A panic disorder is a form of anxiety characterized by panic attacks that occur unexpectedly and repeatedly – seemingly for no reason. The fear of panicking will lead the person affected to display avoidance behaviors that will modify their everyday life.
- “Panic attacks” are an alarm signal raised by the body – in the case of panic disorder, without a valid reason.
- Panic disorder is one of the manifestations of “anxiety disorders.”
- “Anticipatory anxiety” is the fear of experiencing a panic attack again, which leads to the development of “avoidance behaviors.”
- “Agoraphobia” is the fear of being in places where it might be challenging to flee or get help during a panic attack.
Panicking is the everyday anxiety we all feel, but one which doesn’t bring on severe physical symptoms like panic attacks. When people have strong feelings of panic or are panicking, their thoughts are similar to those experiencing attacks. We’ve all had moments where we feel a loss of control or overwhelming, irrational fear, right?
In this article, we will explore:
- What panic disorder is
- Common signs of panic disorder
- Causes of panic disorder
- Common complications of panic disorder
- Speaking out and consulting a doctor about panic attacks
- The effect of exercise on panic attacks
- Similar psychiatric conditions to panic disorder
- Treatment options for panic disorder
What is panic disorder?
One speaks of panic disorder when one lives in the anxiety of a new panic attack, which leads to modifying one’s behavior with “avoidance behaviors.” Panic disorder is one of the manifestations of “anxiety disorders.” Anxiety and panic attacks are not generally severe when you experience them infrequently or as a one-off, but they can be worrying, even traumatic, for both the person and those around them.
A panic attack is a very painful acute anxiety attack (“terror attack”) that appears suddenly and unexpectedly and lasts from a few minutes to a few hours. The person will experience intense fear (of dying, or going crazy, for example) and a feeling of immediate danger with unpleasant physical perceptions (palpitations, sweating, tremors, chest pain), which will typically aggravate the fear felt, giving the person the impression of completely losing control.
When real danger triggers a panic attack, the reaction of terror may save the person’s life. But in the case of a person experiencing panic attacks due to panic disorder, the terror reaction occurs when there is no reason to raise the alarm. These panic attacks often happen unexpectedly in a familiar setting or situation with no real danger. However, our bodies and minds don’t distinguish between a ‘real’ threat and an imagined one – the feeling of terror is just as strong and authentic and associated with extreme physical and psychological manifestations.
Gradually, after someone experiences panic attacks repeatedly, “anticipatory anxiety” sets in. The person lives in fear of having another panic attack and the embarrassment and shame that go alongside the physical experience. This fear of seeing it reappear anywhere and anytime can lead to “avoidance behavior,” which occurs in all areas:
- professional (absenteeism)
- personal (fear of leaving home)
- family (conflict)
These avoidance behaviors result in a loss of opportunities and sometimes friendships and relationships.
Panic disorder can sometimes be accompanied by “agoraphobia,” the fear of being in places where it might be challenging to flee or seek help in the event of a panic attack. Some agoraphobes circulate only within a limited perimeter or need to be accompanied by a trusted person. As you can imagine, this heavily impacts their closest friends and relatives.
The frequency of panic attacks varies from person to person. Some people will experience only one or two over their entire life, while others will have several a day.
Signs of Panic Disorder
Often, the signs of a panic attack come on suddenly, with no actual trigger – an intense burst of fear out of nowhere, completely unpredictable. Symptoms reach their maximum intensity in a few minutes and last, on average, half an hour.
The main signs of a panic attack are physical, psychological, and – like we’ve already talked about – behavioral.
The physical signs vary from person to person and from one panic attack to another and can lead to looking for other illnesses (infarction, asthma, etc.). These may be signs of heart disease as an acceleration of the heart rate may occur (“tachycardia”), even actual palpitations, with pain or discomfort in the chest. There may also be a respiratory discomfort suggestive of lung disease with a feeling of suffocation, malaise, dizziness, or of an acute belly disease with pain in the belly, nausea, vomiting, or diarrhea.
Sometimes there are tremors, muscle cramps, blurred vision, ringing in the ears (“tinnitus”), sweating, chills, or hot flashes. Only after careful examination by the doctor will there be a determination of these as signs of anxiety (vs. a physical disease). Unpleasant physical sensations increase anxiety and fear, creating a vicious circle.
In this way, panic disorder also influences an individual psychologically – and in more ways than one! There can be a psychosomatic effect that can evoke asthma, cardiac disorders, digestive, etc. The psychic sensations are dominated by catastrophic thoughts and loss of control sensations associated with various fears: fear of illness or disease, choking, fainting, dying, having a heart attack, or going crazy.
