Causes Of Panic Attacks And Panic Disorder
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.
Panic attacks can also be caused by medical conditions and other physical causes. If youre suffering from symptoms of panic, its important to see a doctor to rule out the following possibilities:
How I Achieved My Cure Of Panic Disorder And Agoraphobia
I have chosen to focus on my healing, and to say only a few words about my long period of suffering. Chances are, you already know firsthand or secondhand more than you’d care to know about the suffering! My own suffering had its unique form, but essentially, it was no different from what you probably already know.
After my first two panic attacks, I awakened each morning to an instantly racing heart, hyperventilation, and cresting waves of fear and apprehension. My range of activity for each day was dictated by my agoraphobia, and my range gradually got narrower and narrower.Every aspect of my life was deeply affected. Once, a friend asked me to explain what things I couldn’t do. I answered that it would take much less time if I simply listed those things I could do.At my low point, I was buffeted from morning to night by waves of panic anxiety, and I was barely able to venture one block from my apartment.To summarize a story that could fill many pages, I spent years doing everything I could to heal from this condition. After many disappointments, my tenacity finally paid off. I found my answer.The answer I found was the deeply transformational process of learning mastery over my panic and anxiety.For me, there were two keys to learning this mastery and curing this condition: education and practice.
What Treatments Can Help
One of the most effective treatments for panic disorder and agoraphobia is cognitive behavioural therapy . CBT recognises that the way we think and act affects the way we feel. With the help of a therapist, you will learn:
- more about your panic reactions and the fight-flight-freeze response.
- to challenge your fears and worries related to the physical symptoms you experience during a panic attack .
- to face the situations that youre afraid of or avoid in a gradual and manageable way. This will allow you to return to the places or activities that you have been avoiding due to fears of having another panic attack.
- a range of relaxation and anxiety management strategies like breathing retraining, to help you get control when you feel a panic attack coming on.
It is generally best to start with psychological treatment however, some people need a little extra help to get their anxiety under control, so your doctor might prescribe antidepressant medication to help you manage.
You May Like: What Is A Depression On A Map
Signs And Symptoms Of Panic Disorder
While many people experience just one or two panic attacks without further episodes or complicationsand theres little reason to worry if thats yousome people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.
You may be suffering from panic disorder if you:
- Experience frequent, unexpected panic attacks that arent tied to a specific situation
- Worry a lot about having another panic attack
- Are behaving differently because of the panic attacks, such as avoiding places where youve previously panicked
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
Anticipatory anxiety Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This fear of fear is present most of the time, and can be extremely disabling.
How Do You Know If You Have Agoraphobia
It is unfortunate that when a person has agoraphobia, it affects each aspect of their life. Since its an anxiety disorder it makes you uncertain why you cant seem to function the way you used to. It is an exhausting condition that stops us from doing what we love.
People with agoraphobia start to feel scared of having a panic attack in public situations. The only thing that makes sense to them is to stay away from the perceived danger. Persons diagnosed with agoraphobia often experience panic attacks even without leaving home.
So how do you know if you have agoraphobia? Take a deep breath, consult a mental professional or doctor, and answer the questions asked, honestly. This can help with the diagnosis and prompt treatment of agoraphobia:
If you answer YES to most of these questions, you should really consider consulting with a mental health professional to confirm the presence of agoraphobia. If you develop agoraphobia, do not be afraid. Do not let agoraphobia interfere with your everyday life and seek treatment as soon as possible.
Recommended Reading: Dehydration Panic Attacks
What Is The Role Of Drugs
Antidepressants are the first line drug for patients with panic disorder: selective serotonin reuptake inhibitors are recommended because they are effective and have few side effects. Few studies have shown differences between these inhibitors, and newer inhibitors are probably no more or less effective than older ones. Some patients experience restlessness, sweating, and tachycardia when they start taking antidepressants. This might be avoided by starting at lower than usual doses. The effects of stopping these drugs may be especially upsetting to some patients with panic disorder, but the effects can be minimised by discontinuing the drugs over several weeks. Although these drugs are not associated with tolerance and craving, discontinuation or withdrawal symptoms may occur when the drug is stopped or doses are missed or, occasionally, when the dose is reduced. These symptoms are usually mild and self limiting but occasionally can be severe, especially if the drug is stopped abruptly.
