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 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) 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

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.

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. 68–70.

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).

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.