It’s normal to experience fear and anxiety from time to time, but full-blown panic attacks are not normal, everyday events. Sometimes these attacks can be predicted when a specific cue or trigger brings on the episode. Sandy’s initial attack was triggered by the emergency evacuation from the plane. But very often, panic attacks happen unexpectedly and may occur almost anywhere or any time.
The individual may be completely relaxed when such an unexpected attack suddenly occur, seemingly without an apparent external cue (e.g., scary event) or internal cue (e.g., fear thought) triggering it.
DO YOU HAVE PANIC DISORDER?
Consider whether you have experienced attacks of intense fear or dread that happen out of the blue. If these attacks were accompanied by several of the following symptoms, then panic disorder may be the source of your unease.
- pounding heart
- chills or sensations of heat
- shortness of breath
- feeling like you’re choking
- fear of going crazy or dying
- feelings of unreality or being detached from yourself
Because of his concerns about Sandy’s behavior since the incident on the airplane, her husband talked her into meeting with a psychiatrist. She was initially reluctant but eventually agreed to see someone her internist recommended. At her first visit, Sandy described her chronic worry about experiencing further attacks and how she often thought about the terror she felt when evacuating from the plane. She talked about how her daily life had changed because she was now avoiding crowds and public places. It seemed like the only place she felt relaxed was at home, and it was tough for her just to come see the doctor. In fact, when Sandy first left the house, she felt her heart start racing, and she couldn’t catch her breath, but breathing into the bag she now kept in her purse helped calm her down.
DIAGNOSTIC FEATURES OF PANIC DISORDER
- The features include recurring, unexpected, and abrupt onset of attacks involving feelings of intense fear or discomfort that peak within minutes. These panic attacks include four or more of the following:
- pounding heart or rapid heart rate
- shaking, trembling
- shortness of breath or feeling smothered
- feelings of choking
- chest discomfort or pain
- nausea or upset stomach
- sensations of heat or chills
- dizziness or light-headedness
- sensations of numbness or tingling
- feeling unreal or detached from oneself
- fear of dying
- fear of going crazy
When people hyperventilate, they are exhaling too much carbon dioxide. Breathing into a bag or holding one’s breath for a short time will increase the body’s carbon dioxide levels, which helps calm them down. If patients continue to hyperventilate, they may develop sensations of tingling in their extremities, which are known as paresthesias that are caused by elevated blood levels of carbon dioxide. Sandy clearly had the diagnostic features of panic disorder as described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Sandy developed a secondary anxiety disorder that is often associated with panic attacks. She began to fear places that she associated with the attacks, such as the supermarket or eventually anywhere outside her home. This is often described as panic attacks with secondary agoraphobia, which afflicts about one out of every three patients with panic attacks. Such patients’ symptoms often begin when they experience physical and emotional symptoms of panic that can seem to come from nowhere and end abruptly. For some patients like Sandy, a particular event, like a terrorist scare, can trigger the initial panic attack. A physical condition may bring on the symptoms, such as a heart flutter from a mitral valve prolapse. Sometimes the patient has a genetic predisposition to panic. For instance, Sandy had a family history of anxiety on her mother’s side.
In her mind, Sandy associated the location of the initial attack as its cause, so she avoided the airport and other crowded places that reminded her of the initial attack. This learned response then developed into a phobia for these places, and over time, her movements became more and more restricted. Eventually, patients like Sandy who develop full-blown agoraphobia can become housebound.
Many patients with panic attacks are so focused on avoiding future attacks that they fail to obtain a proper diagnosis. Because many of the symptoms of panic are physical, patients may obtain multiple medical consultations searching for an underlying physical condition as the cause, unaware that their symptoms are the result of a psychiatric disorder.
This is unfortunate since panic disorder can have a negative impact on a person’s everyday life and well-being. Patients like Sandy often lose time from work and have trouble functioning normally. Some patients become so desperate to end their discomfort that they consider suicide as an option. Patients with panic disorder have a higher rate of other medical illnesses, particularly heart disease. Despite what the patient may believe, chest pain that develops during the panic attack is usually not due to a heart problem.
MEDICAL CONDITIONS OFTEN PRESENT IN PANIC DISORDER PATIENTS
- cardiac disease
- chronic pain
- irritable bowel syndrome
- mitral valve prolapse (bulging heart valve)
- respiratory disease
- thyroid disease
- vestibular (inner ear) disorder
To obtain an accurate diagnosis, the doctor will inquire about details of the recent symptoms as well as past history of psychiatric and medical conditions. These can include any use of alcohol or drugs, prescribed and over-the-counter medications, and other substances such as caffeine that can worsen symptoms. Major life events, certain occupations (e.g., military service), and a family history of similar disorders may also increase risk for panic and guide the doctor toward an accurate diagnosis. The doctor may also draw blood to test for thyroid abnormalities or other medical conditions that could contribute to symptoms.Image courtesy of Pixabay and some sources from these References