Unanswered research questions
Also see www.rcgp.org.uk/nccpc
Evidence for the effectiveness of other drugs is less compelling. NICE guideline 22 concludes that, sedating antihistamines or antipsychotics should not be prescribed in the treatment of panic disorder. Imipramine and chlomipramine are efficacious. Preliminary evidence shows that some of the newer antidepressants may also be effective.
Information sources for patients
What Is Panic Disorder
The main feature of panic disorder is recurrent, unexpected panic attacks. Most patients with the disorder avoid situations where they think a panic attack may occur, and avoidance may severely limit their life. Agoraphobia can occur without panic attacks, although patients may have episodes such as gastrointestinal distress and diarrhoea that are equivalent to panic attacks. Most of the evidence based studies on panic disorder and agoraphobia use the DSM-IV criteria . However, many practitioners use ICD-10 , which states that the essential feature is recurrent attacks of severe anxiety , which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.
Read Also: What Is The Phobia Of Long Words
Myth : I Could Have A Heart Attack And Die During A Panic Attack
Fact: A healthy heart can beat two hundred beats per minute for days without being damaged in any way .
However, if you experience panic attacks, it is recommended to see a doctor for a full physical examination to make sure that your symptoms are related to panic attacks and not to some kind of physical problem.
What Causes Panic Disorder
The cause of panic disorder is unknown. Several factors probably contribute to its development, and no biological test is available. Genetic and early family factors, or both, are important. Gorman et al argue that patients inherit a sensitive central nervous system fear mechanism, centered in the amygdala although several other brain areas are also implicated.9 A psychological model suggests that panic attacks and panic disorder represent fear of fear.10 In this model , physical sensations associated with anxietyfeeling dizzy or faint, or having a pounding heart, shortness of breath, or chest painare interpreted as indicating a dire consequence . This leads to hypervigilance about bodily sensations, increased arousal of the sympathetic nervous system, more physical sensations, and heightened anxiety, which spirals into a panic attack.
Cognitive model of panic: symptoms, hypervigilance, and anxiety spiral into panic attack. Patients develop fear of fear and avoid situations where they think they will have a panic attack
American Psychiatric Association DSM-IV criteria for panic disorder and agoraphobia
A discrete period of intense fear or discomfort in which four of the following symptoms developed abruptly and reached a peak within 10 minutes:
Panic disorder without agoraphobia
Panic attacks are not due to drug misuse, prescribed drugs, or a medical condition
The panic attacks are not better accounted for by another disorder
You May Like: Aphobic Definition
What Is The Role Of Psychoeducation And Self Help
Educating patients about the nature of panic disorder can be helpful and may be sufficient for patients without complications, although this assumption has not been tested in controlled studies. The basic information can be presented in a handout, or patients can be referred to self help and internet resources.
Hour Seven: Journaling And Recovery
Summarize the day in your journal by writing brief sentences on how things went and what youll work on tomorrow. Mathew shares this example on penning the first part:
I learned some very helpful stuff I didnt know about my one trigger on way to work and started work to defuse it. Still have terrible period of anxiety just before noon. Need to work on breathing and on-site muscle relaxation. Dont know for sure if programs working still lots of anxiety. Doing this creates anxiety sometimes. Need to work harder on diversions in skill learning.
He shares this example for tomorrows plan: Return to brainsciencepodcast.com to finish neuron study start day with adding to list of avoidances to work on print out music for song to learn
The more you write, the more youll understand your anxiety and yourself. You can even start your journaling practice with this prompt from Mathews: Im a fifth-grade teacher, and I ask, Will you explain to my students in class tomorrow exactly what you have and what they can do to avoid getting it? Go back to this entry, and revise it.
Living with agoraphobia can be agonizing. Thankfully, it is highly treatable. Please dont hesitate to seek professional support and create a daily routine filled with key steps for helping you get better. Because you can get better.
Last medically reviewed on May 17, 2016
Recommended Reading: Phases Of Schizophrenia
The Road To Progress Isnt Always Straight
Overcoming your fearful thoughts around panic attacks is not a linear process.
