Entries

Gale Encyclopedia of Mental Disorders Gale Encyclopedia of Alternative MedicineGale Encyclopedia of Medicine, 3rd ed.UXL Complete Health Resource Further reading

NON JS

Panic disorder

Panic disorder

Definition

Panic disorder is a condition in which the person with the disorder suffers recurrent panic attacks. Panic attacks are sudden attacks that are not caused by a substance (like caffeine), medication, or by a medical condition (like high blood pressure), and during the attack, the sufferer may experience sensations such as accelerated or irregular heartbeats, shortness of breath, dizziness, or a fear of losing control or "going crazy." The sudden attack builds quickly (usually within 10 minutes) and is almost paralyzing in its severity. When a diagnosis of panic disorder is given, the disorder can be considered one of two different typespanic disorder with or without agoraphobia .

The handbook for mental health professionals (called the Diagnostic and Statistical Manual of Mental Disorders , or the DSM-IV-TR) classifies both types of panic disorder as anxiety disorders.

Panic disorder without agoraphobia

Panic disorder without agoraphobia is defined by the DSM-IV-TR as a disorder in which patients are plagued by panic attacks that occur repeatedly and without warning. After these attacks, the affected individual worries for one month or more about having more embarrassing attacks, and may change his or her behavior with regard to these attacks. For example, a patient may fear that he or she has a cardiac condition, and may quit a job or quit exercising because of the fear. Patients may also worry that they are going to lose control or appear insane to other people. Panic disorder without agoraphobia has a less severe set of symptoms than panic disorder with agoraphobia. Patients without agoraphobia do not become houseboundthey suffer panic attacks but do not have significant interference in their level of function and are still able to accomplish their daily activities.

Panic disorder with agoraphobia

People who suffer from this kind of panic disorder may experience their agoraphobia in one of two ways. They may experience sudden, unexpected panic attacks that cause them to fear being in a place where help might not be available; or, they may experience sudden panic attacks in specific, known situations, and fear those situations or places that may trigger attacks. In either case, the fear of further panic attacks restricts the affected person's activities. For example, people whose attacks are triggered by being in crowds may avoid shopping malls for fear that they will be in a crowd and have a panic attack . Or, a person may experience sudden, debilitating panic attacks without a particular trigger, and, as a result, he or she is afraid to go to a supermarket (or similar place) for fear that a panic attack could occur while there and no one could help.

Description

Panic disorder can be very difficult to distinguish from other mental illnesses such as major depression, other anxiety disorders, or medical conditions such as heart attacks. Panic attacks differ from general anxiety in that they are episodes that last for discrete periods of time and the symptoms that people suffer are more intense. Panic attacks have three types: unexpected, situationally bound, and situationally predisposed. The unexpected attacks occur without warning and without a trigger. The situationally bound attacks happen repeatedly when the person is performing some activity, about to do that activity, or even when the person thinks about doing that activity. For example, a person whose panic attacks are triggered by being in crowds can have an attack just by thinking about going to a shopping mall. Situationally predisposed attacks are similar to the situationally bound attacks, except that they do not always occur when the trigger stimulus is encountered. For example, someone who experiences panic attacks while in crowds may sometimes be in crowds and not experience attacks, or may experience attacks in other, non-crowded situations, as well.

Patients who suffer from panic disorder without treatment usually have a diminished quality of life and end up spending excessive money on health care because of frequent visits to emergency rooms and to other medical doctors. However, very effective treatments for panic disorder exist.

Agoraphobia is a fear of being in a place or situation from which escape might be difficult or embarrassing, or in which help may not be available in the case of a panic attack. It is not clear why some people develop agoraphobia and other people do not. Many people may develop their agoraphobia symptoms right after their first attack, but others do not develop agoraphobia until sometimes years after their attacks began.

Causes and symptoms

Causes

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. It is extremely difficult to study the brain and the underlying causes of psychiatric illness; and understanding the chemistry of the brain is the key to unlocking the mystery of panic disorder. The amygdala is the part of the brain that causes fear and the response to stress . It has been implicated as a vital part of anxiety disorders. Sodium lactate, a chemical that the body produces when muscles are fatigued, and carbon dioxide are known to induce panic attacks. These substances are thought to inhibit the release of neurotransmitters in the brain, which leads to the panic attacks. One hypothesis is that sodium lactate stimulates the amygdala and causes panic attacks. Another hypothesis is that patients with panic disorder have a hypersensitive internal suffocation alarm. This means that the patient's brain sends the body false signals that not enough oxygen is being received, causing the affected person to increase his or her breathing rate. Panic disorder patients have attacks when their overly sensitive alarm goes off unpredictably. Yohimbine, a drug used to treat male sexual dysfunction, stimulates a part of the brain called the locus ceruleus and induces panic symptoms thus pointing to this area of the brain's involvement in panic disorder. Brain neurotransmitters serotonin and GABA are suspected to be involved in causing the disorder, as well.

GENETICS. Genetics also plays a pivotal role in the development of panic disorder. Twin studies have demonstrated that there is a higher concordance in identical versus fraternal twins thus supporting the idea that panic disorders are inherited. Family studies have also demonstrated that panic attacks run in families. Relatives of patients with panic disorder are four to 10 times more likely to develop panic disorder. People who develop early onset of panic attacks in their mid-20s are more likely to have relatives who have panic disorder. When relatives of patients with panic disorder are exposed to high levels of carbon dioxide, they have panic attacks. Another hypothesis is that patients with panic disorder who develop agoraphobia have a more severe form of the disease. Current efforts to identify a gene for panic disorder have not been successful.

PERSONAL VARIABLES. There are several themes in the psychology of panic disorder. Research has shown that patients who develop panic disorder have difficulty with anger. They also have difficulty when their job responsibilities are increased (as in the case of a promotion), and are sensitive to loss and separation. People with this disorder often have difficulty getting along with their parents, whom they see as controlling, critical, and demanding, causing the patients to feel inadequate. Early maternal separation is thought to be an underlying cause of panic disorder.

