Panic Disorder

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

Almost everyone has occasional moments of anxiety, but panic attacks are sudden and unprovoked, having little to do with real danger. Panic disorder is achronic (long-term) condition that can have a devastating impact on a person's family, work, and social life.

People with panic disorder usually have their first panic attack in their 20s. The first attack usually strikes without warning. A person might be walkingdown 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. Some people feel an overwhelming urge to escape. Others are convinced they are about to have a heart attack, suffocate, losecontrol, or "go crazy." While the attack may last only seconds or minutes, the experience can be so disturbing that the person starts to worry that it might happen again any time.

As the fear of future panic attacks deepens, the person begins to avoid places or situations in which panic occurred in the past. People with severe panicdisorder may even become afraid to leave home. This fear of being in exposedplaces is called agoraphobia.

People with untreated panic disorder may have problems getting to work or keeping their jobs. As the person's world narrows, untreated panic disorder canlead to depression, substance abuse, and in rare cases, suicide.

Scientists aren't sure what causes panic disorder, but they suspect the tendency to develop the condition can be inherited. Some experts think that peoplewith panic disorder may have a hypersensitive nervous system that responds to nonthreatening situations as if they were dangerous. Research suggests thatpeople with panic disorder may not be able to make proper use of their body's normal stress-reducing chemicals.

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

Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic disorder, taking into account not just the actualepisodes, but how the patient feels about the attacks and how the attacks affect everyday life. 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 mistake the symptoms of panicdisorder for true disasters.
  • 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.
  • Howto "desensitize" themselves to their own physical sensations, such as rapid heart rate.

In addition, some medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. It may be necessary totake a drug for several months to determine whether it is working. With effective drugs, treatment usually continues for at least six months to a year.

Patients can make certain lifestyle changes to help keep panic at bay, such as reducing or eliminating caffeine and alcohol and avoiding cocaine, amphetamines, and marijuana.

A variety of alternative therapies may also be helpful in treating panic attacks. Nutritional supplementation (especially with B vitamins, magnesium, andantioxidant vitamins), creative visualization, guided imagery, and relaxationtechniques may help some people suffering from panic attacks. Hydrotherapies, especially hot epsom salt baths or baths with essential oil of lavender (Lavandula officinalis), can help patients relax.

While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very wellto 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 thatnormal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, andjobs.

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