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Panic disorder is marked by panic attacks that strike suddenly and repeatedly without warning. These attacks often occur for no apparent reason. In addition, they are followed by at least a month of anticipatory anxiety -- intense worry about having another attack or about the consequences of an attack (for example, losing control or having a heart attack).
Often those affected will become anxious about having panic attacks in certain public places or situations where they have had them before. This causes them to deliberately avoid those situations or places, a behavior known as phobic avoidance. About one-third of those with panic disorder develop agoraphobia, an extreme form of public avoidance. Many people with agoraphobia grow so afraid of being out in public that they become housebound.
Two-thirds of those with panic disorder also have other psychiatric disorders. About half experience an episode of major depression, which may come either before or after the first panic attack. Research suggests that having panic disorder along with a mood disorder, personality disorder, or alcoholism may increase the risk of suicide.
Panic disorder is a real illness that can be successfully treated. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweating, weakness, faintness, or dizziness. Because many symptoms of panic attacks are indeed physical, a large proportion of panic disorder patients actually seek emergency medical help before it becomes clear that it is a psychiatric disorder.
During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
Research shows a combination of cognitive-behavioral therapy (CBT) and medication may be a more effective treatment for panic disorder than treatments often provided by primary care physicians.
The prevailing theory of panic disorder states that there are two types of panic attacks, spontaneous panic (not related to a fearful idea or event) and 'triggered' panic. Spontaneous panic attacks are thought to be the result of abnormal, over-sensitivity of a brain alarm system whose function is to detect early signs of increased carbon dioxide-which is something that occurs with suffocation. The main symptoms of nonphobic panic are respiratory: shortness of breath, chest discomfort, palpitations and choking or suffocation sensations. Neurons in the solitary nucleus (SN) of the brain stem, and the locus coeruleus (LC) are involved. There is a second wave of symptoms of panic, involving the non-respiratory symptoms (fight/flight) as well as compensation mechanisms in the respiratory system itself (hyperventilation). The panic itself is a time limited episode of short (about 4 minutes) duration, and really, of no danger. It is however, exceedingly uncomfortable and terrifying to those who do not understand it. Spontaneous panic will occur whenever CO2 levels build up (e.g., meditation, before sleep, exercise). Patients with this type of panic chronically hyperventilate and sigh, as a way of preventing sensations of respiratory distress and suffocation. Interestingly, women are more vulnerable to panic attacks premenstrually and just after childbirth. Importaantly, untreated panic attacks are a significant risk factor for suicide. The second type of panic (trigger induced) is the more common type, and is fear induced. It is manifested primarily by symptoms of pounding heart (palpitations), sweating, and trembling. In this type of panic the LC is activated by a real or percieved situation (e.g., of a threat of death or severing of a relationship). Sometimes it can be triggered by an unconscious awareness of a cue that is linked to a previously dangerous situation. While therapy and medications are the mainstay of treatment, relapse rates upond discontinuation of medication are high. Therefore, education and (cognitive behavioral) therapy are very important. It is critical that a thorough evaluation be undertaken, so that poteential physical causes of panic attacks are not missed (e.g., B12 deficiency, hyperthyroidism, medication side effects, caffeinism, lung disease, pheochromocytoma, carcinoid syndrome, brain diseases, mitral valve prolapse, etc)
Panic disorder is characterized by chronic, repeated, and unexpected panic attacks - bouts of overwhelming fear of being in danger when there is no specific cause for the fear. In-between panic attacks, persons with panic disorder worry excessively about when and where the next attack may occur.
A person with panic disorder has current, unexpected panic attacks. Fear of experiencing these attacks can cause people to avoid certain situations. Watch Dr. Oz to learn more about panic.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.