Panic disorder patients also have a pattern of dependency in their interpersonal relationships. As children, people with panic disorder relied on parents to protect them from fear. As a result, they develop an angry dependence on their parents and fear detaching from them. They constantly feel as though they are trapped.

There is also an association between sexual abuse and patients who have panic attacks. Sixty percent of female patients with panic disorder were sexually abused as children. This explains their difficulty with developing trusting relationships.

Symptoms

PANIC ATTACK SYMPTOMS. The DSM-IV-TR lists thirteen symptoms to meet the criteria for a diagnosis of panic attack. The affected person must have four or more of these symptoms within ten minutes of the beginning of an attack in order to meet the panic attack criteria:

  • bounding or pounding heartbeat or fast heart rate
  • sweating
  • shaking
  • shortness of breath
  • feeling of choking
  • pains in the chest; many people they feel as though they are having a heart attack
  • nausea or stomach ache
  • feeling dizzy or lightheaded as if he or she is going to pass out
  • feeling of being outside of one's body or being detached from reality
  • fear that he or she is out of control or crazy
  • fear that he or she is going to die
  • feeling of tingling or numbness
  • chills or hot flashes

Symptoms of panic disorder without agoraphobia

The DSM-IV-TR criteria for panic disorder without agoraphobia include:

  • recurrent panic attacks (see above) that occur without warning for one month
  • persistent worry that panic attacks will recur
  • possible change in behavior because of that fear
  • no agoraphobia
  • not due to a medical condition or substance abuse
  • not due other mental illness like specific phobia, social phobia , obsessive-compulsive disorder , separation anxiety disorder , or post-traumatic stress disorder

Symptoms of panic disorder with agoraphobia

The DSM-IV-TR criteria for panic disorder with agoraphobia are the same as above, but agoraphobia is present. The symptoms of agoraphobia include fear of being in situations that can trigger panic attacks, and avoiding places where attacks have occurred because of the affected person's fear that he or she will not be able to leave, or will not be able to get help. People with this condition may need to have another person accompany them when going to a place that may trigger anxiety attacks. Sometimes this fear can be so severe that the person becomes housebound. This fact is important to consider because 15% of the general population can have one spontaneous panic attack without the recurrence of symptoms.

Demographics

Factors such as race, gender and socioeconomic status are important factors in the development of panic disorder. An individual has a chance of between one and two percent of developing panic disorder with or without agoraphobia. The symptoms usually begin when the person is in his or her early to mid-twenties. Women are twice as likely as men to develop panic attacks regardless of age. The National Institute of Mental Health Epidemiologic Catchment Area Study (ECA) shows no real significant differences between the races or ethnic groups, although it appears that African American and Hispanic men between the ages of 40 and 50 have lower rates of panic disorder than white men. Panic disorder patients are at increased risk for major depression and the development of agoraphobia. According to ECA studies, an individual with panic disorder has a 33% chance of developing agoraphobia. People without panic disorder only have a 5.5% chance of developing agoraphobia. Again, women were more likely to develop agoraphobia than men. Over the course of their lifetime, African Americans were more likely to develop agoraphobia than whites or Hispanics. Agoraphobia is more prevalent among people with less education and lower economic class.

Diagnosis

Differential diagnosis

Differential diagnosis is the process of distinguishing one diagnosis from other, similar diagnoses. Panic disorder can be difficult to distinguish from other anxiety disorders such as specific phobia and social phobia. However, in general, specific phobia is cued by a specific trigger or stimulus and social phobia by specific social situations, while the panic attacks of panic disorder are completely uncued and unexpected. In certain cases, it may be difficult to distinguish between certain, situational phobias and panic disorder with agoraphobia, and the mental health professional must use the DSM and professional judgment in these cases. Panic attacks that occur during sleep and wake the person up are more characteristic of panic disorder, than are the other disorders that include panic attacks. It can be distinguished from posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) again by what cues the attacks. In PTSD, thinking about the traumatic event can trigger attacks. In obsessive-compulsive disorder, worries about getting dirty can fuel an attack of anxiety. In generalized anxiety disorder, general worries or concerns can lead to the symptoms of panic. However, in panic disorder, a main component is that the affected individual fears recurrent panic attacks.

Panic attacks can often be difficult to distinguish from other physical problems such as hyperthyroidism, hyperparathyroidism, seizure disorder, and cardiac disease. If patients are middle aged or older and have other complaints, including dizziness and headaches, their attacks are more likely to be another medical problem and not panic attacks. Panic attacks can also be difficult to distinguish from drug abuse since any drug that stimulates the brain can cause the symptoms. For example, cocaine, caffeine, and amphetamines can all cause panic attacks. Therefore, a person must be free of all drugs before a diagnosis of panic disorder can be made. Many patients may attempt to self-medicate with alcohol to try to calm down. Withdrawal from alcohol can lead to worse panic symptoms. The patient may believe that he or she is reducing symptoms while actually exacerbatng their panic attacks.

Dual diagnosis

Individuals with panic disorders have a high rate of coexisting depression. Patients who have panic disorder have about a 4080% chance of developing major depression. In most situations, the panic disorder happens first and the depression comes later. Patients are also at risk for substance abuse difficulties as a result of attempts to stop attacks. These attempts may involve the use of alcohol, illicit or unprescribed sedatives, or benzodiazepines (medications that slow down the central nervous system, having a calming effect). Patients with panic disorder are not at high risk for suicide attempts. A recent Harvard-Brown study showed that people with panic disorder with or without agoraphobia are not at risk for suicide unless they have other conditions such as depression or substance abuse.

