PANIC DISORDER

General Information

DEFINITION--A severe, spontaneous form of anxiety that is recurrent and unpredictable. Most attacks last 2-10 minutes, but some may extend over an hour or two. This type of anxiety occurs with attack-like symptoms (often during sleep), while chronic anxiety (generalized anxiety) is a persistent state of anxiety.

BODY PARTS INVOLVED--Central nervous system; heart; lungs; skin; hands; feet.

SEX OR AGE MOST AFFECTED--Twice as many females as males; young adults, ages 25-44.

SIGNS & SYMPTOMS

Physical symptoms:

• Palpitations, rapid heart beat; chest pains.
• Shortness of breath; choking feeling; hyperventilation; weakness or faintness; fainting (occasionally); sweating and trembling.
• Numbness and tingling around the mouth, hands and feet.
• Muscle spasm or contractions in the hands and feet.
• Feeling of "butterflies in the stomach".

Emotional symptoms:

• Intense fear of losing one's sense of reason (fear of going crazy); fear of dying; sense of terror, doom or dread.
• Feelings of unreality, loss of contact with people and objects.

CAUSES

• Most often an unresolved emotional conflict or unrecognized conflict. The physical symptoms are a result of the autonomic nervous system being set in motion by the arousal of frightening fantasies, impulses and emotions.
• A variety of disorders can simulate panic attacks (heart rhythm problems, angina, respiratory illness, asthma, obstructive pulmonary disease, endocrine disorders, seizure disorders, stimulating drugs and withdrawal from certain drugs).

RISK INCREASES WITH

Stress; feelings of guilt; fatigue or overwork; illness; alcohol and drug abuse.

HOW TO PREVENT--There are no specific measures to prevent a first panic attack; therapy may help prevent additional episodes.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory tests as needed to rule out other disorders.

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment, if the cause is organic or symptoms are prolonged.
• Psychotherapy or counseling to uncover the emotional conflicts causing the anxiety and finding ways to deal with them.

POSSIBLE COMPLICATIONS

• Chronic anxiety or depression.
• Phobias, including agoraphobia, a fear of being alone or being in public places.
• Drug dependency.

PROBABLE OUTCOME--For many, this disorder may run a limited course with a few attacks and long periods of remission. For others, treatment with psychotherapy and/or medication is effective.

How To Treat

GENERAL MEASURES--

• Talk to a friend or family member about your feelings. This sometimes defuses your anxiety.
• Keep a journal or diary about your anxious thoughts or emotions. Consider the causes and possible solutions.
• Join a self-help group. Call your local mental health society for referrals.
• Learn relaxation techniques. For some, meditation is effective.
• Reduce stress (see How to Cope with Stress in Appendix).
• For hyperventilation symptoms, cover the mouth and nose with a small paper bag and breathe into it for a few minutes.

MEDICATION--Your doctor may prescribe a tricyclic antidepressant, MAO inhibitor, benzodiazepine or beta-blocking agent. The medicine may be slowly reduced or discontinued after 6 months to a year to determine if the panic attacks return. If not, the medicine can be discontinued.

ACTIVITY--

• Get physical exercise regularly.
• Get adequate rest at night.

DIET--Consider giving up caffeine (coffee, tea, soft drinks). You may experience withdrawal symptoms of headache or tiredness, but they stop in a few days.

Call Your Doctor If

• You have symptoms of panic disorder that don't diminish with self-treatment.
• Treatment program fails after 8 weeks.
• New, unexplained symptoms develop.