Panic

Panic Disorder

Panic disorder is a type of anxiety disorder characterized by experiencing sudden, recurring thoughts causing bouts of fear that trigger panic attacks. While a temporary sense of panic is a normal human response, panic attacks become a disorder when they are recurrent, unexpected, and associated with excessive concern and/or maladaptive changes in behavior to avoid attacks. 

Panic attacks activate a stress response in the body and brain to enter “fight, flight, freeze or fawn” mode. This type of panic response often ensues without the presence of any danger. Regardless, the brain and body perceive a sense of danger and trigger a stress response due to an inability to control fearful thoughts and physical reactions to emotions. 

Experiences with panic disorder may include excessive worry or uneasiness related to the onset of the next attack. One might react as if they are on edge, feel irritable, and experience physical restlessness. A sense to gain control over the onset of panic attacks causes a vicious cycle of fearing the attacks and incontrary, losing control or “going crazy” as anticipating for the next attack. 

Similar to the anxiety related to future attacks, intrusive thoughts of consequences related to panic attacks instill feelings of fearfulness, worry and influence behaviors of isolation and avoidance. Perceived social humiliation from a public panic attack may increase risk of isolating from social events and avoiding public spaces. Eventually, intense stress from daily panic will influence aspects of functioning. 

Panic attacks can occur in any state- from calm or from an already fearful state, and can last for several minutes to recurring throughout the day. Panic disorder may present as:

✅ concerns about fainting
✅ fearful of embarrassment
✅ mimicking a heart attack
✅ overly concerned about dying
✅ fearing loss of control

Causes of Panic Disorder

Experts are unsure of what exactly causes panic disorder. Research suggests various clues that may soon clarify our understanding of panic disorder. What seems to be clear is that trauma can have a massive impact on panic- whether it is experienced firsthand or vicariously. Proneness to experiencing negative emotions and anxiety sensitivity increase the onset of panic attacks, as well as the worry about panic.  

The following the attributes associated with the cause of panic disorder and those unrelated:

💡 genetics
💡 family history
💡 comorbid mental health diagnoses  
💡 medical history
💡 major life stressors  
💡 trauma
💡 temperament
💡 environmental conditions
💡 physical or sexual assault
❌ expressing emotions
❌ sensitivity
❌ crying
❌ talking about stressors
❌ immunizations
❌ a desire or inclination to act out
 ❌ panic thoughts = feelings / behaviors

💡 genetics
💡 family history
💡 comorbid mental health diagnoses
💡 medical history 
💡 major life stressors  
💡 trauma 
💡 temperament
💡 environmental conditions
💡 physical or sexual assault
❌ expressing emotions
❌ sensitivity
❌ crying
❌ talking about stressors
❌ immunizations
❌ a desire or inclination to act out
 ❌ panic thoughts = feelings / behaviors

Misconceptions About Panic Disorder

Panic is a natural emotion, response, and part of human experience. Most people experience a panic attack at some point in their lives. However, according to the American Psychological Association, 1 out of every 75 people might have a panic disorder.

This means that panic is not:

🚫 unnatural
🚫 within someone’s control
🚫 feelings and emotional reactions which are common throughout life 
🚫 attention-seeking
🚫 an uncommon diagnosis 
🚫 feelings of fear in response to a scary situation

Because panic can be caused by almost anything, misconceptions still exist surrounding panic as a disorder. Some might believe panic disorder and panic attacks are caused by things like oversensitivity or spoiledness, and may even invalidite panic by dismissing it as an act out for attention. However, this is simply not the case.