Psychological measures and diagnostic testing

Currently there is no diagnostic test for panic disorder. Any patient who has panic attacks should receive a thorough medical examination to rule out any medical condition. Patients should have baseline blood counts and glucose should be measured. Patients with cardiac symptoms need a cardiac workup and should see their primary medical doctor. Patients who have complaints of dizziness should receive a thorough neurological evaluation. There are several psychological inventories that can help the clinician diagnose panic disorder including the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Specific Fear Inventory, Clinical Anxiety Scale (CAS), and the Clinical Global Inventory (CGI).

Treatments

Psychological and social interventions

A psychotherapeutic technique that is critical to the treatment of panic disorder is cognitive-behavioral therapy (CBT). Patients are panic-free within six months in about 8090% of cases. Some people even experience long-term effects after the treatments have been stopped. About half of the patients say that they have rare attacks even two years after treatment has ended.

New studies reveal that the approach to treating panic disorder should have three aspects: the cognitive, the physiological, and the behavioral. The cognitive techniques try to focus on changing the patient's negative thoughtsfor example, "I will die if I don't get help." Patient education about symptoms is also critical to the treatment of panic attacks. In one physiological approach, patients are taught breathing techniques in an effort to try to help them lower their heart rate and decrease their anxiety. Repeated exposure to physical symptoms associated with the panic disorder is also a part of treatment. The patients cause themselves to hyperventilate in effort to reproduce the panic symptoms. In behavioral approaches, the individual who experiences panic attacks also needs to be exposed to situations that he or she may have previously feared. A patient can also be taken to places associated with agoraphobia with the therapist.

Some patients may benefit from psychodynamic psychotherapy and group therapy . Psychodynamic psychotherapy explores thoughts and ideas of the person's subconscious. It takes a longer time to achieve efficacy than cognitive-behavioral therapy, but it can be just as effective for patients with panic disorder. Group therapy is also just as helpful to some patients as CBT. Support groups can also be helpful to some patients. It can be very therapeutic and healing to the individual to discuss their problems with someone who has actually experienced the same symptoms. Patients can learn from each other's coping styles.

Medical treatments

Panic disorder patients have a 5080% chance of responding to treatment, which attempts to block the symptoms of panic attacks. Treating the agoraphobia symptoms is more challenging. Developing some antipanic regimens that address all symptoms is important.

The Food and Drug Administration (FDA) to treat panic disorder approves only five classes of drugs. They are:

  • benzodiazepines
  • Selective serotonin reuptake inhibitors (SSRIs), which cause a buildup of serotonin. This buildup is thought to cause the antidepressant effect.
  • Tricylic antidepressants (TCAs).
  • Monoamine oxidase inhibitors (MAOIs) and reversible MAOIs, which inhibit the breakdown of neurotransmitters in the brain, including dopamine and serotonin.
  • Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), trazodone (Desyrel), and others.

Patients should first be started on a low-dose SSRI and then the dose should be increased slowly. Patients with panic disorder are extremely sensitive to the side effects that many patients experience in the first weeks of antidepressant therapy. Patients should also have a benzodiazepine, such as clonazepam (Klonopin) or alprazolam (Xanax), in the first weeks of treatment until the antidepressant becomes therapeutic. Most people need the same dose of antidepressant as patients with major depression. About 60% of patients will have improvement in their symptoms while taking an antidepressant and a benzodiazepine. Patients with mitral valve prolapse may benefit from a beta blocker. Patients who have tried an SSRI, and after six weeks, show no improvement can be switched to another SSRI, benzodiazepine, TCA, MAOI, or venlafaxine (Effexor). An SSRI should be stopped if the patient has intolerable side effects such as loss of sexual libido, weight gain, or mild form of manic depression. When SSRIs are stopped, it is important that the dosage is gradually tapered because patients can suffer symptoms when it is abruptly withdrawn. These symptoms may include confusion, anxiety and poor sleep.

Alternative therapies

Some alternative therapies for panic disorder are hypnosis, meditation , yoga , proper nutrition, exercise, and abdominal breathing techniques that foster relaxation and visualization. Visualization is imagining oneself in the stressful situation while relaxed so that coping strategies can be discovered. The herb kava kava has been studied in trials to treat anxiety attacks and has been found to be effective in some clinical trials; but has not been studied intensely enough to determine its benefits and side effects, and has been associated liver toxicity. The National Center for Complementary and Alternative Medicine was going to conduct two research studies of kava kava but as of 2002 it has suspended the trials until the FDA has determined whether or not the herbal supplement is safe.

Prognosis

Patients with panic disorder have a poor prognosis particularly if untreated. Patients often relapse when they attempt to discontinue treatment. However, if patients are compliant and willing to stay in treatment, then the long-term prognosis is good. According to one study, eight years after treatment has been done, 3040% of patient are doing better. Only 1020% of patients do poorly. The patient with panic attacks has a relapsing and remitting course that can be worsened by significant stressors such as the death of the spouse or divorce. Cognitive-behavioral therapy has an 8090% chance that the patient will benefit six months after treatment. Medications have a 5080% efficacy. If patients are committed to staying in treatment, their prognosis is very favorable.

Prevention

Although panic disorder is not totally preventable, individuals with a strong family history of them who are susceptible to panic atacks are encouraged to be aware of the symptoms and get treatment early. Compliance with treatment is important to the recovery from panic disorder.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington DC: American Psychiatric Association, 2000.

Cox, Brian J. and Stephen Taylor. "Anxiety Disorders Panic and Phobias." In Oxford Textbook of Psychopathology, edited by Theodore Millon, Paul H. Blaney, and Roger D. Davis. New York: Oxford University Press, 1999.

Sadock, Benjamin J., M.D., and Virginia A. Sadock,M.D., eds. "Anxiety Disorders." In Comprehensive Textbook of Psychiatry. Volume I, 7th edition. Written by Jack Gorman M.D., Laszlo A. Papp, M.D., Glen O. Gabbard,M.D., and others. Philadelphia, PA: Lippincott Williams and Wilkins, 2000.

