Anxiety and panic are normal responses to dangerous and overwhelming situations, but recurring bouts of panic can be a sign of panic disorder. This frightening condition incapacitates sufferers but, with effective treatment, they can overcome the panic to lead fulfiling lives.
An Overview of Panic Disorder
Panic disorder involves unexpected and frequent panic attacks for no obvious reason and intense worry about having future attacks. [1] This constant fear can trigger more attacks.[2]
Causes of Panic Disorder
Although the cause of panic disorder isn’t fully understood, it likely stems from a combination of psychological and physical factors including catastrophic thinking, genetics, imbalance in neurotransmitters, and sensitivity to carbon dioxide.
Catastrophic Thinking
People who have panic attacks may fixate on minor physical symptoms and regard them as severe and dangerous. This distress induces a nervous system response that can bring on a panic attack. [3]
Genetics
Research suggests that panic disorder is hereditary, so close family members of someone with the condition could be more susceptible to it.[4]
Imbalance of Neurotransmitters
An imbalance in the neurotransmitters dopamine, gamma-aminobutyric acid (GABA), norepinephrine, and serotonin may increase the risk of developing panic disorder.[5]
Sensitivity to Carbon Dioxide
People with a heightened sensitivity to carbon dioxide or who inhale high levels of the gas may have panic attacks or develop panic disorder.[6]
Trauma
Traumatic experiences can cause panic attacks soon after the trauma occurs or years later.
Symptoms of Panic Disorder
Panic disorder has two primary symptoms: anxiety and panic attacks.[7]
Anxiety
Anxiety is a feeling of agitation, fear, and frustration. Constant anxiety that impacts daily living can be a sign of an anxiety disorder.[8]
Panic Attacks
A panic attack is an extreme form of anxiety that comes on very fast. [9]
Types of panic attacks
There are two types of panic attacks: expected and unexpected.[10]
Expected
Expected panic attacks occur when people face situations that they fear. For example, a person who fears heights may have a panic attack when walking over a bridge.
Unexpected
Unexpected panic attacks develop rapidly for no clear reason. A person could be feeling relaxed then suddenly experience panic.
Symptoms of panic attacks
Panic attacks can cause multiple physical and psychological symptoms.[11]
Physical symptoms
· Chest pain
· Chills
· Choking sensation
· Churning stomach
· Dizziness
· Dry mouth
· Hot flushes
· Nausea
· Need to go to the bathroom
· Numbness or tingling sensation
· Racing heartbeat
· Ringing ears
· Shaky limbs
· Shortness of breath
· Sweating
· Tingling in the fingers
· Trembling
Psychological symptoms
· Feeling detached from your body
· Feeling dread
· Feeling like you’re going to faint
· Feeling out of control/crazy
· Fear of dying
Duration and number of panic attacks
Panic attacks generally last from 5 to 20 minutes, but they can last as long as an hour. The number of panic attacks depends on the severity of the condition. Some people have one or two attacks a month while others experience them several times a week. [12]
Secondary Effects of Panic Disorder
Panic disorder causes or contributes to phobias, substance abuse, unemployment, and other problems that diminish quality of life.[13]PhobiasPanic disorder causes people to avoid the situations they were in when the attacks occurred. For example, if a person has a panic attack in a supermarket, he/she may avoid supermarkets and develop a phobia toward them. In the most extreme cases, people are afflicted with agoraphobia—the fear of being in open spaces, going to shopping centres, leaving home, or travelling on public transport.[14]
Alcohol and Drug Abuse
Panic disorder can cause some people to use drugs such as alcohol, stimulants, and cannabis to relieve their symptoms, but these substances can make the disorder worse. For example, alcohol can have a calming effect so reducing or eliminating it can increase anxiety, which could lead to panic attacks. Stimulants such as amphetamine, caffeine, and nicotine can intensify anxiety and cause physical changes that resemble panic attacks, which can induce actual attacks in people who’ve had them in the past.[15] Cannabis can increase symptoms of anxiety and panic, including racing thoughts and increased heart rate, in some people.[16]
Job loss or Under-employment
The need to avoid certain situations, places, and experiences as well as the debilitating nature of panic disorder can cause some sufferers to lose or quit their jobs or take lower-paying jobs to minimize panic attacks.
