Panic disorder refers to the repeated experience of relatively brief, but distressing periods of extreme anxiety symptoms. These are referred to as panic attacks. Essentially a panic attack is a sudden experience of intense fear or extreme discomfort that peaks within about 10 minutes and can last for around 30 minutes, although the after effects of anxiety can take some time to settle. These attacks are very unpleasant, and often a person will think they are going to die, and panic attacks are typically unexpected. They even occur during sleep, causing the person to wake. Around 40% of people will experience a panic attack over their life time, however the occurrence of one attack is not frequent enough for it to be considered as panic disorder.
Signs and symptoms
During a panic attack a person can experience a number of symptoms. To be diagnosed with panic disorder, using the DSM-5 (2013), four or more of the following panic symptoms need to occur:
- Palpitations, and heart racing
- Shaking or trembling
- Feeling short of breath or like being smothered
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, and faint
- Chills or heat sensations
- Feelings of unreality or detachment
- Fear of losing control or ‘going crazy’
- Fear of dying
After these panic attacks there also needs to be at least 1 of month of either constant concern or worry about having another attack, or changing behaviour to try and avoid the attacks (e.g., avoiding exercise, or unfamiliar situations).
Prevalence and who is more likely to experience panic disorder
Estimates suggest that 5% of Australians will experience panic disorder at some time in their life, with around 2.6% of people experiencing it in a 12 month period. Panic disorder typically starts in early to mid 20’s, but also can begin around middle age. It is slightly more common in women than in men.
There is strong evidence for the use of psychological treatment of panic disorder. The most frequently used approach is Cognitive Behavioural Therapy (CBT) that targets thoughts, feelings and behaviours. This approach also provides education (called psycho-education) about anxiety and helping people understand the physiological response in their body, and the interplay between the mind and body in panic disorder. The cognitive approach of this strategy helps calm the worrying thoughts, and challenge those ones that are unrealistic and driven by anxiety. The approach also uses behavioural techniques such as relaxation strategies to help gain control over the body symptoms and anxious thoughts. It also can involved what is called graduated exposure. Where someone may be avoiding a place where they have had a panic attack before, a person is gradually given tasks to overcome this fear and avoidance. There is a high association also between panic disorder and agoraphobia.
Some antidepressant medication can also be used to help with very severe symptoms. Using medication must be taken in consultation with your doctor. Antidepressants are used for longer periods of time, in contrast to drugs such as benzodiazepines, which are used only in the short term (two to three weeks), or intermittently as part of an overall treatment plan. Caution is taken in the use of benzodiazepine because of their addictive nature.