Panic disorder – panic attacks, causes, symptoms, diagnosis, treatment & pathology

I’m sure you’ve heard someone say or joke
about “having a panic attack,” but panic attacks are very real situations where someone
has a sudden period of intense fear or discomfort that something bad’s going to happen, and
that there’s some imminent threat or danger. These feelings are often so intense that they’re
accompanied by physiological symptoms like heart palpitations, dizziness, or shortness
of breath. These symptoms peak within the first 10-20 minutes, but some might last hours.
Sometimes patients having a panic attack might feel as though they’re having a heart attack
or some other life-threatening illness. Panic attacks can happen even in familiar places
where there are no real threats, and therefore they’re unpredictable, which can further
increase anxiety about when the next panic attack is going to happen. In order to be characterized as a panic attack,
the Diagnostic and statistical manual for mental disorders, the fifth edition, or DSM-V,
says patients need to have an abrupt onset of four of the following thirteen symptoms:
pounding heart or fast heart rate, chest pain or discomfort, , sweating, trembling, shortness
of breath, nausea, dizziness, chills, numbness, feelings of choking, feelings of being detached
from oneself, fear of losing control, and fears of dying. Admittedly, some of these symptoms might naturally
happen together, and so they can be very hard to tease apart. For example, it would be unusual
for a person that is sweating, feeling dizzy, and feeling chills, to also not be trembling.
It’s also important to note that some of these are physical symptoms whereas others
are specific thoughts/ideas. Panic attacks can happen in the context of several mental
disorders including depressive disorders, posttraumatic stress disorder, and substance
abuse disorders. It can also, however, happen in the context of a panic disorder, which
is basically defined by the panic attacks being recurrent, meaning 2 or more, and unexpected.
In addition, the DSM-V says that for somebody to be diagnosed with a panic disorder, they
also need to have persistent worry or change in behavior because of their panic attacks.
Also, the panic attacks can’t be due to the effects of some substance, like an illicit
drug or medication. Finally, the panic attacks aren’t better explained by some other anxiety
disorder, like agoraphobia or social anxiety disorder. Patients with a panic disorder can’t predict
where the panic attack will happen next, so it’s important to get treated before patients
develop something called avoidance, which is when they actively avoid the places where
one previously happened. They might stop doing activities that they think might trigger the
attacks, like going to the park, riding in elevators, or driving. Avoiding these situations
might temporarily reduce symptoms of anxiety about having a panic attack, but it makes
daily life really tough, right? And ultimately doesn’t stop the attacks from happening. Sometimes patients get anxiety just thinking
about the possibility of having a panic attack, and this is called anticipatory anxiety. Anticipatory
can be particularly debilitating because it might cause the patient to be reclusive and
choose to endure the attacks alone instead of risking an attack in public—this situation
can actually lead to the development of agoraphobia, a fear of going into crowded spaces. Panic disorder is twice as common among women
as men, and it appears to have a genetic component and run in families, although we don’t know
exactly what causes it. Treating someone with panic disorder usually involves psychotherapy,
medication, or both. Cognitive behavior therapy has been an effective type of psychotherapy
for patients with panic disorder, and this relies on five fundamental steps. First, they
just learn about panic disorder, and how to identify certain symptoms. Second, they monitor
their panic attacks using a diary. Third, they work on breathing and relaxation techniques.
Fourth, they start rethinking and changing their beliefs about the severity of a panic
attack from totally catastrophic to a realistic level. Fifth, they allow themselves to be
exposed to situations that provoke fear and anxiety. Now if medications are used, antidepressants
like SSRIs are the most commonly prescribed, which have sedative and relaxing effects.
Anti-anxiety medications might also be prescribed, like benzodiazepines, which also have a relaxing
effect, although the use of anti-anxiety medications can sometimes lead to unwanted side effects
like tolerance, dependence, and withdrawal. If very severe, anti-seizure medications may
sometimes be prescribed. Overall though, between cognitive behavior
therapy and medication, many patients can be effectively treated for panic disorder.