Generally, the more you practice, the more you continue to build your skills. But there will be days when you feel less confident, and certain situations will be hard to tackle.
Remind yourself that progress isnt measured by the presence or absence of your panic and anxiety symptoms, but rather how you respond to panic and anxiety.
Your willingness to respond with courage and acceptance is a better measure of progress.
Keep in mind change does not happen overnight and the real benefits are going to show up after much time and effort.
Once the strategies youve learned become habits and the concepts become a natural part of your mindset, youll start to notice that youre going in your desired direction.
What Do I Do If Im Having A Panic Attack
With or without panic disorder, panic attacks are common. And theres a big misconception around dealing with them, Gruner explains.
The most common advice people hear when theyre experiencing a panic attack is to take deep breaths, think positively, and try to calm down, he says.
However, trying to control anxiety in these ways can backfire. Struggling to prevent a panic attack can have a paradoxical effect and actually cause a panic attack.
During a panic attack, a person should do the counterintuitive thing: let go of control and allow the panic attack to run its course.
It can also be useful to remind yourself that you cant die from a panic attack, and that its your bodys normal, natural reaction, which is not dangerous.
Gabe Gruner, LICSW, is a psychotherapist at the Psychiatry Outpatient Clinic at Brigham and Womens Hospital .
You May Like: Pristiq What Is It Used For
Panic Disorder With Agoraphobia
Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.
If youre agoraphobic, youre afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldnt be able to get help. Because of these fears, you start avoiding more and more situations.
For example, you may begin to avoid:
- Crowded places such as shopping malls or sports arenas.
- Cars, airplanes, subways, and other forms of travel.
- Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.
- Physical exercise in case it triggers panic.
- Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.
New Therapy For Agoraphobia: Gentler And Faster Freedom From Anxiety
One form of therapy with which anxiety patients are usually very quickly able to significantly reduce all symptoms of agoraphobia and even completely overcome them in the long term is the so-called Bernhardt-Method. Without confrontation and without medication, those affected learn special mental techniques through which the neuronal programming of the fear is literally erased. One of the reasons why this works so well is that agoraphobics usually do not want to avoid real threats, but only the thought of what could happen triggers the fear reaction and even a panic attack.
However, if pure fantasies can turn healthy people into anxiety patients, then logically there must be other fantasies that reverse this process. And this is exactly what the Bernhardt Method is about, which was developed a few years ago at the Institute for Modern Psychotherapy in Berlin, Germany. For those who want to learn more about this innovative self-therapy, we recently launched our online video course The Anxiety Cure. Get started right now, the first 3 episodes are free.
Don’t Miss: Define Phobia In Psychology
Dont Engage With That Thought
You might not be able to challenge all of your distorted thoughts or correct all of your thinking errors.
For instance, you might find yourself thinking, What if this gets worse and I cant handle it?
Such thought can be hard to challenge because you cant predict the future and reassure your mind.
In this case, try not to engage with these thoughts by doing the following:
1. Take a step back and notice the thought without engaging with it or identifying it as your own.
2. Say to yourself, Im noticing that Im having the thought that .
So instead of thinking, Im having a panic attack thats going to embarrass me in front of everyone, you could say, Im having the thought that this panic attack is going to embarrass me in front of everyone.
3. Stay present and be an observer.
Agoraphobia Vs Panic Disorder
The distinction between agoraphobia and panic disorder is mainly based on how many activities an individual avoids.
People with panic disorder may avoid a few uncomfortable situations but will remain relatively active.
However, when the number of normal activities avoided increases, agoraphobia would be a more appropriate diagnosis.
Recommended Reading: Does Celine Dion Have An Eating Disorder
Panic Attack Signs And Symptoms
The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while youre in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.
Panic attack symptoms include:
- Shortness of breath or hyperventilation
- Heart palpitations or racing heart
- Chest pain or discomfort
- Feeling unreal or detached from your surroundings
- Feeling dizzy, light-headed, or faint
- Numbness or tingling sensations
- Fear of dying, losing control, or going crazy
Is it a heart attack or a panic attack?
Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think youre having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While its important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, its often panic that is overlooked as a potential causenot the other way around.