To fight these fears, some people will quickly flee the place where they are by trying to hide the trying experience; others are flabbergasted and unable to move. In the most severe forms of a panic attack, an impression of depersonalization and/or derealization can exist with a loss of contact with reality. These are the behavioral signs of panic disorder.
Panic Disorder Causes
Panic disorder does not have a single cause; it results from the combination of:
- Severe stress
- Genetics
- Temperament – some people are more prone to stress and experience negative emotions
- Brain function changes
According to some theories, it is an inappropriate or excessive reaction to stress. Thus, different situations of fear and anxiety (including not being able to breathe) can trigger hyperventilation, which can cause certain signs, in particular dizziness, numbness of the limbs, tremors, and palpitations. In turn, these feelings worsen fear and anxiety. It is, therefore, a vicious circle that is self-sustaining through certain neurotransmitters in the brain.
There are also several risk factors for the condition, including:
- Smoking or consuming excessive amounts of caffeine
- Family history of panic disorder
- Experiencing physical or sexual abuse in childhood
- Major life stress or traumatic events (e.g., divorce, the arrival of a baby, death, serious illness, sexual assault, serious accidents, etc.)
Much like other mental health disorders, panic disorder usually appears in late adolescence or young adulthood. The first crisis can occur after an instance of great psychological stress, for example, the loss of a loved one, a separation, an illness, or an accident. Panic attacks, especially their anticipation, persist even after the stressful situation has disappeared.
Case Study: Dan Harris Panic Attack
In 2004 Dan Harris had a panic attack on Good Morning America. He’s since said fear, then humiliation “rushed in” after knowing he’d had it on live TV. It had been “building for years.”
Harris concluded, “it’s the inner voice that can control us…We all spend time fixating on these self-defeating voices.” His inner voice was pushing him to succeed, and he doubted if he was good enough. So he became a workaholic. He slowed down after a long time in war zones, and that’s when the attack happened. Recreational drug use played a large part in panicking on live TV.
He found meditation, much of which drew from Buddhism, was the best cure for panic attacks after many months of speaking and working with “gurus” who claimed to have solutions.
10.6 million people viewed the ABC news broadcast where he had the attack on live TV.
How Does Panic Disorder Progress?
Without proper help, panic disorder can progress and cause even more distress. The constant threat of not knowing when or where a new crisis will occur can cause “anticipatory anxiety, “that is, the constant fear that other panic attacks will occur. It is not enough to avoid feared situations or places to prevent this feeling of anxiety or fear.
Panic disorder most often develops chronically. Untreated, it often evolves with fluctuating phases of spontaneous remission but also stages of relapses that can span several months or years.
Certain psychiatric disorders such as “agoraphobia” or depression can appear secondarily to the repetition of panic attacks. The fear of being invaded by a new attack in a public place without the possibility of being rescued can induce new fears, such as the fear of going out, being in the presence of strangers, or participating in various social or professional activities.
What Are the Complications of Panic Disorder?
Panic attacks, anticipatory anxiety, and avoidance behaviors can have severe consequences if left untreated. These could be:
- Avoidance of so many social situations that the individual loses close friends
- Psychiatric conditions such as anxiety or depression
- Frequent health concerns
- Developing specific phobias
- Higher risk of suicidal ideation and suicide itself
- Professional and personal difficulties
- Financial challenges
Some people experiencing panic disorder may begin to abuse alcohol, recreational drugs (cannabis), or pharmaceutical drugs such as benzodiazepines, to avoid panic attacks.
Other psychiatric disorders are very frequently associated with panic disorder: social phobia, “generalized anxiety disorder,” obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD). Without proper care, they only worsen the signs inexorably.
When Should You Talk about a Panic Disorder?
Panic disorder usually appears in late adolescence or early adulthood.
It is easy to confuse it with many other medical or psychiatric problems. People usually see several doctors before getting a diagnosis.
In the event of an intense and unexpected anxiety attack, with no real triggering factor, especially if avoidance behaviors develop, it is necessary to quickly consult a treating doctor because he alone will be able to make sense of the difference between an episode of acute anxiety and a disease with similar symptoms.
When to Consult a Doctor
As soon as the first panic attack occurs, it is essential to consult a doctor.
