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
12/8/09

Anxiety Disorders

Anxiety Disorders

We are all familiar with what anxiety feels like. This uncomfortable gnawing feeling in our body, the fear that we might not be in control, the sense that we are vulnerable, or that something bad or awful could happen is not something that we look forward to.

Occasionally, We may experience an even more powerful emotion that is attached to a situation, event, or stimulus that is a physical danger or threat. Strong anxiety attached to these specific things is called fear. Fear is not always bad. For example, fear related to drowning when around water, being out from cover in a lightening storm, or driving in fast and congested traffic, etc., is normal. If we cope effectively and learn how to swim or put on a life-jacket, seek shelter, or slow down, these normal fears are short-lived and beneficial because they help us survive.

Sometimes a person’s anxiety is not attached to anything identifiable. This form of anxiety is called “free floating” because it is not related to anything in particular and seems to exist "all on its own". Experiencing this kind of anxiety can be very unpleasant and fatiguing.

For some people, anxiety may become a periodic or chronic condition that is not associated with any particular environmental event. But, when it strikes it does so in a rapidly intensifying attack which is relatively short-lived, but is never the less terrifying. The fear of these anxiety attacks can cause individuals to escape and avoid the conditions that have been associated with them. This fear can generalize to other similar conditions. Unfortunately, then, these attempts to escape or avoid the feared circumstances cause these individuals to be increasingly socially isolated and unhappy.

In this way, and in others, fears and anxieties can become attached many situations, events, or stimuli that are not dangerous, possess no real threat, and that are normally enjoyable and beneficial.

Anxiety disorders are the most frequent of all psychological disorders. It is estimated that anxiety disorders afflict around 19% of our adult population each year.

Fortunately, most anxiety disorders can be treated with good effect.

My next several postings will focus upon several of the most common anxiety disorders.

God Bless,

Dr. Tom
12/06/09