27 Replies to “Panic disorder – panic attacks, causes, symptoms, diagnosis, treatment & pathology

  1. I haven't had a panic attack since I was a kid at school and recently, I got a really bad one out of nowhere. I felt like I was going to choke on my tongue, my heart was racing, my hands and feet went cold… Now I'm on edge that I'm going to get another one. I haven't felt right for a week ;-;

  2. Well my therapist believes I could have a panic disorder even though my panic attacks aren’t from an unknown source, I know why I have them (it’s always social events or the mandatory dance class I have to take for my course) it’s basically just because I avoid situations that I know will cause a panic attack leading to me having no social life and causing problems with my university course

  3. Pounding heart/fast heart rate
    Cheat discomfort
    Shortness of breath
    Feelings of being detached from one self
    Fear of losing control
    Fear of dying

    Yep. That’s me:)

  4. I had 2 but I did not breakdown. Another 2 times I broke down but I had few to none symptoms of a panic disorder. Whattt???

  5. Anxiety is gut problem cause by stones in the liver bile duct….you can fix that with andreas Moritz liver flush

  6. Im feeling this when i'm thinking a negative thoughts,thinking i might fail,or having a new friends maybe they dont like me…i dont really trust peopleeee. When they have FAKEU PERSONALITIES/ATTITUDES

  7. I thought I was having a stroke. My face went numb, lost speech, pounding heart, dizziness, shaking , feeling of impending doom – awful

  8. Just wasted my time ……. leant nothing new …… they have to hurry up and develop safe drugs for this disgusting and debilitating disorder …

  9. I had my first panic attack when I was at school. It Wasa loud noise/voice which caused this and i remember, that I covered my ears the whole time, it felt like everything turned around in my head, I couldn‘t breath and talk. I was sweating and trembling and crying during class and I couldn‘t walk, so I had to stay inside..

  10. the moment i get in a vehicle and drive more than a mile from my house the panic starts. i have to take Klonopin an hour and ahalf before i go anywhere. it sucks. I've had anxiety since i was 17 but the panic disorder only started within the last 3 years. I'm now 35. but i manage.

  11. I had an operation like 6 months ago but before that I had been in so much pain that I Don't want to remember it…I had never been afraid of pain before that I could bear all the pain but after that I really can't bear amy pain.. After I found out that there is a chance that that pain cam come back I can't breathe I can't sleep(because I had that pain while I was sleeping).. What can i Do to avoid a this panic..I can't breath I can't eat I can't sleep.. It really freaks me out

  12. i’ve had these but the attacks eventually goes away when i cry so hard, do others experience the same thing?

  13. I get dizzy can’t breathe ya know the normal stuff but I get these waves of an out of body feeling like in my legs. like they feel weightless and whole body feels like someone hit a refresh button on my whole body. It doesn’t make any sense

  14. Is it normal to cry non stop during a panic attack? I feel like I had a panic attack but I’m not sure, I was trembling, feeling dizzy, heart pounding and I was really scared, but none of the symptoms I’ve read mention crying. I spent one hour crying and I wouldn’t respond to anyone. Is that a panic disorder or not ? I’ve experienced it twice.

  15. I have epilepsy and take lamictal that is a mood stabilizer and used to treat bipolar disorder as well as epilepsy, but even that isn't helping with my anxiety which is strange.

  16. For me, since I was a toddler, I get very dizzy. It feels like I'm spinning in all directions at once. Head over heals and around and around. When it begins it feels like it comes into my body from behind my neck. It oozes in and takes over.

  17. This problem started for me about 2 years ago. I was just walking to school to practice for a performance i had to do with my class and out of nowhere i started to feel super dizzy and i started panicking because i didn't know what was happening to me. Ever since that day my life has been a living hell! I can't live normally anymore. I'm anxious 24/7. I feel dizzy amd anxious every single day. It's been so hard and what sucks the most is that i have no one but myself to help me. My mom and brother always call me crazy and tell me to chill out but they just don't understand how hard it is for me.

  18. I got diagnosed with this it’s ruining my life! I constantly am out of breathe, nauseous, dizzy, my heart races, I cry uncontrollably and I can’t breathe

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