Most panic disorders occur on healthy physical grounds. It is vital that the doctor carefully examines and reassures the person who is particularly afraid of having an undetected organic disease. He can suggest listening and assessing the state of anxiety. Early consultation also generally helps to reduce apprehension about a new crisis.
In general, the earlier people get support, the better the prognosis for the disease will be. It is essential to act before the troubles take on significant proportions in everyday life. It is possible to consult your general practitioner or a therapist to discuss adapted and personalized care. Many people find journaling about their challenges also therapeutic.
Exercise and Panic Attacks
One well-known way to combat anxiety is by walking or doing other forms of physical activity. Regular exercise seems effective at improving panic disorder symptoms, but scientific studies are yet to confirm this.
Many people find that they need individualized advice about what exercises would best suit their specific needs.
Indoor cycling is effective for dealing w/ panicky states because biking requires very little energy yet offers excellent mental stimulation.
Biking also releases endorphins, which have mood-boosting and pain-relieving effects. This can make it an ideal activity for people who suffer from panic attacks.
For some people, though, the thought of exercising can trigger a panic attack. If this is the case, starting slowly and building up gradually is important. Starting with simple activities like walking or biking before moving on to more strenuous exercise can be helpful.
It’s also important to focus on breathing during exercise, as proper breathing can help to prevent panic attacks. Some people find it helpful to wear a heart rate monitor to keep track of their heart rate and ensure they’re not overexerting themselves.
How to Diagnose Panic Disorder
Panic disorder is defined by at least one panic attack and a significant apprehension over a month or more. Panic attacks are a very distressing experience and leave traumatic imprints: the victim is constantly thinking about them and living in fear that other attacks will occur at any time. The anticipation anxiety then sets in, corresponding to the fear of suffering from such a crisis again. The diagnosis of panic disorder is made when the anticipation of crises has lasted for more than a month and has a real impact on personal, family, and professional daily life.
The frequency and intensity of panic attacks can vary significantly from one individual to another. It can last through one’s life or several times a day in a shorter period. Panic attacks are unexpected in panic disorder; exposure to feared objects or situations does not usually trigger them, as in the case of phobias. Nor should they be triggered by the consumption of psychoactive substances such as alcohol, drugs, or medication.
Panic disorder has a substantial impact on the functioning of affected people. All of life is reorganized around the fear of reliving a new crisis. The search for new avoidance strategies likely to reduce the risk of their occurrence takes precedence over all aspects of life: personal, family, and professional.
Confusing Panic Disorder With Other Psychological Conditions
Panic attacks can also be present in other related anxiety disorders, such as “social phobia” or “specific phobia” (seeing a spider, for example). They can be confused with anxiety disorders due to other psychiatric pathologies such as depression and schizophrenia.
Many diseases of the body can cause identical signs of panic attacks. It would be unreasonable to say that breathing difficulties or tetany problems are always synonymous with anxiety attacks. It is essential to consult your doctor in all cases to get the correct diagnosis.
Apart from situations of fear or normal anxiety, it is also possible to confuse panic disorder with anxiety induced by a substance (cocaine, amphetamines, cannabis) or alcohol withdrawal.
The most challenging situation is differentiating panic attacks from anxious manifestations due to certain medical diseases: prolapse of the mitral valve, high blood pressure, asthma, temporal epilepsy, duodenal ulcer, migraine, and others.
Does Psychotherapy Help People With Panic Disorder?
The effectiveness of psychotherapy in treating panic disorder has been scientifically demonstrated. In many cases, it is even the treatment of preference before resorting to medication.
Cognitive-behavioral therapy (CBT) is the standard psychotherapy for treating panic disorder. The person learns to recognize the signs as soon as they appear, avoid misinterpretations, and remain in the situation rather than flee if a panic attack occurs. They also know how to reduce their fears and thus acquire a better grip on the situation. Therapy aims to change thought patterns, helping people analyze their feelings. It enables the person to distinguish between realistic and unrealistic thoughts.
It can sometimes be interesting to combine it with other types of psychotherapy (analytical, systemic therapy, etc.) to develop assertiveness to improve emotional control and develop new behaviors adapted to react to situations deemed to be distressing.
Analytic psychotherapy (psychoanalysis) can be used when there are conflicting elements related to the person’s personal history.
Panic Disorder Medications
Among the drug treatments, several classes have been proven to reduce the frequency of acute anxiety attacks. Antidepressants are the first choice because they help treat panic disorder over the long term. “Selective serotonin reuptake inhibitors” (SSRIs) and “tricyclic antidepressants” are the most used. The doctor prescribes antidepressant treatment for 12 weeks; then, they reassess the individual to decide whether to continue the medicine or change it.
