What to know about panic attacks and panic disorder
In people who do not have an anxiety disorder, a panic attack can happen if an event triggers anxiety.
A panic attack and panic disorder can affect anyone of any ethnic background, but it is more common among women than men.
Panic can lead to lightheadedness.
A panic attack often stems from a direct trigger or incident, but they can also begin suddenly and randomly with no obvious cause. They are believed to come from an evolutionary response to danger.
Having a panic attack is said to be one of the most intensely frightening, upsetting and uncomfortable experiences in a person's life.
The American Psychological Association (APA), notes that an attack may only last for 15 seconds, but symptoms can to continue for about 30 minutes or longer, and sometimes for hours.
According to the Anxiety and Depression Association of America, a panic attack involves at least four of the following symptoms:
- Chest pain and discomfort
- Chills or feeling unusually hot
- Derealization, or feeling detached
- Dizziness and feeling lightheaded
- Experiencing a strong, sudden fear of dying
- Fear of losing control or feeling as if a person is "going crazy"
- Feelings of choking
- Heart palpitations, irregular heartbeat, or rapid heart rate
- Nausea and stomach upset
- Numbness or tingling
- Shaking or trembling
- Trouble breathing, feeling as if a person is smothering
Panic attacks can also be associated with agoraphobia, a fear of places from which the individual considers to be dangerous, or difficult to escape from. People who have experienced a panic attack often say after that they felt trapped.
Sometimes the symptoms associated with a panic attack can mirror other medical conditions. Examples of these include lung disorders, heart conditions, or thyroid problems.
Sometimes a person may seek emergency medical attention for a heart attack, yet anxiety is the true cause. Panic attacks are highly treatable and don't mean that a person is a hypochondriac or mentally ill.
What is panic disorder?
Panic disorder is an underlying medical condition, and panic attacks are a symptoms. According to the Anxiety and Depression Association of America, an estimated 6 million Americans have a panic disorder.
Women are most likely to experience the condition and it most commonly occurs when a person in early adulthood, from ages 18 to 25 years.
The condition occurs when a person has experienced multiple panic attacks and also lives in fear of having another panic attack. While everyone can experience a panic attack in their lifetime, those with a panic disorder experience recurrent attacks.
The fear they may experience another attack can cause them to withdraw from friends and family. They may fear going outside or in public places. A panic disorder can severely affect a person's quality of life and should be treated.
Experts say that anxiety and panic, to a certain extent, are a necessary part of our survival. However, when levels become so high that they undermine regular thought processes, a person naturally becomes afraid.
When the brain receives a surge of nervous signals designed to warn of imminent danger, the amygdala, a part of the brain, is activated. The amygdala controls a person's anxious response.
Some people's amygdala reacts with anxiety when there is no imminent danger, making it much more likely that they will experience high anxiety and panic attacks.
When a person is given the signal to react with anxiety, they produce adrenaline, also known as epinephrine.
Adrenaline is released by the adrenal glands. Some people call adrenaline the "fright or flight" hormone. A release of adrenaline into the system can raise the heartbeat, cause sweating, churn the stomach, and provoke irregular breathing. These are all characteristics of a panic attack.
If there is no imminent danger and the system is loaded with adrenaline, that hormone will not be used up for running away. The buildup can cause a panic attack.
A number of risk factors can increase the likelihood a person will have panic attacks and panic disorder.
Genetics may play a role. If a person has a close family member, such as a parent or sibling, with panic disorder, they may be more likely to have a panic attack.
In addition to family history, experiencing major stress or life change can trigger increased anxiety and panic attacks.
Examples include a recent loss of a loved one or separation of marriage. Having a history of physical or sexual abuse may also increase a person's likelihood of having a panic disorder.
Habits such as smoking or drinking excessive amounts of caffeine are also risk factors associated with panic disorder. Use of drugs?
Sometimes, however, there appears to be no particular incident or family history to trigger an attack. They can occur without warning.
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The APA publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The manual lists criteria to help a doctor diagnose mental health disorders, such as depression or panic disorder, and it aims to provide a standard for diagnosis across the country.
Frequent and sudden panic can be a sign of a panic attack.
The criteria for diagnosing a panic disorder include:
- Experiencing frequent and unexpected panic attacks
- Having at least one month of ongoing fear of having a panic attack and its accompanying symptoms, such as losing control. A person may significantly change his or her behavior for fear of having a panic attack in public
- Having panic attacks that are not attributable to taking certain medicines or having another mental health disorder, such as social phobia
A person who has these symptoms is likely to have a panic disorder.
The most common treatments for panic disorder are medications and psychotherapy sessions.
Known as "talk therapy," psychotherapy involves talking with a licensed mental health professional to identify potential triggers of a panic attack in with the aim of overcoming fears.
Medications may also help to correct imbalances in neurotransmitters in the brain that can lead to severe anxiety.
- Benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonopin)
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as hydrochloride (Effexor XR)
Sometimes one medication will work for one person with anxiety disorder, but not another. A person should always discuss potential benefits and side effects.
A doctor may also prescribe medicines known as beta blockers, which keep a person's heart rate from becoming too rapid and contributing to further anxiety, according to the National Institute of Mental Health (NIMH).
In addition to these medical treatments for panic disorder, some lifestyle changes can help a person make to reduce the incidence of panic attacks and panic disorder.
- Avoiding substances known to contribute to panic disorders, including caffeine, smoking, or using recreational drugs
- Getting enough sleep every night
- Joining a support group for those who experience regular panic attacks
- Taking steps to reduce stress in one's life, such as practicing yoga, engaging in deep breathing, or engaging in regular physical activity
If left untreated, a panic disorder can begin to impact many aspects of a person's life.
Complications can include:
- Abusing alcohol or other substances as a way to "escape" the concerns of daily life
- Developing phobias, such as agoraphobia
- Experiencing financial problems
- Increased risk of suicidal thoughts
- Refraining from social situations
- Requiring frequent medical care due to health concerns
Seeking medical treatment for panic disorder can help to prevent these complications.Written by Rachel Nall RN, BSN, CCRN