Understanding Panic Disorder: Symptoms, Diagnosis, Causes, and Treatment

December 17, 2023

Understanding Panic Disorder: Symptoms, Diagnosis, Causes, and Treatment

Although panic disorder was not well-known just a decade ago, it is now a very familiar condition. Many public figures have openly disclosed their diagnosis and treatment for panic disorder, raising public awareness of its symptoms and severity. However, as we become more familiar with panic disorder, many people are confused about what it entails. A number of participants in our cognitive behavior therapy programs often ask, "Do I have a panic disorder?" This post aims to provide a simple explanation of what panic disorder is.

Understanding panic disorder begins with understanding the concept of a 'panic attack.' A panic attack refers 1) to an intense fear that suddenly rolls in during an unexpected situation, 2) accompanied by physical symptoms like rapid heart rate or breathing difficulties, and 3) a feeling of imminent death. If such panic attacks are repeatedly experienced, one may be diagnosed with panic disorder. This means that experiencing panic attacks once does not lead to a diagnosis of panic disorder.

Medically, if four or more of the following 13 symptoms are present, it can be defined as a panic attack:

  • A sensation of heart palpitations or rapid heart rate
  • Sweating
  • Tremors in the hands, feet, or body
  • Rapid breathing
  • Feeling of suffocation
  • Chest pain or discomfort
  • Nausea or stomach discomfort
  • Feeling of dizziness or fainting
  • Feeling of unreality or feeling that the world or oneself has changed
  • Fear of going crazy
  • Fear of dying
  • Strange sensations in hands and feet
  • A flush of heat in the body

The term 'panic attack' is used because it swiftly descends in an extreme form, similar to a seizure. Panic symptoms rapidly worsen due to a cognitive pattern referred to as 'catastrophizing,' a process where the worst-case scenario is brought to mind, creating worry and apprehension as if such an event will occur. This pattern is common in panic disorder, often appearing in thoughts like, "I might have a heart attack," "I might lose my sanity," or "I could suffocate and die."

The process typically unfolds like this:

  1. Recognize an abnormal physical sensation: "Hmm, my breathing feels odd right now."
  2. Catastrophizing thought: "Could this be dangerous?"
  3. The sympathetic nervous system's fight or flight response is activated in the body.
  4. Hormonal influences intensify physical reactions, causing rapid heartbeat and breathing.
  5. Catastrophizing thought again: "I feel like I can't breathe," "This is serious."
  6. Increase conscious focus on physical sensations.
  7. Catastrophizing thought again: "I'm going to die soon."
  8. The loop from steps 4 to 7 repeats, leading to a panic attack wherein one feels they are losing control.

Diagnosis of panic disorder not only requires repeated panic attacks but also persistent fear of recurring panic attacks. Often, significant behavioral changes occur, like excessive worry about the effects or results of a panic attack or avoidance of going out due to fear of panic attacks. For example, one might walk a far distance to avoid taking the subway for fear of having a panic attack.

While the precise cause of panic disorder remains unknown, it is known to be triggered by various environmental causes, often surfacing suddenly in situations of extreme stress, such as conflicts with others. Conversely, managing psychological and physical stress can help improve symptoms of panic disorder. Factors like stress, fatigue, alcohol, and caffeine can exacerbate symptoms, so managing them effectively is meaningful.

Lastly, as the prognosis for panic disorder is better when detected early, it's crucial to seek treatment promptly once symptoms are identified.

For a diagnosis of panic disorder, not only must panic attacks occur repeatedly, but a persistent fear of recurrent panic attacks should be present as well. Excessive worry about the influence or outcomes of a panic attack or notably altered behavior such as avoiding going out due to panic attacks are common signs. For example, someone might decide to walk a far distance instead of taking the subway for fear of having a panic attack.

The exact cause of panic disorder is still unknown, but it is known to be triggered by various environmental causes. It can often abruptly appear in situations of extreme stress, such as conflicts with others. Conversely, this implies that if psychological and physiological stresses are well managed in daily life, symptoms of panic disorder can be improved. Additionally, factors such as stress, fatigue, alcohol and caffeine intake can worsen symptoms of panic disorder, and managing these elements effectively in life is significant.

Panic disorder is a condition where early detection and treatment lead to a better prognosis. This post does not delve deeply into the treatment for panic disorder, but in general, medication can be used to quell immediate anxiety, and cognitive behavioral therapy is needed for a more long-term escape from panic. Looking at the cyclical process of how a panic attack occurs, which point seems the weakest? Hormonal reactions are beyond our control, but catastrophizing thoughts can be changed. These thoughts incessantly worsen panic attacks, and this can be trained through systematic thought and distancing work.

If you exhibit these symptoms, do not hesitate to seek help from a professional. Consider medication and undergo cognitive behavior therapy. Compared to other psychiatric disorders, overcoming panic disorder is entirely feasible.

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