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Panic attacks are sudden, discrete periods of intense anxiety, mounting physiological arousal, fear and discomfort that are associated with a variety of somatic and cognitive symptoms. The onset of these episodes is typically abrupt, and may have no obvious trigger. Although these episodes may appear random, they are considered to be a subset of an evolutionary response commonly referred to as fight or flight that occur out of context, flooding the body with hormones (particularly adrenalin) that aid in defending itself from harm. Experiencing a panic attack is said to be one of the most intensely frightening and uncomfortable experiences of a person's life. (Bourne 2005).
According to the American Psychological Association the symptoms of a panic attack commonly last approximately ten minutes. However, panic attacks can be as short as 1-5 minutes, while sometimes panic attacks may form a cyclic series of episodes, lasting for an extended period, sometimes hours. Often those afflicted will experience significant anticipatory anxiety and limited symptom attacks in between attacks, in situations where attacks have previously occurred, and in situations where they feel "trapped". That is, where escape would be obvious and/or embarrassing.
Panic attacks also affect people differently. Experienced sufferers may be able to completely 'ride out' a panic attack with little to no obvious symptoms or external manifestations. Others, notably first time sufferers, may even call for emergency services; many who experience a panic attack for the first time fear they are having a heart attack or a nervous breakdown.
Many who suffer from panic attacks state they are the most frightening experiences of their lives. Sufferers of panic attacks report a fear or sense of dying, "going crazy", and/ or experiencing a heart attack, feeling faint, nauseous, or losing control of themselves. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the sympathetic "fight or flight" response).
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms may include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering or derealization, or the feeling that nothing is real. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety, and forms a positive feedback loop.
Often when shortness of breath and chest pain are the predominant symptoms the sufferer incorrectly appraises this as a sign or symptom of a heart attack. This results in the person experiencing a panic attack to seek treatment in an emergency room.
The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not always indicative of a mental disorder, nor are they uncommon. Up to 10 percent of otherwise healthy people experience an isolated panic attack about once per year, and 1 in 60 people in the U.S. will suffer from a panic disorder at some point in their lifetime. (Anxiety Disorders Association of America)
Triggers and causes
While the various symptoms of a panic attack may feel that the body is failing, it is in fact protecting itself from harm. The various symptoms of a panic attack can be understood as follows. First, there is frequently (but not always) the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response wherein the person's body prepares for strenuous physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation) which may be perceived as shortness of breath (dyspnea), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH (respiratory alkalosis or hypocapnia), which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness. Lastly, a panic attack can cause blood sugar to be drawn away from the brain and towards the major muscles. This can also cause derealization and lightheadedness.
The "Panic Trick" (Carbonell 2004)
Many experts and researchers including Dr. David Carbonell describe panic attacks and Panic Disorder as a "trick" (a very effecrive trick) on two crucial fronts. Firstly, it tricks the sufferer into believing what they are experiencing is dangerous (i.e. having a heart attack, fainting, insanity, and/or "doing something crazy") when a panic attack presents absolutely no danger whatsoever. Secondly, they trick the afflicted into doing anything and everything that they believe will help them when it actually makes the panic attacks worse- the second component of the trick. These activities would include avoidance behaviors, trying to control panic attacks, fighting panic attacks,superstitions and rituals to avoid panic attacks and excessive self-protection. That is to say, what people faced with panic attacks do, most often, perpetuates the panic and sometimes turns panic attacks into Panic Disorder.(Carbonell 2004)
The symptoms of a panic attack can be remembered with the mnemonic: STUDENTS FEAR the 3 Cs: Sweating, Trembling, Unsteadiness/dizziness, Derealization/depersonalization, Elevated heart rate (tachycardia), Nausea, Tingling, Shortness of breath, FEAR of dying, FEAR of losing control, FEAR of going crazy, 3 Cs - Choking, Chest pain, Chills.
Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty traveling from this "safe place". The word "agoraphobia" is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as "a fear of the marketplace" however the essence of agoraphobia is a fear of panic attacks. This translation is the reason for the common misconception that agoraphobia is a fear of open spaces, and is not clinically accurate.
People who have had a panic attack in certain situations — for example, while driving, shopping in a crowded store, going to a party, experimenting with psychedelic drugs, etc. — may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place. Agoraphobia of this degree is extremely rare. It should be noted that upwards of 90% of agoraphobics achieve a full recovery. Agoraphobia is actually not a fear of certain places but a fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing.
The thinking behind agoraphobia usually follows the line that were a panic attack to occur, who would look after the person, how would he or she get the assistance and reassurance they needed? The vulnerability grows from the feeling that once victims of agoraphobia are caught in the anxiety, they are suddenly unable to look after themselves and are therefore at the mercy of the place they find themselves in and the strangers around them. In its extreme form, agoraphobia and panic attacks can lead to a situation where people become housebound for numerous years.(Barry 2006). In Japan this condition is coined and down-played as Hikikomori, as it is rather commonly perceived by the Japanese psychiatrists as a state of mere laziness and indulgent behaviour forgiven by the mercy of the sufferers family. General perception amongst the Japanese are that Hikikomori sufferers are lazy freeloaders of the society.
