Panic disorder involves the recurrence of unexpected panic attacks1,2. Thus, the clinical picture of this disorder consists of more than one of such attacks that occur without obvious triggers or cues. Panic attacks are quite common but having one attack does not qualify one for a diagnosis of panic disorder.
Panic attacks are discrete, unexpected events characterized by excessive, abrupt and intense fear which peaks within a few minutes of onset. During this period an individual may feel four or more symptoms from the following list1,2:
- Sweating profusely
- Shortness of breath
- Cold or heat sensations
- Feeling of choking
- Numbness or tingling
- Feeling dizzy, light headed
- Feeling detached from your body
- Stiffness in neck
- Chest pains
- Fear dying
- Fear of losing control
An individual may feel like one is “going crazy” accompanied by cognitive and physical changes. Panic attacks can occur to anyone who may or may not have any pre-existing anxiety disorder. Panic attacks are often followed by an excessive worry about experiencing another panic attack or suffering through consequences due to the panic attack. For example an individual may worry about being judged by others, or the presence of a physical ailment, etc. The worry causes the person to avoid certain situations or activities. Thus, panic disorder is associated with considerable distress in physical and mental functioning3. Females are twice as likely to develop panic disorder as males. The median onset for panic disorder ranges from 20-24 years. However, onset after 45 years of age is a low probability.
Assessment and Diagnosis
The assessment and diagnosis of panic disorder is done by trained professionals such as psychiatrists and clinical psychologists. Assessing the symptoms of panic disorder requires thorough medical and psychiatric evaluation4. Medical assessments become necessary to rule out the presence of other physical ailments that may mimic signs of panic attacks. Diagnostic symptoms are further assessed by the use of rating scales or self report inventories.
Agoraphobia is often found to be co-morbid with panic disorder. It is characterized by intense and marked anxiety about being in situations such as being in open spaces, being in enclosed areas (like a cinema), standing in a queue or crowd, using public transport and being alone and outside one’s home1. Individuals can present with varying degrees of agoraphobia or panic disorder. Thus, clinical judgment is key in identifying this condition
Treatment of Panic Disorder
- Cognitive Behavioral Therapy (CBT): Under the cognitive behavioral model, the panic attack and associated distress are considered as a manifestation of the “fight-or-flight” response that gets activated unexpectedly. Thus, misinterpretations of bodily sensations become a primary focus under this therapeutic treatment3. For example considering palpitations as a signal of an impending heart attack. Such maladaptive interpretations are identified and then worked upon in CBT sessions.
- Other psychosocial approaches5: Psychodynamic psychotherapy is used for the treatment of panic disorder by focusing on the effect of traumatic experiences, childhood experiences, exploring feelings, etc. Eye movement desensitization and reprocessing (EMDR) is also used by targeting the negative effect of life events and experiences associated with panic attacks.
Pharmacological treatments: Anti-panic medications used as a line of treatment in panic disorder, which include the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRI’s) and serotonin norepinephrine reuptake Inhibitors (SNRI’s)4. Pharmacological and CBT are often applied in combination for better outcome of treatment.
Panic disorder is often considered a disabling condition due its pervasive effects on daily life and activities. However, timely and effective management not only helps with controlling panic symptoms, but also bolster the process of dealing with anticipatory anxiety issues5.
1.American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2.World Health Organization (1993). Neurotic, stress related and somatoform disorders. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author
3.Kinrys, G., & Pollack, M. (2004). Panic disorder and Agoraphobia. In Stein, D.J. (Ed.), Clinical manual of anxiety disorders (pp. 13-42). Arlington;VA: American Psychiatric Publishing.
4.Asmundson, G. & Taylor, S. (2008). Anxiety disorders: Panic disorder with and without agoraphobia. In Tadman, A., Kay, J., Lieberman, J.A., First, M.B., & Maj, M. (Eds.). Psychiatry (pp. 1392-1408). West Sussex;England:Wiley Blackwell.
5.American Psychiatric Association. (2010). Practice guideline for the treatment of patients with panic disorder. Retrieved from psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf.