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DEFINITION:
Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include:
· Racing heartbeat
· Difficulty breathing, feeling as though you can't get enough air
· Terror that is almost paralyzing
· Dizziness
· Lightheadedness or nausea
· Trembling
· Sweating
· Shaking
· Choking
· Chest pains
· Hot flashes, or sudden chills
· Tingling in fingers or toes (pins and needles)
· Fear that you're going to go crazy or are about to die
These behaviors are typical of the classic 'flight or fight' response that human beings experience when they are in a situation of danger. However, during a panic attack, these symptoms seem to occur without the normal stimulus that would be expected to trigger such a reaction. They occur in seemingly harmless situations--they can even happen while a person is asleep. In addition to the above symptoms, a panic attack is marked by the following conditions:
· An attack occurs suddenly, without any warning and without any way to stop it.
The reaction is significantly out of proportion to the actual situation; often, in fact, it is completely unrelated.
· Like an appropriate response, an attack normally passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated panic attacks can continue to recur over an extended period.
· A panic attack, in and of itself, is not dangerous, but it can be terrifying, largely because it feels crazy and out of control. Panic disorder is frightening because of the panic attacks associated with it. It also can lead to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.
· In reality, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger such an attack.
EXAMPLES OF WHAT AN ATTACKS FEEL LIKE:
A: A panic attack is an almost violent experience. I feel disconnected from reality. Even though I know what is happening, I feel like I’m losing control over my behavior. My heart pounds really hard, I feel like I can’t get my breath, and I have an overwhelming feeling that things are crashing in on me.
B: In between attacks there is this dread and anxiety that it’s going to happen again. I’m afraid to go back to places where I’ve had an attack. Unless I get help, there soon won’t be anyplace where I can go and feel safe from panic.
PREVALENCE:
Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer.
Panic disorder affects about 6 million American adults and is twice as common in women as men. The frequency in children is unknown, but felt to be significantly underreported and under-diagnosed.
Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited. Children and adolescents with panic disorder may begin to feel anxious most of the time, even when they are not having panic attacks. Some begin to avoid situations where they fear a panic attack may occur, or situations where help may not be available. For example, a child may be reluctant to go to school or be separated from his or her parents. In severe cases, the child or adolescent may be afraid to leave home. Panic disorder in children can be difficult to diagnose. Children and adolescents with symptoms of panic attacks should first be evaluated by their family physician or pediatrician.
TREATMENT:
Panic disorder is a real illness that can be successfully treated. Most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases.
The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. Cognitive restructuring (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.
Cognitive therapy can help the patient identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.
Behavioral therapy is also used to deal with the situational avoidance associated with panic attacks. One very effective treatment for phobias is in vivo exposure, which is in its simplest terms means breaking a fearful situation down into small manageable steps and doing them one at a time until the most difficult level is mastered.
Relaxation techniques can further help someone 'flow through' an attack. These techniques include breathing retraining and positive visualization. Some experts have found that people with panic disorder tend to have slightly higher than average breathing rates, learning to slow this can help someone deal with a panic attack and can also prevent future attacks.
In some cases, medications may also be needed. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.
Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place of therapy, but it can be a useful adjunct.
If one suffers from panic disorder, these therapies can help. But it is generally not possible for an individual to do them without help; all of these treatments must be outlined and prescribed by a psychologist or psychiatrist.
LONG TERM OUTLOOK:
Some people’s lives become so restricted that they avoid normal activities, such as grocery shopping or driving. About one-third become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person. When the condition progresses this far, it is called agoraphobia, or fear of open spaces. Early treatment can often prevent agoraphobia, but people with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety.
Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism. These conditions need to be treated separately. Symptoms of depression include feelings of sadness or hopelessness, changes in appetite or sleep patterns, low energy, and difficulty concentrating. Most people with depression can be effectively treated with antidepressant medications, certain types of psychotherapy, or a combination of the two.
SOURCES:
http://www.nimh.nih.gov/health/topicspanic-disorder/index.shtml
http://www.apa.org./topics/anxietyqanda-html
http://www.aacap.org/cs/root/facts_for_families/panic_disorder_in_children_and_adolescents
http://www.keepkidshealthy.com/welcome/conditions/Anxiety_Disorders.html