The anxiolytics such as benzodiazepines are prescribed if anxiety and agitation are important. They must, however, be used in the short term because of their side effects and the risks of addiction. Therefore, anxiolytics are preferred because they don’t have drawbacks with antihistamines (hydroxyzine) or a beta-blocker (propranolol).
CBD and Medical Marijuana and Panic Disorders
Those who want to avoid taking traditional antidepressants or find them ineffective increasingly turn to CBD for panic attacks or non-psychoactive mood boosters.
In recent years, more and more people are turning to medical marijuana and CBD to treat panic attacks. While research is still ongoing, studies have shown that medical cannabis can address some symptoms associated with anxiety disorders, including racing heart rate and sudden fear.
Cannabidiol (CBD) sometimes produces a calming sensation within the body, which can help reduce panic and fear when taken in small doses. Marijuana can also be an analgesic for physical pain experienced during panic attacks.
CBD also modulates the production of vital neurotransmitters such as norepinephrine, dopamine and serotonin, the latter of which is the chief stabilizer of mood and well-being. Acute sensations of terror or the imminent loss of control are fundamentally caused by an imbalance of neurotransmitters and hormones. By binding to and inhibiting serotonin-releasing receptors, CBD may be able to act as a natural alternative to SSRIs and maintains a healthy balance of vital neurotransmitters when administered in the correct dosage.
There’s an impressive amount of data in current research that substantiates the case for developing CBD-based anxiolytic medication to treat or reduce the effects of panic attacks. A 2020 comprehensive review by Professor Mortimer Mamelak from the University of Toronto’s Department of Psychiatry found that cannabinoids are uniquely effective at interposing and suppressing somatic manifestations of acute anxiety disorder, such as attacks that can occur with post-traumatic stress disorder (PTSD).
A 2020 systematic review by Lancet Psychiatry’s Black, Stockings, Campbell et al also acknowledged CBD’s early and effective onset of anxiolytic action when compared to commonly-prescribed drugs such as antidepressants – which have a much longer latency period of response – and benzodiazepines, which carry a caveat of dangerous side effects. CBD does not induce motor impairment, sedation, dependency or withdrawal and is thus a candidate for extensive study.
Black’s review also emphasized the need for sound laboratory practices, as established and maintained by international standards, in the testing and study of CBD’s viability in developing new medication. According to the review, “randomized, double-blind, placebo-controlled clinical trials with larger sample sizes and chronic administration are still necessary to ascertain the safety, adequate dose range, and efficacy of cannabinoids as medicines,” whether for the management of anxiety disorder or other conditions.
How to Prevent Panic Disorder
There is no real “common sense” method to prevent panic attacks, mainly because they usually occur unpredictably. Appropriate pharmacological and non-pharmacological management may include learning to manage stress and prevent crises from becoming too frequent or too debilitating.
A healthy lifestyle is essential to prevent the occurrence of new panic attacks and reduce anxiety and bring it back to a tolerable level.
Maintain
- Good work/rest/ leisure balance
- A balanced diet, low in sugars, low consumption of caffeine, alcohol, and nicotine
- Restful and sufficient sleep
- Regular physical exercise
- Relaxation activities (meditation, relaxation, yoga)
Certain factors can trigger panic attacks. These vary enormously from one person to another, and in many cases, there is no clear, identifiable trigger.
Several studies have shown that the influence of traumatic events experienced during childhood, especially concerning separation anxiety (fear of separating from one’s parents), is common among those suffering from panic attacks.
Among other factors which are often found, we can cite the following stressful factors: a context of relationship difficulties such as divorce or dismissal; bereavement or illness; the consumption of alcohol, cannabis, or illicit drugs; certain anxiety-provoking situations such as public transport, planes and crowds; and abrupt taking or stopping of certain medications, particularly antidepressants.
How to Live With a Panic Disorder
Healing can take several months, especially if there are other illnesses to consider (depression, phobia, alcohol or drug abuse).
Consultation and diagnosis are essential steps toward the cure of the disease. Recognition in itself helps relieve anxiety around symptoms.
The support of family and good adherence to treatment (psychotherapy and/or medication) are essential to promote healing in the long term.
Healthy living, relaxation activities, and a balance between professional, personal, and family life help prevent crises and anticipate them. Little by little, it is possible to free yourself from your avoidance behaviors and find freedom daily.