Swede, Shirley and Seymour Sheppard Jaffe, M.D. The Panic Attack Recovery Book: Revised and Updated. 2nd edition, revised. New York: Penguin Putnam Inc, 2000.

PERIODICALS

Frank, Ellen, Ph.D. and others. "Influence of Panic Agoraphobic Spectrum Symptoms on Treatment Response in Patients With Recurrent Major Depression." American Journal of Psychiatry July 2000: 11011107.

Kessler, Ronald C., Ph.D. and others. "The Use of Complementary and Alternatives Therapies to Treat Anxiety and Depression in the United States." American Journal of Psychiatry February 2001: 289294.

Milrod, Barbara, M.D., and others. "Open Trial of Psychodynamic Psychotherapy for Panic Disorder: A Pilot Study." The American Journal of Psychiatry November 2000: 18781880.

Sheikh, Javaid I.,M.D., M.B.A., Gregory A. Leskin, Ph.D. and Donald F. Klein, M.D. "Gender Differences in Panic Disorder: Findings From the National Comorbidity Survey." American Journal of Psychiatry January 2002: 5558.

Warsaw, Meredith G., M.S.S. and others. "Suicidal Behavior in Patients With Current or Past Panic Disorder: Five Years of Prospective Data From the Harvard /Brown Anxiety Research Program." American Journal of Psychiatry November 2000,18761878.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW,Washington, D.C. 20005. <http://www.psych.org/public_info/panic.html>.

Anxiety Disorders Association of America. 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. (301) 231-9350. <www.adaa.org>.

National Center for Complementary and Alternative Medicine. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. <http://nccam.nih.gov>.

National Institute of Mental Health. 6001 Executive Boulvevard, Rm.8184, MSC9663,Bethesda, MD 20892-9663. (301) 443-4513. <http://www.nimh.nih.gov/anxiety/panicmenu.cfm>.

Open Mind, <http://open-mind.org/SP>.

Susan Hobbs, M.D.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Hobbs, Susan. "Panic disorder." Gale Encyclopedia of Mental Disorders. 2003. Encyclopedia.com. 28 May. 2016 <http://www.encyclopedia.com>.

Hobbs, Susan. "Panic disorder." Gale Encyclopedia of Mental Disorders. 2003. Encyclopedia.com. (May 28, 2016). http://www.encyclopedia.com/doc/1G2-3405700282.html

Hobbs, Susan. "Panic disorder." Gale Encyclopedia of Mental Disorders. 2003. Retrieved May 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405700282.html

Panic Disorder

Panic disorder

Definition

A panic attack is a sudden, intense experience of fear coupled with an overwhelming feeling of danger, accompanied by physical symptoms of anxiety , such as a pounding heart, sweating, and rapid breathing. A person with panic disorder may experience repeated panic attacks (at least several a month) and feel severe anxiety about having another attack.

Description

Each year, panic disorder affects one in every 63 Americans. While many people experience moments of anxiety, panic attacks are sudden and unprovoked, having little to do with real danger.

Panic disorder is a chronic, debilitating condition that can have a devastating impact on a person's family, work, and social life. Typically, the first attack strikes without warning. A person might be walking down the street, driving a car, or riding an escalator when suddenly panic strikes. Pounding heart, sweating palms, and an overwhelming feeling of impending doom are common features. While the attack may last only seconds or minutes, the experience can be profoundly disturbing. A person who has had one panic attack typically worries that another one may occur at any time.

As the fear of future panic attacks deepens, the person begins to avoid situations in which panic occurred in the past. In severe cases of panic disorder, the victim refuses to leave the house for fear of having a panic attack. This fear of being in exposed places is often called agoraphobia.

People with untreated panic disorder may have problems getting to work or staying on the job. As the person's world narrows, untreated panic disorder can lead to depression , substance abuse, and in rare instances, suicide.

Causes & symptoms

Scientists aren't sure what causes panic disorder, but they know that a tendency to develop the condition can

be inherited. In 2001, a team of geneticists pinpointed an abnormal duplication (known as DUP25) of a segment of human chromosome 15q as implicated in panic disorder. In addition to genetic factors, some experts think that people with panic disorder may have a hypersensitive nervous system that unnecessarily responds to nonexistent threats. Research suggests that people with panic disorder may not be able to make proper use of their body's normal stress-reducing chemicals. And in some cases, panic disorder develops as a drug intolerance reaction to medications given to reduce high blood pressure.

People with panic disorder usually have their first panic attack in their 20s. Four or more of the following symptoms during panic attacks would indicate panic disorder if no medical, drug-related, neurologic, or other psychiatric disorder is found:

  • pounding, skipping, or palpitating heartbeat
  • shortness of breath or the sensation of smothering
  • dizziness or lightheadedness
  • nausea or stomach problems
  • chest pains or pressure
  • choking sensation or a "lump in the throat"
  • chills or hot flashes
  • sweating
  • fear of dying
  • feelings of unreality or being detached
  • tingling or numbness
  • shaking and trembling
  • fear of losing control

A panic attack is often accompanied by the urge to escape, together with a feeling of impending doom. Others are convinced they are about to have a heart attack , suffocate, lose control, or "go crazy." Once people experience one panic attack, they tend to worry so much about having another attack that they avoid the place or situation associated with the original episode.

Diagnosis

Because its physical symptoms are easily confused with other conditions, panic disorder often goes undiagnosed. A thorough physical examination is needed to rule out a medical condition. Because the physical symptoms are so pronounced and frightening, panic attacks can be mistaken for a heart problem. Some people experiencing a panic attack go to an emergency room and endure batteries of tests until a diagnosis is made.

Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic and panic disorder, taking into account not just the actual episodes, but how the patient feels about the attacks, and how they affect everyday life.