Signs and Symptoms of Panic Disorder

Experiencing panic attacks can be debilitating and extremely stressful, despite the presence or imminent of the threat. Many people report experiencing physical sensations and symptoms of a heart attack when in the wave of a panic. During a panic attack, at least four of the following physical and emotional effects occur:

🚩 increased heart rate
🚩  depersonalization (detached from self)
🚩  chest pain or discomfort
🚩  fear of losing control or “going crazy”
🚩  palpitations or pounding heart
🚩  fear of dying
🚩  sweating
🚩  derealization (feelings of unreality)
🚩  chills
🚩  paresthesias (numbness/tingling)
🚩  trouble breathing
🚩  chills or heat sensations 
🚩  feelings of choking
🚩  restlessness
🚩  shaking/trembling
🚩  irritability
🚩  dizziness  
🚩  anxiety
🚩  fatigue or weakness
🚩  feeling unsteady or faint 
🚩  sensations of shortness of breath
🚩  sensations of smothering 
🚩  nausea or abdominal distress

🚩 increased heart rate
🚩  depersonalization (detached from self)
🚩  chest pain or discomfort
🚩  fear of losing control or “going crazy”
🚩  palpitations or pounding heart
🚩  fear of dying
🚩  sweating
🚩  derealization (feelings of unreality)
🚩  chills
🚩  paresthesias (numbness/tingling)
🚩  trouble breathing
🚩  chills or heat sensations 
🚩  feelings of choking
🚩  restlessness
🚩  shaking/trembling
🚩  irritability
🚩  dizziness  
🚩  anxiety
🚩  fatigue or weakness
🚩  feeling unsteady or faint 
🚩  sensations of shortness of breath
🚩  sensations of smothering 
🚩  nausea or abdominal distress

Diagnosing Panic Disorder

Panic is diagnosed by offering a mental health or psychiatric evaluation to the person experiencing symptoms after eliminating any biological causes of symptoms. Questionnaires or assessment scales are often administered for baseline readings of symptoms and experiences. Panic is one of six types of anxiety disorders, therefore it is imperative to differentiate the disorder from other mental health conditions. 

When individuals experience panic attacks, they may feel as though they are having a heart attack and seek physical medical attention. When medical professionals rule out potential heart attack cases, shifts in treatment moves towards mental health for other possible problems.

Panic attacks vary in severity and frequency. According to the DSM-5, there are two types of panic attacks:

⚡️ Expected is anticipated by a person subjected to specific triggers or cues
⚡️ Unexpected occurs suddenly without any blatant cause or indication

In order to be diagnosed with panic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one must experience:

⚠️ recurrent and unexpected panic attacks 

      • abrupt surges of intense fear escalating quickly 
      • four or more of the symptoms of panic occur
      • attack has been followed by 1 month or more of 1 or more of the following:
      • persistent concern about additional attacks
      • worry about the implications of the attack or its consequences
      • maladaptive change in behavior related to controlling attacks

Additionally…

⚠️ panic attacks are not due to direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition
⚠️ symptoms of panic attacks do not meet other diagnosing criteria

Conditions Commonly Mistaken for Panic Disorder

Panic disorder can be easily mistaken for other mental health diagnoses, anxiety disorders, and medical conditions. Due to the physical distress from panic attacks, such as difficulting breathing and tightness in chest, behaviors that mimic other diagnoses are considered. When diagnosing practitioners request lab testing such as blood work and heart monitor readings for medications, it is specially related to ruling out these physical concerns to avoid harm. 

The symptoms of panic can be similar or overlapping with other conditions such as:

✳️ heart disease or heart attacks are typically reported during an unknown experienced panic attack. Panic causes somatic responses such as tightness in the chest and loss of breath. Respiratory issues linked to loss of breath also suggests the onset of a heart attack, while panic is responsible for the  physical symptoms.   
✳️ generalized anxiety disorder is often the first diagnosis choice if unexpected panic attacks have never been experienced. 
✳️ anxiety disorder due to another medical condition often needs to be ruled out first before assigning panic disorder as a diagnosis. 
✳️ substance/medication-induced anxiety disorder are often a subject of experienced panic attacks. 
✳️ psychotic disorders can trigger panic attacks such as social situations will trigger social anxiety disorders.

Treating Panic Disorder

The best course of treatment of panic includes mental health professionals educated on panic disorder, specializing in treating, diagnosing, and supporting clients. To receive support regarding concerns of panic start by consulting a physician about symptoms. Support can also be provided by speaking to a therapist, psychiatrist and/or counselor. 

