of having a panic attack. In some cases, people are afraid to leave their own home.
Ending the fear
If you have had panic attacks and are fearful of having another, please consider seeking treatment. A mental health doctor or licensed therapist can determine if you have panic disorder. People with this disorder respond very well to treatment. There is no reason to feel ashamed or to live in fear any longer. Recovery is possible.
Resource
American Psychological Association
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8; National Alliance on Mental Illness; Diagnostic and Statistical Manual of Mental Disorders-V, www.dsm5.org/Research/Documents/Craske_PD%20Review.pdf; National Institutes of Health, www.ncbi.nlm.nih.gov/pubmed/15893248
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options
Panic Disorder: Treatment
Summary
- It can be treated with talk therapy, drugs, or both.
- It responds very well to treatment.
- Avoid using alcohol, caffeine, sugar, and nicotine.
Panic attacks are scary. They may make you feel like you are losing control or dying. It is no wonder that the fear of having another one can be disabling. You may have started to withdraw from certain people and places. You may have begun to avoid the places and settings where you had prior attacks. Over the course of time, panic attack symptoms may improve or get worse. The good news is that there is no need to keep living in fear. Panic disorder responds well to treatment.
Panic disorder can be treated with talk therapy, medications, or both. These two types of treatment have about the same level of success. Some people will do better with one versus the other. Sometimes a combination of the two works best. It is important that you seek help right away. If you put off treatment it can lead to phobias. Talk to your doctor or have someone you trust set up a visit for you.
Talk therapy
Cognitive-behavioral therapy (CBT) can help change the way a person thinks, feels, and responds. A type of CBT modified to treat panic disorder has been proven to be useful. A person is shown how fear relates to panic attack symptoms. The person is also taught how to spot triggers and lessen their effects.
Exposure therapy recreates some of the symptoms of a panic attack in a controlled setting. This teaches the person how to stay in control during an attack. This can be useful in easing the impact of these symptoms.
Other methods can be used to help a person be more relaxed during an attack. These include learning how to slow down breathing and using positive thinking. Some people find that taking yoga classes or massage therapy can also be helpful.
Medicine
Your doctor may want to use medications to help treat your panic disorder. This will usually be an antidepressant or anti-anxiety drug. Celexa®, Paxil®, Prozac®, Lexapro®, and Zoloft® are commonly given. These drugs may take a number of weeks before they start working. They can be helpful but may cause certain side effects, such as nausea or headaches. They can also cause you to have trouble sleeping. A person who is starting these drugs should be watched closely. Young people may have an increased risk of suicidal thoughts while taking these pills.
Benzodiazepines, such as Ativan and Xanax, may also be prescribed. These drugs start working quickly but are not meant for long-term use. They can be habit forming, and it may be hard to stop taking them after a while.
Other treatment
Along with pills and talk therapy, there are other ways to help treat panic disorder. These include getting proper rest, exercising, and eating well. Reducing the use of alcohol, caffeine, sugar, and nicotine can also be helpful. Learning how to better handle stress can be useful. A Wellness Recovery Action Plan® (WRAP®) may be helpful as well. WRAP involves listing your own support tools and then using them to make action plans to use in stressful times.
Perhaps most important in treating panic disorder is to not do it alone. You need guidance from a licensed therapist or mental health doctor familiar with panic disorder. Joining a support group of other people with the disorder can be helpful. You will also need the support of family and friends. There is no need to live in fear or shame. Panic disorder responds well to proper treatment and full recovery is possible.
Resources
American Psychological Association
National Alliance on Mental Illness
Wellness Recovery Action Plan® (WRAP®)
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8; National Alliance on Mental Illness, www.nami.org
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options
Panic Disorder: What Is It?
Summary
- A type of anxiety disorder
- Involves panic attacks and great fear
- Is highly treatable
Panic disorder is a type of anxiety disorder. It is common and can be severe and disabling. It most often first starts in the teen and young adult years. It affects twice as many women as men, but it is not known why. Panic disorder is marked by repeated and unexpected anxiety attacks and the fear of having the next one. Avoiding places, activities, and situations that triggered a panic attack are also an important aspect it.
Panic attacks
A panic attack is a sudden, overwhelming feeling of fear, doom, and, at times, a sense that death may be about to happen. It can happen to anyone at any time. It can occur anywhere and without warning. It is often accompanied by physical symptoms that can mimic the symptoms of a major health issue. A panic attack may cause a person to have a rapid heartbeat and shortness of breath. There may also be dizziness, sweating, numbness and tingling in the hands, nausea, and chest pains. It is often thought to be a heart attack. The person may feel like he is losing control or dying.
Kinds of panic attacks
Panic attacks can happen in two ways. The term expected refers to an awareness of some sort of cause. The attack could be due to a stressful event or substance use, for instance. These types of attacks are more common with phobias or other disorders, such as claustrophobia or social anxiety disorder.
An unexpected attack seems to come out of nowhere and for no clear reason. It is not a response to any danger. It can occur in any setting and for no real reason.