Treatment

One approach used in several medical centers focuses on teaching patients how to accept their fear instead of dreading it. In this method, the therapist repeatedly stimulates a person's body sensations (such as a pounding heartbeat) that can trigger fear. Eventually, the patient gets used to these sensations and learns not to be afraid of them. Patients who respond report almost complete absence of panic attacks.

Neurolinguistic programming and hypnotherapy can also be beneficial in treating panic attacks, since these techniques can help bring an awareness of the root cause of the attacks to the conscious mind.

Herbs known as adaptogens may also be prescribed by an herbalist or holistic healthcare provider to treat anxiety related to panic disorder. These herbs are thought to promote adaptability to stress , and include Siberian ginseng (Eleutherococcus senticosus ), ginseng (Panax ginseng ), wild yam (Dioscorea villosa ), borage (Borago officinalis ), licorice (Glycyrrhiza glabra ), chamomile (Chamaemelum nobile ), milk thistle (Silybum marianum ), and nettles (Urtica dioica ). Herbal preparations of skullcap (Scutellaria lateriafolia ), lemon balm (Melissa officinalis ), passionflower (Passiflora incarnata ), and oats (Avena sativa ) may also be recommended to ease the symptoms of panic disorder. Nutritional supplementation with B vitamins, magnesium , and antioxidant vitamins are also useful for relieving anxiety.

Chinese medicine regards anxiety as a disruption of qi, or energy flow, inside the patient's body. The practitioner of Chinese medicine chooses acupuncture and/or herbal therapy to rebalance the entire system. In acupuncture, the kidney meridian is associated with fear and may be out of balance. Reishi (Ganoderma lucidum ), or ling-zhi is a medicinal mushroom prescribed in TCM to reduce anxiety and insomnia . It is available in extract form, but because reishi can interact with other prescription drugs and is not recommended in patients with certain medical conditions, individuals should consult their healthcare practitioner before taking the remedy. Other TCM herbal remedies for panic disorder include the cordyceps mushroom (also known as caterpillar fungus.) There are several herbal formulas, depending on the pattern of imbalance in an individual.

Meditation and mindfulness training can be beneficial to patients with phobias and panic disorder. Hydrotherapy, massage therapy , and aromatherapy are useful to some anxious patients because they can promote general relaxation of the nervous system. Popular aromatherapy prescriptions for anxiety relief include essential oils of lavender , ylang-ylang, and chamomile . Relaxation training, which is sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction of anxiety. Yoga , aikido, t'ai chi , and dance therapy help patients work with the physical, as well as the emotional, tensions that either promote anxiety or are created by the anxiety.

Finally, patients can make certain lifestyle changes to help keep panic at bay, such as eliminating caffeine and alcohol, cocaine, amphetamines, and marijuana .

There are also homeopathic remedies that may be helpful by seeing a trained homeopathic practitioner.

It is important for patients who are using alternative treaments for panic disorder alongside allopathic medications or treatments to keep their health care provider informed about any herbal remedies they may be taking that could interact with prescription medications. A study done in 2001 found that Americans are more likely to seek alternative treatment for anxiety disorders than standard allopathic therapies, and that the percentage of alternative therapy users was the same in both sexes. In addition, the percentage was not affected by age, race, education, income, place of residence, marital status, or employment.

Allopathic treatment

Most patients with panic disorder respond best to a combination of cognitive-behavioral therapy and medication. Cognitive-behavioral therapy usually runs from 1215 sessions. It teaches patients:

  • How to identify and alter thought patterns so as not to misconstrue bodily sensations, events, or situations as catastrophic.
  • How to prepare for the situations and physical symptoms that trigger a panic attack.
  • How to identify and change unrealistic self-talk (such as "I'm going to die!") that can worsen a panic attack.
  • How to calm down and learn breathing exercises to counteract the physical symptoms of panic.
  • How to gradually confront the frightening situation step by step until it becomes less terrifying.
  • How to "desensitize" themselves to their own physical sensations, such as rapid heart rate.

At the same time, many people find that medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. People with panic disorder usually notice whether or not the drug is effective within two months, but most people take medication for at least six months to a year.

Several kinds of drugs can reduce or prevent panic attacks, including:

  • Selective serotonin reuptake inhibitor (SSRI) antipressants like paroxetine (Paxil) or fluoxetine (Prozac), some approved specifically for the treatment of panic.
  • Tricyclic antidepressants such as clomipramine (Anafranil).
  • Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin).
  • A combination of sertraline, another SSRI, with clonazepam has been reported as especially effective in treating panic disorder.

Expected results

While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very well to treatment; panic attacks decrease in up to 90% of people after six to eight weeks of a combination of cognitive-behavioral therapy and medication.

Unfortunately, many people with panic disorder never get the help they need. If untreated, panic disorder can last for years and may become so severe that a normal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, and jobs.

Prevention

There is no way to prevent the initial onset of panic attacks. Antidepressant drugs or benzodiazepines can prevent future panic attacks, especially when combined with cognitive-behavioral therapy. There is some suggestion that avoiding stimulants (including caffeine, alcohol, or over-thecounter cold medicines) may help prevent attacks as well.

Resources

BOOKS

Bloomfield, Harold H. Healing Anxiety with Herbs. New York: Harper Collins, 1998.

Sheehan, Elaine. Anxiety, Phobias and Panic Attacks: Your Questions Answered. New York: Element, 1996.

Wilson, Robert R. Don't Panic: Taking Control of Anxiety Attacks. New York: Harper Collins, 1996.

PERIODICALS

"Alternative Treatment of Anxiety and Depression." Harvard Mental Health Letter 18 (October 2001): np.

Boschert, Sherry. "Drug Intolerance, Mood Disorders Linked in HT (Panic Attacks, Anxiety, Depression)." Internal Medicine News 34 (November 2001): 30.

Goddard, Andrew W. "Early Administration of Clonazepam with Sertraline for Panic Disorder." Journal of the American Medical Association 286 (October 24, 2001): 1955.

