2.3% of people in the United States report experiencing panic disorder per year, and that number doesn’t even account for those uncomfortable sharing that information (Kessler, Chiu, Demler, & Walters, 2005; Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012). So, most likely, you or someone you know has probably experienced at least one panic attack or the physiological sensations associated with Panic Disorder.
It can be such a terrifying experience to have a panic attack and feel completely out of control in your own body. Further, panic attacks are sudden and unpredictable. Whether there has been one or multiple panic attacks, clients have reported months to several years of feeling isolated and afraid before seeking help and/or gaining an understanding of what is truly happening. Psychoeducation about what to expect and what is normal, when it comes to having panic attacks and panic disorder, is the first step toward effective treatment. So, reading an article like this or talking to a mental health professional for more information is the first step toward relief of these unpleasant symptoms.
How do you know if you have had, or are having, a panic attack? Below is a list from the Anxiety and Depression Association of America that outlines common physiological experiences that can occur during an attack. These symptoms come up suddenly and tend to peak in a few minutes or less.
- Palpitations, pounding Heart, accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
So, as you can imagine and may know, these symptoms lead people to believe that they are having a heart attack or that there is a significant medical issue. In order to be diagnosed with panic disorder you would experience four or more of the above physiological symptoms during a panic attack. Subsequently, you would notice continued preoccupation and worry about future panic attacks and/or a significant change in your behavior. These changes in behavior vary, but often fall into the categories of avoidance or over preparation. Because these episodes are often extremely uncomfortable and frightening, it is not uncommon to avoid anything that may trigger another attack (APA, 2013).
In order to illustrate an example of how Panic Disorder may look and feel, below is a case that highlights the symptoms above. Please note this is not a real client example, but represents actual experiences with this disorder.
Case example
Greg is in the grocery store with a full cart, and realizes he forgot something in the produce section. As he heads over to that area, he notices how crowded it is and starts to feel slightly anxious. Suddenly he notices he is getting short of breath, dizzy and really warm. Greg starts to pay close attention to his increased heart rate, the way he has started to sweat and feels like he can’t catch his breath. Within about one minute Greg feels like he can’t breathe and believes he is having a heart attack. All of these startling experiences lead Greg to call 911 and go straight to the hospital. He is there for a few hours and after several tests, everything appears to be normal. The doctor tells him he thinks he just had a panic attack.
While it is relieving to know that there isn’t any medical issue, it at can be really frustrating for folks who don’t know what to do next. So, it’s common for people to try and work through the anxiety and future panic attacks without the support of a specialist.
So, this brings us back to Greg. Greg decides that he will be alright if he just avoids the grocery store at busy times and makes sure to eat and drink enough before going. However, this avoidance and preparation doesn’t stop him from having another panic attack at a department store and another when he attends his son’s baseball game. Soon, he experiences high anxiety throughout each day and this leads him to avoid social situations, certain work events and ultimately he ends up fearful of most activities outside of the home. Ultimately, the fear of the unknown and repercussions of people noticing keeps Greg feeling stuck and safest in a more isolated and familiar environment.
Back to the facts…
Avoidance looks different for everyone. In the above example, Greg starts to avoid the specific location and scenario where he first experienced panic. For some people, avoidance grows and environments where there is any perceived similarity to the original place(s) become anxiety provoking as well. Further, some people start over preparing for activities where they think they could have high anxiety or a panic attack. Often this can be making sure to have water, cell phone, charger, a pre-planned exit strategy, and more.
These preparations and avoidance in general can seem like a very logical solution to any of us who don’t want to feel uncomfortable or embarrassed. This is because of basic biology. The symptoms of panic are similar to what we experience when we are in fight or flight mode. Naturally, all of us are wired to respond to these cues we feel when anxious or panicking by fighting/ fleeing/ freezing. So, if we feel anxious and find our way to an exit when the fire alarm goes off, that is a natural and appropriate response. However, with panic, the body starts signaling there is danger inaccurately. That is why there is such an intense and common urge to have exit plans and avoid situations after having panic attacks. This then leads a vicious “fear of fear” cycle (Craske & Barlow, 2007).
So, what does all of this mean for people who struggle with panic?
Even though it makes sense to avoid things that create such a high level of discomfort and potential embarrassment, it is extremely important to avoid avoidance! The more you avoid, you are reinforcing that those situations are dangerous and this will only increase your anxiety over time. The most effective way to experience relief from panic attacks, in my experience, has been with Cognitive Behavioral Therapy (CBT) and exposure work.
It is important to work with a clinician who can help distinguish between real danger versus perceived, and then slowly work toward approaching previously avoided situations. Restructuring thoughts and beliefs that continue to trigger the “fear of fear” response and resisting avoidance through exposure work are what I assist clients with when they come in with this diagnosis. I have personally helped many people work through fears that they never thought were possible to approach. Further, clients have reported improved confidence that they can live their life according to their values without the preoccupation of “what ifs” and fear of the unknown.
Panic attacks and Panic Disorder do not have to be a life sentence. It is possible to see change and improvement with evidenced based treatment.
References
American Psychiatric Association (2013). Diagnostic and statistical manual for mental disorders (5th ed.). Washington, DC.
Craske, M. G. & Barlow, D. H. (2007). Mastery of Your Anxiety and Panic: Workbook for Primary Care Settings. New York: Oxford University Press, Inc
Hofman, S., PhD, Hay, A., PhD, & Barthel, A. (n.d.). Panic Attacks and Panic Disorder: Symptoms, Treatment, Causes, and Coping Strategies [Web log post]. Retrieved June 27, 2019, from https://www.anxiety.org/panic-disorder-panic-attacks
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169-184.