Living with
Panic Disorder

What is panic disorder?

Panic disorder is characterised by recurrent and unexpected panic attacks.
These attacks may last from for a few seconds to a few minutes and are known to be extremely frightening and uncomfortable.

Panic disorder is often accompanied by agoraphobia (an irrational fear of places or situations where escape is difficult or where you feel trapped or unsafe, helpless or embarrassed; typically, these areas are crowded and enclosed spaces or those that are very public or open).

How do you know if you have panic disorder?

During a panic attack there is a rapid escalation of symptoms over approximately ten to thirty minutes.
The psychological symptoms are severe, including intense anxiety and a feeling that something terrible is going to happen and that you have no control of over it. For example, you may have a feeling of impending doom or that you are going to die.
This is accompanied by multiple physical symptoms, such as:

• Shortness of breath
• Palpitations, especially a racing or pounding heart rate
• Dizziness or light-headedness
• Trembling or shaking
• Chest pain or discomfort
• Tightness in your throat, a feeling of choking or feeling that you cannot breathe
• Sweating
• Dry mouth
• Headache
• Nausea and/or abdominal cramps
• Muscle tension
• Visual disturbances
• Numbness or a tingling sensation
• Hot flashes or chills
• Feelings of unreality or detachment.

People with panic attacks may often consult various doctors and medical specialists, such as cardiologists or neurologists, fearing that they suffer from a life-threatening disease. It is not unusual for many years to go by before an accurate diagnosis is made.
During this time, sufferers tend to avoid situations or places that they fear.

What causes panic disorder?

Any person could develop panic disorder, irrespective of gender, race or socio-economic status. It usually has its onset in early adulthood but can occur at any age.

Studies have shown that about 2 to 4 in every 100 persons may suffer from panic disorder at some point in their lives, and that the prevalence of agoraphobia is even higher.

The first attack often follows a stressful life event such as the death of a close family member or friend, loss of a close interpersonal relationship or after a separation.

Women are two to three times more likely to develop panic disorder than men.

It is now known that brain chemistry and genetic factors play a role in panic disorder, as well as stressful life events or circumstances.
First-degree relatives of people with panic disorder have a five times greater likelihood of developing panic disorder than the rest of the population, which means that if you have a close family member (like a parent or sibling) with panic disorder, you are more at risk of developing the disorder as well.

How is panic disorder diagnosed?

You must seek medical help as soon as possible if you have had a panic attack or experience symptoms of one. While panic attacks are generally not dangerous, they are hard to manage by yourself and can worsen without treatment.
Additionally, you may want to have your symptoms checked by your doctor, as the physical symptoms of panic attack can also resemble those of other serious health problems, such as a heart attack.

Your doctor may diagnose you with panic disorder through one or more of the following ways:

• Physical examination and history taking: Your doctor can look for the physical symptoms of panic disorder such as sweating and trembling. While talking and interacting with a patient, a doctor can also observe their behaviour and general mood and ask questions about their general daily-life experience.
  The physical exam may also look for signs of any underlying heart disease or use an ECG (a heart monitor, or electrocardiogram) to check that any worrying symptoms, like chest pain and shortness of breath, are due to panic disorder and not heart attack.
• Laboratory tests (blood tests): Your doctor can check for hormone and vitamin levels in the blood. This can show if you have thyroid disease, for example, which is known to affect mood and cause anxiety.
• Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them.
  They will also determine whether you have any other mental health condition, like depression or anxiety disorders that are associated with panic attacks and panic disorders. They may also want to talk to your family or people you live with to determine your everyday functioning.
• DSM-5: Your doctor or mental health professional may use the criteria for panic attack that are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Living and managing

While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage your symptoms:

• Stick to your treatment plan, especially if it involves CBT, no matter how scared or fearful you are: Take your medications regularly and as prescribed; do NOT stop taking your medication without talking to your doctor or healthcare provider.
• Avoid stimulant substances like caffeine, alcohol, smoking and recreational drug use: These substances can all trigger or worsen panic attacks. Speak to your doctor or mental health professional about ways to quit smoking or drinking alcohol if you think you are addicted.
• Practice stress management and relaxation techniques: Regularly doing yoga, deep breathing exercises and progressive muscle relaxation – tensing one muscle at a time, and then completely releasing – helps to create a relaxation response in the body.
• Keep physically active and get enough sleep: Regular exercise can help relieve stress and regulate emotions and mood. Getting enough sleep is also important as insufficient sleep can make you feel more anxious.
• See your doctor or find a support group: Get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having panic disorder.
  Find out more about panic disorder on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.

What treatment is available for panic disorder?

The most important step is to consult a professional for an accurate diagnosis. Help is available and in most cases is effective in relieving symptoms.
Both medication and psychotherapy are used, and a combination of these two treatment methods is often recommended. Self-help cognitive-behavioural techniques (CBT) are also of value.

Medications for treating panic disorder include some sedatives that work immediately, but which can cause dependence (for example, benzodiazepines), and those that work slowly and can readily be discontinued (like antidepressants). In general, it is suggested that the slow, but sure, path is the best form of treatment for panic disorder.

The term “antidepressant” is a poor one, as many of these agents are excellent anti-panic medications as well. The most widely used antidepressant agents for treatment of panic disorder are the selective serotonin re-uptake inhibitors (SSRIs) and venlafaxine, a serotonin-noradrenaline re-uptake inhibitor (SNRI), which are safe and easy to use.

Perhaps the key element of the psychotherapy (talk therapy) for panic disorder is “exposure” to feared stimuli. Many people with panic attacks begin to avoid places where they experienced a panic attack; a vicious cycle then develops of more and more restrictions.
Learning not to avoid is a crucial aspect of treatment. By continuing exposure to these stimuli, at the same time experiencing that they do not in fact lead to catastrophic results, may ultimately help to overcome panic attacks.

As in the cognitive-behaviour treatment of other anxiety disorders, this approach is difficult as it initially involves increased anxiety levels. There are, however, several ways to help decrease such feelings of anxiety that trained mental health professionals can use to help you manage these.

What are the complications of panic disorder?

Panic attacks and panic disorder, if left untreated, may cause you to live in a constant state of fear, reducing how you can function in everyday life.

Complications that panic attacks may cause are:

• The development of specific phobias, such as fear of leaving the house, for example.
• Avoidance of places and social situations, leading to isolation and loneliness.
• The development of other mental health conditions like depression, generalised and social anxiety disorders, or even other mental health problems like substance abuse.
• Self-harm, suicide ideation and an increased risk of suicide.