Gratacos, M., M. Nadal, R. Martin-Santos, et al. "Polymorphic Genomic Mutation on Human Chromosome 15 and Susceptibility to Anxiety Disorders (Panic Disorder and Social Phobia)." American Journal of Human Genetics 69 (October 2001): 177.

Katerndahl, David A. "Panic Attacks and Panic Disorder." Journal of Family Practice 43 (September 1996): 275-283.

ORGANIZATIONS

Anxiety Disorders Association of America. 11900 Parklawn Dr., Ste. 100, Rockville, MD 20852. (301) 231-9350.

Anxiety Network Homepage. http://www.anxietynetwork.com.

National Institute of Mental Health, Anxiety Disorders Education Program. Rm 15C-05, 5600 Fishers Lane, Rockville, MD 20857. (800) 64-PANIC. <www.nimh.nih.gov/anxiety.>.

Paula Ford-Martin

Rebecca J. Frey, PhD

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Ford-Martin, Paula; Frey, Rebecca. "Panic Disorder." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. 28 May. 2016 <http://www.encyclopedia.com>.

Ford-Martin, Paula; Frey, Rebecca. "Panic Disorder." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. (May 28, 2016). http://www.encyclopedia.com/doc/1G2-3435100594.html

Ford-Martin, Paula; Frey, Rebecca. "Panic Disorder." Gale Encyclopedia of Alternative Medicine. 2005. Retrieved May 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3435100594.html

Panic Disorder

Panic Disorder

Definition

A panic attack is a sudden, intense experience of fear coupled with an overwhelming feeling of danger, accompanied by physical symptoms of anxiety, such as a pounding heart, sweating, and rapid breathing. A person with panic disorder may have repeated panic attacks (at least several a month) and feel severe anxiety about having another attack.

Description

Each year, panic disorder affects one out of 63 Americans. While many people experience moments of anxiety, panic attacks are sudden and unprovoked, having little to do with real danger.

Panic disorder is a chronic, debilitating condition that can have a devastating impact on a person's family, work, and social life. Typically, the first attack strikes without warning. A person might be walking down the street, driving a car, or riding an escalator when suddenly panic strikes. Pounding heart, sweating palms, and an overwhelming feeling of impending doom are common features. While the attack may last only seconds or minutes, the experience can be profoundly disturbing. A person who has had one panic attack typically worries that another one may occur at any time.

As the fear of future panic attacks deepens, the person begins to avoid situations in which panic occurred in the past. In severe cases of panic disorder, the victim refuses to leave the house for fear of having a panic attack. This fear of being in exposed places is often called agoraphobia.

People with untreated panic disorder may have problems getting to work or staying on the job. As the person's world narrows, untreated panic disorder can lead to depression, substance abuse, and in rare instances, suicide.

Causes and symptoms

Scientists are not sure what causes panic disorder, but they suspect the tendency to develop the condition can be inherited. Some experts think that people with panic disorder may have a hypersensitive nervous system that unnecessarily responds to nonexistent threats. Research suggests that people with panic disorder may not be able to make proper use of their body's normal stress-reducing chemicals.

People with panic disorder usually have their first panic attack in their 20s. Four or more of the following symptoms during panic attacks would indicate panic disorder if no medical, drug-related, neurologic, or other psychiatric disorder is found:

  • pounding, skipping or palpitating heartbeat
  • shortness of breath or the sensation of smothering
  • dizziness or lightheadedness
  • nausea or stomach problems
  • chest pains or pressure
  • choking sensation or a "lump in the throat"
  • chills or hot flashes
  • sweating
  • fear of dying
  • feelings of unreality or being detached
  • tingling or numbness
  • shaking and trembling
  • fear of losing control or going crazy

A panic attack is often accompanied by the urge to escape, together with a feeling of certainty that death is imminent. Others are convinced they are about to have a heart attack, suffocate, lose control, or "go crazy." Once people experience a panic attack, they tend to worry so much about having another attack that they avoid the place or situation associated with the original episode.

Diagnosis

Because its physical symptoms are easily confused with other conditions, panic disorder often goes undiagnosed. A thorough physical examination is needed to rule out a medical condition. Because the physical symptoms are so pronounced and frightening, panic attacks can be mistaken for a heart problem. Some people experiencing a panic attack go to an emergency room and endure batteries of tests until a diagnosis is made.

Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic attack and panic disorder, taking into account not just the actual episodes, but how the patient feels about the attacks, and how they affect everyday life.

Most health insurance policies include some limited amount of mental health coverage, although few completely cover outpatient mental health care.

Treatment

Most patients with panic disorder respond best to a combination of cognitive-behavioral therapy and medication. Cognitive-behavioral therapy usually runs from 12-15 sessions. It teaches patients:

  • how to identify and alter thought patterns so as not to misconstrue bodily sensations, events, or situations as catastrophic
  • how to prepare for the situations and physical symptoms that trigger a panic attack
  • how to identify and change unrealistic self-talk (such as "I'm going to die!") that can worsen a panic attack
  • how to calm down and learn breathing exercises to counteract the physical symptoms of panic
  • how to gradually confront the frightening situation step by step until it becomes less terrifying
  • how to "desensitize" themselves to their own physical sensations, such as rapid heart rate

At the same time, many people find that medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. People with panic disorder usually notice whether or not the drug is effective within two months, but most people take medication for at least six months to a year.

Several kinds of drugs can reduce or prevent panic attacks, including:

  • selective serotonin reuptake inhibitor (SSRI ) antidepressants like paroxetine (Paxil) or fluoxetine (Prozac), are approved specifically for the treatment of panic
  • tricyclic antidepressants such as clomipramine (Anafranil)
  • benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin)

Finally, patients can make certain lifestyle changes to help keep panic at bay, such as eliminating caffeine and alcohol, cocaine, amphetamines, and marijuana.

