Tuesday, December 8, 2009

Panic Disorder

Panic Disorder

Panic disorder consists of a series of panic attacks that are unexpected, spontaneous, and without apparent cause. Panic attacks are often described by the sufferer as coming,"out of the blue." A panic attack is an interval of very intense fear and anxiety comprised of a variety of physical and psychological symptoms. These symptoms include a growing sense of discomfort, immediate danger, impending doom, and an increasingly intense desire to escape the situation. During the attack, people variously report experiencing a fear of loosing control of themselves or "going crazy", fear of dying, heart palpitations, shortness of breath, sweating and trembling/ shaking, a sense of smothering, chest pain or discomfort, nausea, dizziness, stomach upset, and chills or sweats. These symptoms arrive quickly, usually peak within ten minutes, and can last for 40 minutes or so.

Panic disorder has about a 1% to 2% prevalence within one year. Major Depression also occurs in 50% to 65% of individuals with panic disorder.

About 33% to 50% of individuals who have Panic Disorder also suffer from Agoraphobia. Agoraphobia is a condition in which those with Panic Disorder also avoid or escape situations that they fear they cannot easily get out of, or fear they would be embarrassed trying to escape from. People with Agoraphobia may also fear that they cannot get help while there in that place (for example, a busy highway, a crowd of people, or a shopping mall). It is thought that Agoraphobia develops out of past panic attacks that have become associated with such situations, or that the individuals begin to worry that their panic attacks could happen in these circumstances and they would loose control of themselves, or could not escape.

Possible Causes

Panic Disorder tends to run in first degree relatives of those who are so diagnosed. Twin studies suggest that panic disorder can have genetic heritability.

Neurobiological factors are also implicated. It is possible that irregular norepinephrine activity in the locus ceruleus of the brain may be involved in panic attacks.

Interestingly, antidepressant medications that alter the activity of norepinephrine reduces panic attacks.

From a cognitive perspective, psychologists believe that how a person thinks about their lower intensity anxiety symptoms determines who will develop panic attacks. From this perspective, a person may be very sensitive to changes in their body and arousal levels. But, such individuals may then create an increasing anxiety spiral ,into a full panic attack, by greatly fearing a loss of control of their anxiety. Throughout this upward spiral, perceived increases in anxiety are noted with increased alarm and even more anxiety. This upward spiral in anxiety eventually reaches a level that we call a panic attack.

Training panic attack sufferers to understand this upward physiological spiral and to control this vicious progression has been very successful. The effectiveness of this intervention lends support the cognitive “fear of fear” theory.

A Case Study and Recommendations

One middle-aged salesman complained that he had recently started to have anxiety episodes while driving his car which were identified as panic attacks. He was already beginning to fear driving, especially on multiple lane city roads with heavy traffic, with few places to easily pull over.

Being able to drive and automobile was essential to his ability to make a living for his family. He was gravely concerned. Psychological testing and clinical interviews led to the diagnosis of Panic Disorder without Agoraphobia, though agoraphobia was in the process of development.

The man was also diagnosed with Major Depression. Antidepressant medication and behavior therapy were successful and this man reported his panic attacks stopped and that his depression improved significantly.

If you or a loved one has similar anxiety symptoms, see your family physician for a physical examination and consider a referral to an psychologist experienced in the practice of Behavior Therapy for Anxiety Disorders.

God Bless,

Dr. Tom

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