Additional Secondary Effects of Panic Disorder
In addition to phobias, addiction, and employment issues, panic disorder can cause these quality-of-life issues:[17]
- Decrease in emotional and physical health
- Fear of driving more than short distances from home
- Financial dependence on others
- Increased risk of suicide attempts
- Less time spent on satisfying activities such as hobbies and entertainment
- More time spent at the A&E
Treatments for Panic Disorder
If you suffer from panic disorder, therapy, medication, self-care, or some combination of these treatments will help you decrease the panic attacks and relieve your symptoms.[18]
Therapy
Therapy can help you work through the unresolved feelings, issues, and traumatic experiences that might be causing your panic attacks and develop ways to cope with the condition.[19] There are several types of psychotherapy including behavioural, cognitive, cognitive-behavioural, humanistic, and psychoanalytic.
Behavioural therapy
Behavioural therapy centres on the idea that all behaviours are learned and can, therefore, be changed. Behavioural therapists help people identify and change problematic behaviours. Treatment often focuses on current problems and ways to solve or manage them.[20]
Cognitive therapy
Cognitive therapy is based on the premise that our thoughts have a tremendous influence on our psychological well-being. For example, people who focus on negative things tend to have a gloomier outlook on life and depressive moods. Cognitive therapists help people identify the cognitive distortions that cause their pessimism and replace them with more realistic and positive thoughts.[21]
Cognitive-behavioural therapy
Cognitive-behavioural therapy (CBT) is based on two concepts: (a) our feelings, thoughts, physical sensations, and actions are interlinked and (b) negative feelings and thoughts can trap us in a "vicious cycle." Cognitive-behavioural therapists help people change negative patterns to improve their outlook on life, develop ways to brighten their moods each day, and break overwhelming problems into smaller parts to better manage them. [22]
Humanistic therapy
Humanistic therapy focuses less on how environmental influences, past experiences, and pathology impact people’s thoughts and behaviours and more on the positive aspects of human nature. It examines the whole person from both the therapist’s perspective and the client’s observation of his/her behaviour. It also focuses on clients’ positive behaviours and traits and their ability to learn, grow, heal, and succeed.[23]
Psychoanalytic therapy
Psychoanalytic therapy helps people uncover the unconscious feelings, memories, and thoughts that influence their behaviours.[24] It also helps people with serious mental health conditions understand and change complex, deeply-rooted, and often unconscious psychological and relationship problems. Unlike most types of talk therapy, psychoanalytic therapy emphasizes personality restructuring and in-depth change in emotional development.[25]
Medication
Antidepressants, anti-anxiety medications, and anticonvulsants are used to treat panic disorder.
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) help balance serotonin—a neurotransmitter associated with mood. This can decrease anxiety, improve sleep, and regulate mood.
Anti-anxiety medications
Anti-anxiety medications slow down the central nervous system to help people feel calmer and less fearful, which can decrease symptoms of panic disorder. [26]
Anticonvulsants
Anticonvulsants such as pregabalin and clonazepam can help reduce anxiety.[27] Pregabalin prevents the brain from releasing the chemicals that cause anxiety.[28] Clonazepam increases the levels of calming chemicals in the brain to relieve anxiety.[29]
Self-care
Taking care of yourself will help you regain a sense of control, reduce your symptoms, and improve your overall well-being. Managing your attacks, eating a healthy diet, exercising, and relaxing are four ways to decrease anxiety and manage panic attacks.[30]
Managing Your Attacks
Taking the following actions when having a panic attack will help you regain your composure.
Stay where you are.
Because panic attacks are frightening and disorienting, staying where you are during an attack (if possible) can help you reduce anxiety and reorient yourself. When driving, pull over and park if it’s safe to do so until the attack passes.
Challenge your fear.
Try to determine the cause of your fear and constantly remind yourself that it isn’t real.
Focus on the fact that the attack won’t last forever.
Keep in mind that the terrifying thoughts, feelings, and physical sensations will pass. Take slow, deep breaths. Rapid breathing can worsen anxiety and panic, so try to take slow, deep breaths to normalize your breathing.
Eating a healthy diet
Erratic blood sugar levels can contribute to panic attacks. Eating a balanced diet, eating regularly, and avoiding sugary foods and drinks will help you maintain a stable blood sugar level. And avoiding alcohol, caffeine, and nicotine as well as drinking plenty of water can decrease anxiety.
Exercising
Exercise, especially aerobics, decreases stress and relieves tension. It also helps the brain release serotonin which improves mood.
Relaxing
Learning to relax will help you reduce the constant stress and anxiety that panic disorder creates. Aromatherapy, massage therapy, yoga, Pilates, and relaxation techniques are some of the ways you can relax.