Alternative treatment

One approach used in several medical centers focuses on teaching patients how to accept their fear instead of dreading it. In this method, the therapist repeatedly stimulates a person's body sensations (such as a pounding heartbeat) that can trigger fear. Eventually, the patient gets used to these sensations and learns not to be afraid of them. Patients who respond report almost complete absence of panic attacks.

A variety of other atlernative therapies may be helpful in treating panic attacks. Neurolinguistic programming and hypnotherapy can be beneificial, since these techniques can help bring an awareness of the root cause of the attacks to the conscious mind. Herbal remedies, including lemon balm (Melissa officinalis ), oat straw (Avena sativa ), passionflower (Passiflora incarnata ), and skullcap (Scutellaria lateriflora ), may help significantly by strengthening the nervous system. Homeopathic medicine, nutritional supplementation (especially with B vitamins, magnesium, and antioxidant vitamins ), creative visualization, guided imagery, and relaxation techniques may help some people experiencing panic attacks. Hydrotherapies, especially hot epsom salt baths or baths with essential oil of lavender (Lavandula officinalis ), can help patients relax.

Prognosis

While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very well to treatment; panic attacks decrease in up to 90% of people after 6-8 weeks of a combination of cognitive-behavioral therapy and medication.

Unfortunately, many people with panic disorder never get the help they need. If untreated, panic disorder can last for years and may become so severe that a normal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, and jobs.

Prevention

There is no way to prevent the initial onset of panic attacks. Antidepressant drugs or benzodiazepines can prevent future panic attacks, especially when combined with cognitive-behavioral therapy. There is some suggestion that avoiding stimulants (including caffeine, alcohol, or over-the-counter cold medicines) may help prevent attacks as well.

Resources

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. http://www.psych.org.

Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org.

Freedom From Fear. 308 Seaview Ave., Staten Island, NY 10305. (718) 351-1717.

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.

National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166. http://www.lexington-online.com/naf.html.

National Institute of Mental Health, Panic Campaign. Rm 15C-05, 5600 Fishers Lane, Rockville, MD 20857. (800) 647-2642. http://www.nimh.nih.gov.

National Mental Health Association. 1021 Prince St., Alexandria, VA 22314. (703) 684-7722. http://www.nmha.org.

OTHER

The Anxiety and Panic Internet Resource. http://www.algy.com/anxiety.

Anxiety Network Page. http://www.anxietynetwork.com.

National Institute of Mental Health Page. http://www.nimh.nih.gov.

"Panic Disorder." Internet Mental Health Page. http://www.mentalhealth.com.

KEY TERMS

Agoraphobia Fear of open spaces.

Benzodiazepines A class of drugs that have a hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety or panic.

Cognitive-behavioral therapy A type of psychotherapy used to treat anxiety disorders (including panic disorder) that emphasizes behavioral change together with alteration of negative thought patterns.

Selective serotonin reuptake inhibitors (SSRIs) A class of antidepressants used to treat panic that affects mood by boosting the levels of the brain chemical serotonin.

Tricyclic antidepressants A class of antidepressants named for their three-ring structure that increase the levels of serotonin and other brain chemicals. They are used to treat depression and anxiety disorders, but have more side effects than the newer class of antidepressants called SSRIs.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Turkington, Carol. "Panic Disorder." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 28 May. 2016 <http://www.encyclopedia.com>.

Turkington, Carol. "Panic Disorder." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (May 28, 2016). http://www.encyclopedia.com/doc/1G2-3451601199.html

Turkington, Carol. "Panic Disorder." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved May 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601199.html

Panic Disorder

PANIC DISORDER

DEFINITION


Panic disorder is a condition in which a person feels sudden over-whelming fright, usually without any reasonable cause. A panic attack is generally accompanied by physical symptoms, such as a pounding heart, sweating, and rapid breathing. A person with panic disorder may have repeated panic attacks and feel constant fear as to when the next attack will occur.

DESCRIPTION


Most people experience moments of anxiety. They worry about money, their job, the future, or some other issue. But panic disorder is far more serious. It is a chronic (long-lasting), crippling condition that can have a devastating impact on a person's family, work, and social life. Panic disorder is thought to affect about one in every sixty Americans.

The first panic attack can strike a person anywhere. Suddenly, for no good reason, the person has a sense of impending doom. His or her palms begin to sweat, and the heart begins to beat wildly.

Panic Disorder: Words to Know

Agoraphobia:
A fear of open spaces.
Anxiety:
Feeling troubled, uneasy, or worried.
Cognitive-behavioral therapy:
A form of counseling designed to help patients change the way they think about their problems and change the way they respond to those problems.
Neurotransmitters:
Chemicals that help carry messages between nerve cells in the brain.
Serotonin:
An important neurotransmitter in the brain.

Panic attacks usually last only a few seconds or minutes. But they are terrifying. People who have experienced a panic attack begin to wonder and worry about when the next attack will occur. They will start to avoid situations that might trigger an attack. In extreme cases, patients may become so frightened that they refuse to leave their homes. This condition is known as agoraphobia (pronounced AG-uh-ruh-FO-bee-uh).

People who have untreated panic disorder are likely to have problems holding a job. They may become depressed, begin to abuse drugs, and even commit suicide.

CAUSES


The cause of panic disorder is not known. Some authorities believe that the condition is inherited. They think that patients may have unusually sensitive nervous systems that respond inappropriately to events and surroundings.

SYMPTOMS


People with panic disorder usually have their first attack in their twenties. Specialists define a panic attack as an event with any four of the following symptoms:

  • Pounding, skipping, or fluttering heartbeat
  • Shortness of breath or a sense of being smothered
  • Dizziness or light-headedness
  • Nausea or stomach problems
  • Chest pains or pressure on the chest
  • Choking sensation or a "lump in the throat"
  • Chills or hot flashes
  • Sweating
  • Fear of dying
  • Feelings of unreality
  • Feelings of tingling or numbness
  • Shaking and trembling
  • Fear of losing control or going crazy

DIAGNOSIS


The first step in diagnosing panic disorder is to rule out physical disorders. Some of the symptoms described also occur with medical conditions, such as heart problems. A doctor must first confirm that the patient does not have some type of medical condition that produces these symptoms.

Once physical causes are eliminated, the patient should be seen by a mental health professional. He or she will take a personal history to learn more about the nature of the panic attacks and the patient's feelings about those attacks. They will also assess the way in which the panic attacks affect the patient's daily life.

TREATMENT


As with most mental disorders, panic disorder is treated with a combination of medication and counseling. Many experts believe that panic attacks are caused by an imbalance of neurotransmitters. Neurotransmitters are chemicals that help carry messages between nerve cells in the brain. An excess or shortage of neurotransmitters can cause a wide variety of mental disorders.

Medications prescribed for panic disorder are designed to restore the proper balance of neurotransmitters. For example, a group of drugs called

selective serotonin reuptake inhibitors (SSRIs) control the action of serotonin (pronounced sihr-uh-TOE-nun). Serotonin is one of the most important neurotransmitters in the brain.

Other medications are designed to calm patients down. These medications are called antidepressants. They can often help relieve the worst symptoms of panic disorder.

One of the most effective forms of counseling is called cognitive-behavioral therapy. The purpose of cognitive-behavioral therapy is to help patients understand the nature of their disorder. Patients are taught to recognize the symptoms of an oncoming panic attack and to learn how to respond to the attack in a reasonable way. They learn breathing exercises that help them to calm down and control the physical symptoms of panic.

Patients can also make changes in their lifestyle to reduce the risk of panic attacks. These changes include eliminating caffeine and alcohol from their diets and avoiding certain legal and illegal drugs, such as marijuana, cocaine, and amphetamines.

Alternative Treatment

Some forms of relaxation therapy may help relieve the symptoms of panic disorder. Yoga, biofeedback training, and hypnotherapy may help patients achieve a more balanced outlook on life. Some practitioners recommend certain herbs to strengthen the nervous system. These herbs include lemon balm, oat straw, passion flower, and skullcap. Hydrotherapy (water therapy) may also help patients relax. The recommended treatment is hot Epsom-salt baths with oil of lavender.

PROGNOSIS


Panic disorder rarely improves without treatment. However, a combination of medication and cognitive-behavioral therapy can reduce symptoms in up to 90 percent of patients. Unfortunately, many people with panic disorder are never diagnosed with the condition and may struggle with their symptoms for years. The disorder may become so bad that they can no longer hold a job or hold on to friends.

PREVENTION


There is no way to prevent an initial panic attack. Future attacks can be prevented or made less severe by a combination of drugs and cognitive-behavioral therapy.

FOR MORE INFORMATION


Books

Bassett, Lucinda. From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer your Fears and Put You in Control of Your Life. New York: HarperCollins, 1995.

Bemis, Judith, and Amr Barrada. Embracing the Fear: Learning to Manage Anxiety and Panic Attacks. Center City, MN: Hazelden, 1994.

Peurifoy, Reneau Z. Phobias and Panic: A Step by Step Program for Regaining Control of Your Life. New York: Warner Books, 1996.

Sheehan, Elaine. Phobias and Panic Attacks: Your Questions Answered. New York: Element, 1996.

Wilson, Robert R. Don't Panic: Taking Control of Anxiety Attacks. New York: HarperCollins, 1996.

Zuercher-White, Elke. An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder. Oakland, CA: New Harbinger Publications, 1995.

Periodicals

Kram, Mark, and Melissa Meyers Gotthardt. "Night of the Living Dread." Men's Health (April 1997): pp. 6870.

Organizations

Anxiety Disorders Association of America. 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. (301) 231-9350. http://www.adaa.org.

National Alliance for the Mentally Ill. 200 N. Glebe Road, #1015, Arlington, VA 22203-3728. (800) 950-NAMI. http://www.nami.org.

National Institute of Mental Health. Panic Campaign. Rm. 15C-05, 5600 Fishers Lane, Rockville, MD 20857. (800) 64-PANIC. http://www.nimh.nih.gov.

National Mental Health Association. 1021 Prince Street, Alexandria, VA 22314-2971. (800) 969-NMHA. http://www.nmha.org.

Web sites

The Anxiety and Panic Internet Resources (tAPir). [Online] http://www.algy.com/anxiety (accessed on October 30, 1999).

The Anxiety Network International Homepage. [Online] http://www.anxietynetwork.com (accessed on October 30, 1999).

"Panic Disorder." Internet Mental Health. [Online] http://www.mentalhealth.com (accessed on October 30, 1999).

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Panic Disorder." UXL Complete Health Resource. 2001. Encyclopedia.com. 28 May. 2016 <http://www.encyclopedia.com>.

"Panic Disorder." UXL Complete Health Resource. 2001. Encyclopedia.com. (May 28, 2016). http://www.encyclopedia.com/doc/1G2-3437000201.html

"Panic Disorder." UXL Complete Health Resource. 2001. Retrieved May 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3437000201.html

panic disorder

panic disorder (pan-ik) n. a condition featuring recurrent panic attacks: brief episodes of acute distress in which the heart beats rapidly, breathing is deep and fast, and sweating occurs. The attacks are especially common in people with agoraphobia. The condition appears to be an organic disorder with a strong psychological component.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"panic disorder." A Dictionary of Nursing. 2008. Encyclopedia.com. 28 May. 2016 <http://www.encyclopedia.com>.

"panic disorder." A Dictionary of Nursing. 2008. Encyclopedia.com. (May 28, 2016). http://www.encyclopedia.com/doc/1O62-panicdisorder.html

"panic disorder." A Dictionary of Nursing. 2008. Retrieved May 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-panicdisorder.html

Facts and information from other sites