Panic Attack Book
Poochie Tenharmsel
Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. People experiencing a panic attack may believe they are dying or going crazy. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them.
You may also think you're having a heart attack, and it's true that some of the symptoms can be similar. However, most people having a panic attack have had one before, triggered by a similar event or situation.
The chest pain of a panic attack usually stays in the mid-chest area (the pain of a heart attack commonly moves toward the left arm or jaw). You may also have rapid breathing, rapid heartbeat, and fear. Panic attacks come and disappear suddenly, but leave you exhausted.
Panic attacks are generally brief, lasting less than 10 minutes, although some of the symptoms may last longer. An isolated panic attack, while extremely unpleasant, is not uncommon or life-threatening.
People with panic disorder may be extremely anxious and fearful, since they are unable to predict when the next episode will occur. Panic disorder is fairly common and affects about 6 million adults in the U.S. Women are twice as likely as men to develop the condition, and its symptoms usually begin in early adulthood.
It is not clear what causes panic disorder. In many people who have the biological vulnerability to panic attacks, they may develop in association with major life changes (such as getting married, having a child, starting a first job, etc.) and major lifestyle stressors. There is also some evidence that suggests that the tendency to develop panic disorder may run in families. People who suffer from panic disorder are also more likely than others to suffer from depression, attempt suicide, or to abuse alcohol or drugs.
Fortunately, panic disorder is a treatable condition. Psychotherapy and medications have both been used, either singly or in combination, for successful treatment of panic disorder. If medication is necessary, your doctor may prescribe anti-anxiety medications, certain antidepressants or sometimes certain anticonvulsant drugs that also have anti-anxiety properties, or a class of heart medications known as beta-blockers to help prevent or control the episodes in panic disorder.
A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.
If you have panic attack symptoms, seek medical help as soon as possible. Panic attacks, while intensely uncomfortable, are not dangerous. But panic attacks are hard to manage on your own, and they may get worse without treatment.
Panic attack symptoms can also resemble symptoms of other serious health problems, such as a heart attack, so it's important to get evaluated by your primary care provider if you aren't sure what's causing your symptoms.
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Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's unknown why a panic attack occurs when there's no obvious danger present.
Left untreated, panic attacks and panic disorder can affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.
Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing control.[1][2][7] Typically, symptoms reach a peak within ten minutes of onset, and last for roughly 30 minutes, but the duration can vary from seconds to hours.[3][8] Although they can be extremely frightening and distressing, panic attacks themselves are not physically dangerous.[6][9] Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting, and uncomfortable experiences of a person's life and may take days to initially recover from. Repeated panic attacks are considered a symptom of panic disorder.[10][11][12]
The essential features of panic attacks remain unchanged, although the complicated DSM-IV terminology for describing different types of panic attacks (i.e., situationally bound/cued, situationally predisposed, and unexpected/uncued) is replaced with the terms unexpected and expected panic attacks. Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comorbidity across an array of disorders, including but not limited to anxiety disorders. Hence, panic attacks can be listed as a specifier that is applicable to all DSM-5 disorders.[13]
Panic attacks can occur due to several disorders including panic disorder, social anxiety disorder, post-traumatic stress disorder, substance use disorder, depression, and medical problems.[2][4] They can either be triggered or occur unexpectedly.[2] Smoking, caffeine, and psychological stress increase the risk of having a panic attack.[2] Before diagnosis, conditions that produce similar symptoms should be ruled out, such as hyperthyroidism, hyperparathyroidism, heart disease, lung disease, drug use, and dysautonomia.[2][14]
Treatment of panic attacks should be directed at the underlying cause.[6] In those with frequent attacks, counseling or medications may be used.[5] Breathing training and muscle relaxation techniques may also help.[15] Those affected are at a higher risk of suicide.[2]
In Europe, about 3% of the population has a panic attack in a given year while in the United States they affect about 11%.[2] They are more common in females than in males.[2] They often begin during puberty or early adulthood.[2] Children and older people are less commonly affected.[2]
People with panic attacks often report a fear of dying or heart attack, flashing vision or other visual disturbances, faintness or nausea, numbness throughout the body, shortness of breath and hyperventilation, or loss of body control.[16] Some people also experience tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the "fight-or-flight response", in which the hormone causing this response is released in significant amounts). This response floods the body with hormones, particularly epinephrine (adrenaline), which aid it in defending against harm.[17]
A panic attack can result when up-regulation by the sympathetic nervous system (SNS) is not moderated by the parasympathetic nervous system (PNS). The most common symptoms include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, heavy-headedness, hyperventilation, paresthesias (tingling sensations), intense muscle cramps (particularly in the hands, which may 'lock up' and become difficult to move),[18][19] sensations of choking or smothering, difficulty moving, depersonalization and/or derealization.[20] These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety and forms a positive feedback loop.[21]
Shortness of breath and chest pain are the predominant symptoms. Many people experiencing a panic attack incorrectly attribute them to a heart attack and thus seek treatment in an emergency room.[22] Because chest pain and shortness of breath are hallmark symptoms of cardiovascular illnesses, including unstable angina and myocardial infarction (heart attack), a diagnosis of exclusion (ruling out other conditions) must be performed before diagnosing a panic attack. It is especially important to do this for people whose mental health and heart health statuses are unknown. This can be done using an electrocardiogram and mental health assessments.
Panic attacks are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature.[17] They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not generally indicative of a mental disorder.
There are long-term, biological, environmental, and social causes of panic attacks. In 1993, Fava et al. proposed a staging method of understanding the origins of disorders. The first stage in developing a disorder involves predisposing factors, such as genetics, personality, and a lack of well-being.[23] Panic disorder often occurs in early adulthood, although it may appear at any age. It occurs more frequently in women and more often in people with above-average intelligence.[24][25] Various twin studies where one identical twin has an anxiety disorder have reported a high incidence of the other twin also having an anxiety disorder diagnosis.[26]
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