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A panic disorder is the repeated occurrence of sudden panic attacks, resulting in a prolonged period of fear, anxiety or inconvenience. A panic attack is a short period of time (minutes) of intense distress or discomfort. Such an attack is experienced as catastrophic. The fear of a panic attack can dominate a person’s life.
Why some people have panic disorder is not clear. The following factors may play a role:
- In some families, panic disorders are more common. Heredity plays a role.
- One person seems to be more vulnerable than the other.
- It is thought that certain substances (neurotransmitters) affect a person’s susceptibility to anxiety or panic. Neurotransmitters are present in everyone’s blood and nervous system.
- The way a person deals with fear seems partly learned. Education and past experiences play a role.
- When having symptoms of anxiety, such as palpitations and shortness of breath, some people have the feeling that they cannot handle the situation. This increases anxiety and they panic.
- Substances, like caffeine, can reinforce the physical symptoms of anxiety. In some people, this can trigger a panic attack.
An attack in a panic disorder may show the following signs and symptoms:
- Palpitations, sweating, chills, dizziness, trembling.
- Breathlessness, discomfort in the chest.
- Tingling or numbness in hands and/or feet.
- Dry mouth, nausea, stomach pain, vomiting or diarrhea.
- Headache, flushing, fainting.
- The feeling of not knowing who or where you are.
- The feeling of losing control of yourself, of becoming crazy or dying.
The diagnosis of panic disorder is made when a person has had at least two unprovoked and unexpected panic attacks, followed by at least a month-long fear of yet another attack. The frequency of attacks can vary considerably. Some people have an attack for months on a weekly or even daily basis, while others have an attack a few days in a row and then weeks or months none.
The treatment of a panic disorder can include medicines (antidepressants or tranquillizers), cognitive behavioral therapy or a combination of both.
Cognitive therapy focuses on the thinking pattern of the patient and let him or her realize that the anxiety is the result of a misinterpretation of physical symptoms, such as rapid heartbeat. Formulating a more realistic interpretation is a large part of cognitive therapy. Behavioral therapy is often effective, because this therapy treats the avoidant behavior of the patient.
A panic disorder can last several years. Periods of high and few symptoms alternate. The panic symptoms are often (rapidly) getting worse. Most people have more and more symptoms within one year after the first panic attack. Half of people have a panic disorder within two years after the first panic attack.
Only thirty to fifty percent of patients recover from panic disorder after six or seven years. They have had no panic symptoms anymore for one year. This doesn’t mean that they function all well again and have returned to the same quality of life.
A person can do a lot to reduce the symptoms:
- Keep a diary and write down what happens at times when feeling anxious. What thoughts play through your mind then, what are you afraid for, what do you feel, how do you respond to this and what will you do then.
- See critically if thoughts are correct and whether there’s really reason to panic. And then think what positive, reassuring thoughts can be put against the anxious thoughts. This is to prevent that fear takes over. It often succeeds better to endure the anxious moments and remain quiet until one feels better.
- Write down these positive thoughts and read them at difficult times. And record what to do on frightening moments from now on. For example, breathing calmly to relax, taking a walk or calling someone.
- Seek support from trusted people and explain to them what you suffer from. Most people will understand.
- It’s good to know that anxiety usually diminishes on its own after sixty to ninety minutes. This may give courage not to avoid but to endure the situation. Thus, it may be evident that there was not much reason to be afraid and the anxiety can slowly go out.
- The prevalence of panic disorder is 4%.
- 10% of people ever had a panic attack.
- Women are at higher risk of having this condition than men.
- Panic disorder starts on average at the age of 25 years in women and 28 years in men. From 65 years, panic disorders are less common.
Cognitive Behavioral Therapy