Panic Disorder

Graphics courtesy of HealioOpens in new window Panic disorder is an anxiety disorder characterized by recurring and unpredictable panic attacks.

Panic attacks are accompanied by at least four of the following symptoms:

People can have panic attacks at any time, even during sleepOpens in new window. People with panic disorder experience panic attacks without any clear provocation. They believe that they are having a serious and dramatic experience such as a heart attack or complete loss of control, or even that they are dying.

It is common that they go to the emergency room believing that they need treatment for their symptoms. Since they cannot predict when the next attack will take place, their unexplained physical symptoms provoke persistent fear about having another attack.

In an attempt to prevent panic attacks, some people restrict their lives by avoiding normal activities. For instance, if an individual experiences a panic attackOpens in new window while on the stairs, he may become so fearful of stairs in any place that he might change his apartment or workplace to avoid stairs.

In addition to recurrent unexpected panic attacks, one must have a month or more of one of the following symptoms for a diagnosis of panic disorder:

• consistent worry about having additional attacks,
• concern about the consequences or implications of the attack, and
• significant behavior change due to the attacks.

Panic disorder affects 2 to 3 percent of the U.S. adult population per year (Kessler, Chiu, Demler, & Walters, 2005). Women are twice as likely to be diagnosed with panic disorder as men. Although many people first experience panic attacks in late adolescence or early adulthood, not everyone who experiences panic attacksOpens in new window develops panic disorder.

About one-third of people with panic disorder also have agoraphobiaOpens in new window (fear of leaving the house). Panic disorder may also be comorbid with depressionOpens in new window and substance abuseOpens in new window (including alcoholismOpens in new window; Preston, O’Neal, & Talaga, 2008).

Several biological factors have been linked with panic disorder. Research suggests that people with panic disorder have problems with norepinephrineOpens in new window (a chemical messenger in the brain), possibly in a part of the brain stem called the locus ceruleusOpens in new window (an area in the brain in which much norepinephrine is present).

Research has shown that when locus ceruleus of monkeys is electrically stimulated, monkeys have symptoms of panic (Redmond, 1977).

The neurotransmitter serotoninOpens in new window and GABA (gamma-aminobutyric acid)Opens in new window may also play a role in panic disorder since medications that operate on these substances relieve symptoms (Preston et al., 2008). The degree of potential genetic contribution to panic disorder has not been studied extensively.

Cognitive-behavioral theoristsOpens in new window suggest that people with panic disorder are highly sensitive to bodily sensations and interpret them in a dramatic fashion (Casey, Oei, & Newcombe, 2004).

All people sometimes experience bodily sensations that may seem out of the ordinary such as the heart racing slightly or an unexplained sensation of pain. People with panic disorder may literally panic when experiencing these sensations, believing that some catastrophe, such as a medical emergency, is occurring.

Treatment

Panic disorder is very responsive to a combination of medication and psychotherapy. In the initial phase of treatment, it is necessary to eliminate or greatly reduce panic attacksOpens in new window. While cognitive and behavioral techniques may help, anxiolytic medications (e.g., benzodiazepinesOpens in new window such as Valium) take effect more quickly.

Other medications useful in treatment include antidepressantsOpens in new window that affect norepinephrine and serotonin (e.g., selective serotonin reuptake inhibitors and monoamine oxidase [MAO] inhibitors) and anxiolytics that affect GABA and reduce panic symptoms (e.g., benzodiazepines).

About 80 percent of panic disorder sufferers experience improvement in symptoms after taking antidepressants that operate on norepinephrine. About half are dramatically improved, some cured, as long as they continue taking the medications (McNally, 2001).

After reducing initial symptoms with medication, behavioral techniques (such as systematic desensitization) may be useful to reduce anxiety-producing situations.

Cognitive therapyOpens in new window has been found to be highly effective (Hoolon, Stewart, & Strunk, 2006). First, therapists educate clients about their bodily sensations, about healthy interpretations of the sensations, and about the nature of panic attacks. Next, clients are trained to make appropriate interpretations even during stressful situations.