Panic disorder and agoraphobia
Having a panic attack does not mean a person has panic disorder. A person with the disorder has had many attacks and fears the next one. This may cause the person to avoid places or situations where a prior attack occurred. If left untreated, this fear can lead to agoraphobia. This is a fear of places where the person might feel trapped by an oncoming attack. This can include being in crowds or lines, open or enclosed spaces, or using public transportation. The person will avoid such settings. People with this phobia are often afraid to drive or to leave home.
Causes
The causes of panic attacks and panic disorder are not fully known. Sometimes it is genetic. There may be an over stimulation in the areas of the brain that process worry and fear. Stressful events in life, such as those involving separation or loss, can be factors. Alcohol, caffeine, and other drugs can cause attacks. Having other mental or physical health issues can raise the risks. Sometimes just the fear of having another attack is great enough to cause one.
Recovery
Panic attacks are scary. They can cause a person to live in fear and shame. The thought of having another attack can be restrictive and even lead to clinical depression.
People with panic disorder respond well to treatment. This may be in the form of talk therapy or medications or both. The key is to not try to fight the illness by yourself. If you think you might have panic disorder, ask your doctor. Over time and with the proper help, the outlook for full recovery is very good.
Resources
American Psychological Association
National Alliance on Mental Illness
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8; National Alliance on Mental Illness, www.nami.org; Diagnostic and Statistical Manual of Mental Disorders-V, www.dsm5.org/Research/Documents/Craske_PD%20Review.pdf
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options
What You Can Do When You Are Having a Panic Attack
Summary
- Stay put and wait it out.
- Take deep breaths.
- Think positive.
What you can do right now
If this is the first time you have had a panic attack and you are unaware of the symptoms, the safest course of action may be to call 911. The operator will be able to talk you through the attack and help you calm down. This is also a good idea in the event that something else is causing your symptoms.
Stay put
If you are having a panic attack you should try to stay put. If you are driving, you will want to safely pull over first. Otherwise, you should stay right where you are and wait it out. Trying to rush to get help will only add to your anxiety.
Take deep breaths
Try to slow down your breathing by taking deep breaths. Slowly count to three as you breathe in and as you breathe out. This might calm you down and help keep you from having a full-blown attack.
Think positive
Try not to focus on the attack. Instead, focus on a positive, peaceful image, such as a beach or a waterfall. Don’t try to fight the attack. This will only lead to more anxiety. If possible, try to reassure yourself that you are not in any real danger and that the attack will soon pass. Distract your mind by counting to yourself or watching the seconds tick on your watch.
What you can do before the next attack
Whether it’s your first or fifth panic attack, it can be very scary. One of the main reasons is because there seems to be no reasoning behind it. You are not in any danger. The panic you are feeling could make no logical sense. The attack may seem to come out of nowhere. There are things you can do that will be helpful.
One thing that can help you is to know the symptoms before your next attack.
Recognize the symptoms
Panic attacks come on quickly and generally subside within about 10 minutes. On rare occasions, they may last for up to an hour. Panic attacks are marked by an intense fear. This fear can be so great that it lingers for several hours after an attack. In addition to extreme fear, panic attacks can produce any of the following symptoms:
- Racing or pounding heartbeat
- Trouble breathing
- Choking feeling
- Chest pains
- Dizziness
- Sweating
- Shaking or trembling
- Nausea
- Hot flashes or chills
- Numbness or tingling
- “Out of body” feeling
- Feeling of losing control
- Feeling of dying
Take care of yourself
Learning to relax is one of the best things you can do to help with panic attacks. This may include breathing exercises as well as taking yoga or getting a massage.
Keep stress from building up by getting regular exercise. This can be brisk walking, running, swimming or taking aerobics classes. It is a good idea to consult your doctor first.
Keep your body fueled by eating a well-balanced, healthy diet. Eat meals regularly and avoid excess sugar, caffeine, alcohol and nicotine.
Find a Wellness Recovery Action Plan® (WRAP®) class near you or learn more about how to be involved in your recovery. WRAP involves listing your own support tools and then using them to make action plans to use in stressful times.
Get checked out
Panic attack symptoms can be similar to those of heart attacks or respiratory issues. For this reason, a person should be thoroughly tested to rule out these or other medical conditions. Sometimes a person will have to see several different doctors before being properly diagnosed.
Having just one panic attack does not mean you have panic disorder. Some people will have one or two during their lives and no more. If you have repeated attacks and are afraid of having more, you may have the disorder. A mental health doctor or licensed therapist will be able to properly evaluate you.
If you are diagnosed with panic disorder, do not worry. With proper treatment, your outlook for recovery is very good.
Resources
National Health Service United Kingdom
Wellness Recovery Action Plan® (WRAP®)
By Kevin Rizzo
©2014-2019 Carelon Behavioral Health
Source: National Health Service United Kingdom, www.nhs.uk/Conditions/Panic-disorder/Pages/self%20help.aspx; National Institute of Mental Health, www.nimh.nih.gov/health/topics/panic-disorder/index.shtml; American Psychological Association, www.apa.org/topics/anxiety/panic-disorder.aspx?item=8
Reviewed by Paulo R. Correa, M.D., Associate Medical Director, Beacon Health Options