It is important to note that agoraphobia is by no means a hopeless situation. Sufferers often do not realize that they have experienced these same situations before and nothing terrible occurred. Successful treatment is possible with the right combination of therapy and medication.
Agoraphobia is often described as a fear of having 'no place to run or hide' if one does have a panic attack.
People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have Panic Disorder. Panic Disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.
Paper bag rebreathing
Some panic attack sufferers and even some doctors recommend breathing into a paper bag as an effective short-term treatment of an acute panic attack. However, this can prove to be fatal in some cases, and it is strongly advised against to engage in such a practice, by well-respected medical studies dating back to 1989 and 1994.
The benzodiazepine class of drugs includes diazepam, lorazepam, alprazolam, and clonazepam. While these drugs are highly effective and very fast acting in stopping panic, they may not be the best solution. First, the body can build a tolerance to the drug, much like alcoholic beverages, making it need more to feel the same benefit. Second, because of this, there is a high risk of abuse and addiction in some people.
As such, some doctors may prefer to prescribe an antidepressant, particularly an SSRI (such as paroxetine, sertraline, fluvoxamine, or fluoxetine), which after an initial titration period may be effective at reducing anxiety. SNRIs such as Venlafaxine can also be prescribed. Studies[specify] have proven they may be more effective than the SSRIs for anxiety. NaSSAs such as Mirtazapine have also been found effective, particularly with individuals whose anxiety and panic causes insomnia.
Treating a Panic Attack
All persons experiencing persistent and frequent panic attacks should consult their physicians. However, many experienced sufferers treat panic attacks with some the following methods and techniques:
Interoceptive Desensitization/Symptom Inductions
One particularly helpful and effective form of therapy is Cognitive Behavioral Therapy (CBT). Interoceptive Desensitization intends to desensitize the afflicted from the symptoms of panic attacks. In a study by Barlow & Craske (1989), 87% of the individuals that participated in the two of four treatments that involved Interoceptive Desensitization were free of panic at the end of treatment and these results were maintained at a 2-year follow up. In controlled studies of Interoceptive Desensitization treatments compared to other treatments, those treatments that included Interoceptive Desensitization were found to be significantly superior to other treatments such as muscle relaxation alone, or education or insight-oriented treatments. Interoceptive Desensitization often leads to a dramatic reduction in the frequency and intensity of panic attacks and as such should be implemented immediately under the guidance of a mental health professional. It is important the patient is given medical clearance and permission from a medical doctor before attempting these exercises.
Symptom Inductions generally occur for one minute and may include
The key to the induction is that the exercises should mimic the most frightening symptoms of a panic attack. Symptom Inductions should be repeated 3-5 times per day until the patient has little to no anxiety in relation to the symptoms that were induced. Often it will take a period of weeks for the afflicted to feel no anxiety in relation to the induced symptoms. With repeated trials, a person learns through experience that these internal sensations do not need to be feared – the individual becomes less sensitized or desensitized to the internal sensation. After repeated trials, when nothing catastrophic happens, the brain learns (hippocampus & amygdala) to not fear the sensations, and the sympathetic nervous system activation fades.
Many people overcome Panic Disorder and sudden Panic Attacks on their own. It takes time, but in a sense, they ride out the panic attacks and eventually learn that nothing is going to happen during one. Often, they 'taper off' until they are not noticeable any longer. It is for this reason that some psychologists helping people with panic disorders induce them into an attack, so they can see for themselves that indeed, nothing will happen.
Increased Risk of Heart Attack and Stroke
A recent study suggests that menopausal women with panic disorder and many occurrences of panic attacks have a threefold higher risk of suffering heart attack or stroke over the next five years. The researchers believe that panic attacks or more accurately their associated symptoms (chest pain, dyspnea) can be manifestations of undiagnosed cardiovascular disease, or result in heart damage due to cardiovascular stress in patients with panic disorder and many panic attacks over periods of years. The study did not find that isolated cases of panic attacks in patients without panic disorder or agoraphobia lead to immediate heart damage, nor did it prove that the correlation between panic disorder and strokes was causal, or that it couldn't be attributed to the cardiovascular effects of medication that many panic disorder patients receive, such as SSRIs and benzodiazepines.
Limited Symptom Attack
Many people being treated for panic attacks begin to experience limited symptom attacks. These panic attacks are less comprehensive with fewer than 4 bodily symptoms being experienced. (Bourne 2005)
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Panic_attack". A list of authors is available in Wikipedia.|