It is always recommended to seek a psychotherapy referral while taking medication for panic. A therapist can assist in medication management, care coordination with other providers such as prescriber, and safety assessment. Typical modalities for treatment may include: 

🧬 psychotherapy                                                             🧬 deep breathing
🧬 cognitive behavioral therapy (CBT)                        🧬 group therapy 
🧬 cognitive behavior modification                              🧬 medication
🧬 rational emotive behavior therapy (REBT)             🧬 aromatherapy
🧬 panic-focused psychodynamic therapy (PFPT)  🧬 yoga
🧬 mindfulness                                                                  🧬 self care routines
🧬 couples and family therapy                                      🧬 cannabis

🧬 psychotherapy
🧬 deep breathing
🧬 cognitive behavioral therapy (CBT)
🧬 group therapy 
🧬 cognitive behavior modification
🧬 medication
🧬 rational emotive behavior therapy (REBT)
🧬 aromatherapy
🧬 panic-focused psychodynamic therapy (PFPT)  
🧬 yoga
🧬 mindfulness
 
🧬 self care routines
🧬 couples and family therapy
🧬 cannabis

Healthcare Professionals Who Treat Panic Disorder

For the best results in a successful treatment of panic disorder, seek providers that have specialities in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with panic disorder. 

Many medical and mental health providers are familiar with the diagnosis of panic disorder.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of panic disorder:

🧠 physicians                                🧠 counselors                      🧠 therapists
🧠 nurse practitioners                 🧠 neurologists                   🧠 psychologists 
🧠 psychiatrists                             🧠 social workers                🧠 mindfulness coaches 

🧠 physicians
🧠 counselors
🧠 therapists
🧠 nurse practitioners
🧠 neurologists
🧠 psychologists 
🧠 psychiatrists
🧠 social workers
🧠 mindfulness coaches 

Recognizing Immediate Need for Panic Disorder Treatment

Remember, you are an expert on your own life. When there is a concern for wellbeing and a decrease in daily functioning, it is critical to start reaching out for professional help. 

Relationships will most likely be the first characteristic affected in the diagnosis. Not only relationships with people, also relationships with self, home space, hygiene, work, enjoyable activities, and health. If there is a sense that something doesn’t feel “right” then follow the intuition and seek support. 

You should consider seeking professional treatment regarding your concerns about panic if it becomes recurring and affects your well-being and ability to live your life. 

This might look like:

🚨 thoughts of suicide                                   🚨 isolation 
🚨 self-harm                                                    🚨 worsening mood
🚨 difficulty with daily functioning              🚨 avoiding social events
🚨 changes in personal relationships        🚨 decline in daily functioning

🚨 thoughts of suicide
🚨 isolation 
🚨 self-harm
🚨 worsening mood
🚨 difficulty with daily functioning
🚨 avoiding social events
🚨 changes in personal relationships
🚨 decline in daily functioning

Panic Disorder Professional Organizations

Provided are some resources to help the start of seeking support for panic disorder. Though these are national links, consider narrowing options down by searching in your current location. 

Anxiety and Depression Association of America
Freedom From Fear
Child Anxiety Network
☎️ Crisis Text Line – Text “HELP” to 741741 (US and Canada)

https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml
https://www.healthline.com/health/how-to-stop-a-panic-attack
https://www.verywellmind.com/psychotherapy-for-the-treatment-of-panic-disorder-2584312
https://my.clevelandclinic.org/health/diseases/4451-panic-disorder
https://www.health.harvard.edu/a_to_z/panic-disorders-a-to-z
https://www.medscape.com/answers/287913-95580/what-are-common-comorbidities-of-panic-disorder
https://www.psychguides.com/mental-health-disorders/panic/
https://www.sonomalavender.com/blogs/news/lavender-is-proven-to-reduce-anxiety-quickly-safely-sonoma-lavender
https://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling
https://www.webmd.com/anxiety-panic/guide/understanding-panic-attack-treatment#:~:text=The%20treatment%20may%20begin%20with,feelings%20that%20cause%20your%20attacks.