When to Seek Help
If you’re experiencing extreme anxiety, having recurrent panic attacks, or feeling hopeless or suicidal, a licensed therapist or counsellor can help you get through this trying time and alleviate your symptoms. At Life Counsel, we provide a safe and welcoming place for you to talk about what you’re going through and find solutions to your problems.
[1] “Panic Disorder,” NHS, accessed May 8, 2021, https://www.nhs.uk/mental-health/conditions/panic-disorder/.
[2] “Anxiety and Panic Attacks,” Mind, accessed May 9, 2021, https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/anxiety-disorders/.
[3] “Panic Disorder: Causes,” NHS Inform, accessed May 8, 2021,https://www.nhsinform.scot/illnesses-and-conditions/mental-health/panic-disorder#causes.
[4] Eun Jeong Kim and Yong-Ku Kim, “Panic Disorders: The Role of Genetics and Epigenetics,” AIMS Genetics 5, no. 3 (July 2018): 177-190, doi:10.3934/genet.2018.3.177.
[5] Katharina Star, “Is Panic Disorder Caused by a Chemical Imbalance?” Very Well Mind, accessed May 11, 2021, https://www.verywellmind.com/is-panic-disorder-caused-by-a-chemical-imbalance-2583984.
[6] Richard Maddock, “Panic Attacks as a Problem of pH,” Scientific American, accessed May 8, 2021, https://www.scientificamerican.com/article/panic-attacks-as-ph-problem/.
[7] “Panic Disorder.”
[8] “Anxiety,” Mental Health Foundation, accessed May 8, 2021, https://www.mentalhealth.org.uk/a-to-z/a/anxiety.
[9] “Panic Disorder.”
[10] Sheryl Ankrom, “Symptoms of Panic Disorder and Attacks,” Very Well Mind, accessed May 8, 2021, https://www.verywellmind.com/symptoms-of-panic-disorder-and-attacks-2584246.
[11] “Panic Disorder.”
[12] “Panic Disorder.”
[13] “Answers to Your Questions About Panic Disorder,” American Psychological Association, accessed May 8, 2021,https://www.apa.org/topics/anxiety/panic-disorder.
[14] “Overview - Agoraphobia,” NHS, accessed May 8, 2021, https://www.nhs.uk/mental-health/conditions/agoraphobia/overview/.[15] “Panic Disorder and Substance Abuse,” The Recovery Village, accessed May 8, 2021, https://www.therecoveryvillage.com/mental-health/panic-disorder/substance-abuse/.
[16] Crystal Raypole, “Marijuana and Anxiety: It’s Complicated,” accessed May 12, 2021, https://www.healthline.com/health/marijuana-and-anxiety.
[17] “Answers to Your Questions About Panic.”
[18] “Panic Disorder: Treatment,” NHS Inform, accessed May 9, 2021,https://www.nhsinform.scot/illnesses-and-conditions/mental-health/panic-disorder#treatment.
[19] Katharina Star, “Effective Treatment Options for Panic Disorder,” Very Well Mind, accessed May 9, 2021, https://www.verywellmind.com/treatment-for-panic-disorder-2584322.
[20] Ana Gotter, “Behavioral Therapy,” Heathline, accessed May 9, 2021, https://www.healthline.com/health/behavioral-therapy.
[21] Kendra Cherry, “How Psychotherapy Is Used to Treat Disorders,” accessed May 9, 2021, https://www.verywellmind.com/psychotherapy-4157172.
[22] “Overview - Cognitive Behavioural Therapy (CBT),” NHS, accessed May 12, 2021, https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/.
[23] “Humanistic Therapy,” Psychology Today, accessed May 9, 2021, https://www.psychologytoday.com/us/therapy-types/humanistic-therapy.
[24] Cherry, “How Psychotherapy Is.”
[25] “Psychoanalytic Psychotherapy with Adults,” Northern School of Child and Adolescent Psychotherapy, accessed May 9, 2021, https://www.nscap.org.uk/content/psychoanalytic-psychotherapy-with-adults.
[26] Star, “Effective Treatment Options.”
[27] “Panic Disorder.”
[28] “Pregabalin,” NHS, accessed May 9, 2021, https://www.nhs.uk/medicines/pregabalin/.
[29] “Clonazepam,” NHS, accessed May 9, 2021, https://www.nhs.uk/medicines/clonazepam/.
[30] “Panic Disorder: Things You Can Do to Help Yourself,” NHS Inform, accessed May 9, 2021,https://www.nhsinform.scot/illnesses-and-conditions/mental-health/panic-disorder#things-you-can-do-to-help-yourself.
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