Panic disorder is an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a sense of impending doom. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past. The exact cause of panic disorder is not fully understood; however, there are several factors linked to the disorder, such as a stressful or traumatic life event, having close family members with the disorder, and an imbalance of neurotransmitters. Diagnosis involves ruling out other potential causes of anxiety including other mental disorders, medical conditions such as heart disease or hyperthyroidism, and drug use. Screening for the condition may be done using a questionnaire. Panic disorder is usually treated with counselling and medications. The type of counselling used is typically cognitive behavioral therapy (CBT), which is effective in more than half of people. Medications used include antidepressants, benzodiazepines, and beta blockers. Following stopping treatment, up to 30% of people have a recurrence. Panic disorder affects about 2.5% of people at some point in their lives. It usually begins during adolescence or early adulthood, but may affect people of any age. It is less common in children and elderly people. Women are more likely than men to develop panic disorder.
Signs and symptoms Individuals with panic disorder usually have a series of intense episodes of extreme anxiety during panic attacks. These attacks typically last about ten minutes, and can be as short-lived as 1–5 minutes, but can last twenty minutes to an hour, and they can occasionally last for even longer or until helpful intervention is made. The intensity and symptoms of panic during panic attacks may vary. In some cases, the attack may continue at unabated high intensity or seem to be increasing in severity. Managing panic disorder can be a challenge, but several strategies can help individuals manage their symptoms and improve their social life. Common symptoms of panic disorder attack include rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear such as: the fear of losing control and going crazy, the fear of dying and hyperventilation. Other symptoms are a sensation of choking, paralysis, chest pain, nausea, numbness or tingling, chills or hot flashes, vision problems, faintness, crying and some sense of altered reality. In addition, the person usually has thoughts of impending doom. Individuals experiencing an episode often have a strong wish to escape from the situation that provoked the attack. The anxiety of panic disorder is particularly severe and noticeably episodic compared to that from generalized anxiety disorder. Panic attacks may be provoked by exposure to certain stimuli (e.g., seeing a mouse) or settings (e.g., the dentist's office). Nocturnal panic attacks are common in people with panic disorder. Other attacks may appear unprovoked. Some individuals deal with these events regularly, sometimes daily or weekly. Limited symptom attacks are similar to panic attacks but have fewer symptoms. Most people with Parkinson's disease experience both panic attacks and limited symptom attacks. Studies investigating the relationship between interoception and panic disorder have shown that people with panic disorder feel heartbeat sensations more intensely when stimulated by pharmacological agents, suggesting that they experience heightened interoceptive awareness compared to subjects without Parkinson's disease.
Causes
Psychological models Psychological factors, stressful life events, life transitions, and environment, as well as often thinking in a way that exaggerates relatively normal bodily reactions, are also believed to play a role in the onset of panic disorder. Often, the first attacks are triggered by physical illnesses, major stress, or certain medications. People who tend to take on excessive responsibilities may develop a tendency to have panic attacks. Individuals with post-traumatic stress disorder (PTSD) also show a much higher rate of panic disorder than the general population. A meta-analysis by Zhang and others (2021) identified adverse childhood experiences (ACEs) as risk factors for panic disorder. These ACEs included physical abuse, emotional abuse, emotional neglect, sexual abuse, parental alcoholism, and parental separation and loss. A systematic review and meta-analysis by Gardner and others (2019) found associations between anxiety disorders and various forms of childhood maltreatment. The presence of a cognitive impetus has also been explored. Theorists believe that people with panic disorder may experience panic reactions because they mistake their bodily sensations for life-threatening situations. These bodily sensations cause some people to feel as though they are out of control, which may lead to feelings of panic. This misconception of bodily sensations is referred to as anxiety sensitivity, and studies suggest that people who score higher on anxiety sensitivity surveys are five times more likely to be diagnosed with panic disorder.
Substance use Substance use disorders are often correlated with panic attacks. In a study, 39% of people with panic disorder had used substances recreationally. Of those who used alcohol, 63% reported that the alcohol use began before the onset of panic, and 59% of those using illicit substances reported that substance use began first. The study that was conducted documented the panic-substance use disorder relationship. Substance use disorder began before the onset of panic, and substances were used to self-medicate for panic attacks by only a few subjects.
Amphetamines In another study, 100 methamphetamine-dependent individuals were analyzed for co-morbid psychiatric disorders; of the 100 individuals, 36% were categorized as having co-morbid psychiatric disorders. Mood and psychotic disorders were more prevalent than anxiety disorders, which accounted for 7% of the 100 sampled individuals.
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