Feelings of anxiousness and nervousness are a normal part of life for the vast majority of the population. Situations that commonly elicit these feelings include making a significant decision, an important presentation at work or test at school, or waiting for news from the doctor’s office. However, those who suffer from an anxiety disorder experience more anxiety with these situations as well as many others. Additionally, the anxiety tends to stick around and may even worsen over time. It may also begin to interfere with the individual’s daily routine. There are a few different types of anxiety disorders, including generalized anxiety and panic disorder. As panic disorder tends to be the least talked about of the different types of anxiety disorders, things can get out of hand quite quickly.
What Are Panic Attacks?
The most common and iconic symptom of panic disorder is panic attacks. A panic attack is more than just feeling anxious or worried for a little while. It is the sudden, intense feeling of fear or discomfort, often referred to as ‘panic.’ A panic attack will include a minimum of four of these signs, including sweating, trembling, chest pain, a pounding heart, shortness of breath, feeling of choking, chills, and hot flashes. Further signs include an upset stomach (nausea), dizziness, lightheadedness, numbness, feeling of no control, tingling, fear of dying and feeling detached.
While the length of a panic attack varies based on the individual case, they typically start suddenly and peak within ten minutes. The peak itself lasts between five to ten minutes before the symptoms of the panic attack begin to lessen, although it can take quite some time for the symptoms to disappear altogether.
When Panic Attacks Become Panic Disorder
Though it might surprise many, panic attacks are quite common. They often appear during periods of significant stress or when an individual is overtired. Panic attacks only develop into panic disorder if the individual experiencing them becomes significantly worried about experiencing more attacks, or if something terrible will occur due to a panic attack. Common examples of this include worrying about fainting, embarrassment, going crazy, having a heart attack, or even dying.
Another critical factor differentiating panic attacks from full panic disorder is the fact that attacks of panic disorder are unpredictable. The patient does not know they are coming until they happen. However, someone who has an intense fear, such as of spiders, is often able to predict a panic attack when they encounter the object of their intense fear. In these instances, the individual is not afraid of the panic attack, but of the thing that caused the attack to happen. In panic disorder, the fear is the panic attack.
Other Symptoms Of Panic Disorder
Beyond the panic attacks themselves, there are quite a few other panic disorder symptoms. The patient will also exhibit an intense fear of experiencing another panic attack, so often that it causes another panic attack to happen. Additionally, the patient will typically go out of their way to avoid potential triggers for panic attacks, to the point where it becomes a significant interference in their life. They may also sit near exits of bathrooms in public places, carry medication or water with them, always have someone accompanying them out of the house, and avoid certain foods or activities that may trigger their attacks.
Causes And Risk Factors
Similar to generalized anxiety disorder, although panic disorder can run in families, it is not clear why some members have it while others do not. With this in mind, however, research indicates several biological and psychological factors play a role. This includes specific brain functions that have a key part in fear and anxiety and the misinterpretation of harmless sensations as threats. There are also several environmental factors that contribute to the development of panic disorder, including traumatic life events, high stress during a significant period, as well as the presence of other medical conditions, particularly psychiatric ones. More research is necessary to accurately determine what causes panic disorder to develop.
Treatment Through Psychotherapy
The first of the two major medical treatment options for panic disorder is a type of psychotherapy called cognitive behavioral therapy (CBT). CBT attempts to teach patients different methods of thinking and reacting to the feelings panic attacks come with that are associated with panic disorder. The frequency of the panic attacks often lessens when patients learn how to adjust their reactions and thoughts about the attacks and their physical sensations. The exact content of CBT varies based on the individual and their specific circumstance, but often include relaxation strategies and cognitive restructuring that includes becoming aware of thought patterns and replacing them with new ones. CBT also includes exposure treatment, which is when the patient enters higher stress situations to put what they have learned into practice.
Medication For Panic Disorder
When doctors believe medication is necessary or will significantly benefit the patient with panic disorder, there are four types: benzodiazepines, beta-blockers, serotonin-norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs). Although both SNRIs and SSRIs are typically used to treat depression, doctors have found that they also assist with panic disorder symptoms. It is essential for patients to note that they can take up to a few weeks to begin working effectively. Side effects are not usually severe since most doctors will prescribe the lowest dose to begin and slowly increase or otherwise adjust as necessary. Side effects may include headaches, nausea, or problems sleeping. However, it is important for patients to discuss any side effects they do experience with their doctor.
Beta-blockers for panic disorder help manage symptoms such as a rapid heart rate, though they are an uncommon prescription for this condition. Similarly, benzodiazepines are only prescribed for short periods, since they are powerful sedative medications and can cause dependence if used for too long. The patient may also build up a high tolerance to them if used continuously. They are, however, incredibly useful at immediately and quickly lowering the symptoms of a panic attack. Doctors will always work with each patient to determine which medication and what dosage works best.
Lifestyle Tips To Manage Panic Disorder
Although medication can work faster than CBT in some instances, both take some time to reach their full potential. With this in mind, it is important to elicit as much support as possible to ensure these treatments work effectively and quickly. This means looking at lifestyle choices. A healthy lifestyle puts patients in the best position to manage their panic disorder. Healthy choices include getting seven to nine hours of sleep a night (ideally, not more or less), exercising for at least thirty minutes five times a week, consuming a healthy, balanced diet, and turning to trusted individuals when additional support is needed.
How To Be Supportive During A Panic Attack
The golden rule when it comes to being the support for someone experiencing a panic attack is to listen to what they tell you. Everyone has different needs. Their needs may also change, so it is essential to always ask first. Many individuals do not like to be touched during a panic attack, so it is important to avoid this unless invited or it is unavoidable. If touching them is unavoidable, such as if they are in a dangerous situation, start by calmly explaining you need to lead them away before holding their elbow or putting an arm around them. Whenever speaking to someone having a panic attack, be as calm as possible and always listen. Bring them water if they ask, don’t say a word if they need it be quiet, and never tell them to calm down. A good alternative phrase to start with is “I know it’s not okay right now, so we’ll just sit here before [doing something they enjoy or something calming to them].”