Panic

Panic (PA-nik) is a sudden surge of overwhelming fear that causes both psychological (sy-ko-LAH-je-kal) and physical symptoms. Panic disorder is a condition that leads to repeated attacks of panic that can strike often and without warning.

Carla was riding her bicycle to school when a speeding car ran a stop sign. The driver slammed on the brakes, but the car kept skidding toward Carla with a sickening squeal. As Carla watched the car bearing down on her, she felt her heart racing, she broke into a sweat and couldn't catch her breath, and everything seemed to be moving in slow motion. For a moment before the car finally came to a stop, Carla feared she was going to die.

What Are Panic Attacks and Panic Disorder?

Carla was feeling panic, a sudden surge of overwhelming terror that causes both psychological symptoms, such as feeling that things are unreal or fearing that death is approaching, and physical symptoms, such as a racing heart, sweating, trembling, shortness of breath, chest pain, upset stomach, and dizziness. These feelings are the body's natural response to danger or stress. For some people, though, the feelings seem to arise from nowhere. They can occur in seemingly harmless situations, such as while taking a quiet walk or sitting in class. Panic attacks are bursts of intense fear or discomfort that happen, often for no obvious reason. They are part of many anxiety (ang-ZY-e-tee) disorders, in which needless fear becomes so intense and long-lasting that it causes problems at home, in school, at play, or elsewhere.

Panic disorder is a particular type of anxiety disorder in which people have panic attacks that strike often and usually without warning. The attacks are so unpleasant that many people live in constant dread of the next one. People may develop phobias (FO-bee-as), intense, unrealistic fears of certain objects or situations, about things linked to past panic attacks. For example, a boy who has had a panic attack during basketball practice might develop a phobia of the gym. As the problem gets worse, people may start to avoid situations where they believe they might have another panic attack. This avoidance may even turn into agoraphobia (a-gor-a-FO-bee-a), a condition that makes people find it hard to go beyond familiar places or even leave their homes. People with agoraphobia are terrified of having a panic attack in a situation where it would be hard to escape or get help.

How Common Is Panic Disorder?

About 1 in every 63 adults in the United States will have panic disorder at some point in his or her life. The problem usually begins during the late teen or early adult years, but children and older adults can have panic disorder, too. Women are affected twice as often as men. People with panic disorder often have other conditions as well, such as other anxiety disorders or depression.

What Causes Panic Disorder?

Genetics

There are probably several causes of panic disorder. Genetics ^* may play a role in some cases, since panic disorder and other forms of anxiety can run in families. Also, research has shown that twins are more likely both to have panic disorder if they are identical twins rather than fraternal ^* twins.

Physical factors

People with panic disorder may not be able to use the natural substances made by the body to reduce feelings of anxiety. Such people may have flaws in nerve cell structures in the nervous system ^* that bind to these substances.

Psychological factors

Other research suggests that it takes very little to set off the body's danger alarm in people with panic disorder. These people may have learned to overreact to normal body changes, giving rise to frequent false alarms. Some scientists believe that the faulty learning may be the result of repeated stress. Once people have learned to react this way, a stressful life event may trigger full-blown panic disorder.

What Are the Symptoms of a Panic Attack?

Panic disorder starts with panic attacks that can seem to come out of the blue. People can be struck suddenly by scary and uncomfortable symptoms, often including terror, a sense of unrealness, or a fear of losing control. These symptoms usually last several seconds, but they may go on for several minutes or longer. Confused by the unexpected rush of symptoms, people may worry that they are going crazy or suffering from a disease. Even when the most intense symptoms of panic have stopped, other anxious or nervous feelings may last for a while.

Symptoms of a panic attack may include:

• pounding or racing heart
• sweating
• trembling
• shortness of breath
• a choking feeling
• chest pain
• upset stomach
• dizziness
• faintness
• feeling as if things are unreal
• fear of losing control
• fear of dying
• numbness or tingling.

First panic attacks may occur when people are under great stress, such as when they are trying to do too much or when they have just lost a loved one because of death, divorce, or a move. A panic attack also may follow surgery or a serious accident or illness. In addition, overuse of caffeine or abuse of cocaine and certain other drugs may trigger panic attacks. Whatever the situation, though, first panic attacks usually take people completely by surprise. This is one reason they are so terrifying and most often remembered.

What Are the Symptoms of Panic Disorder?

Some people have a single panic attack or occasional attacks, but they never have a problem serious enough to affect their lives. For others, however, panic attacks can continue and cause much misery. People with panic disorder have attacks so often that they start to live in constant fear of the next one. This "fear of fear" can become so intense and last so long that it greatly interferes with people's lives. Panic disorder tends to get worse over time if it is not properly treated.

How Is Panic Disorder Treated?

Early treatment helps keep panic disorder from reaching the stage where people experience severe problems in everyday life. With proper care, 70 to 90 percent of people with panic disorder can feel much better. Before treatment starts, a medical checkup can determine if there are other possible causes for the person's physical symptoms, such as an overactive thyroid gland ^* , certain types of epilepsy ^* , or problems with the rhythm of the heartbeat.

Medications

Certain medications can prevent or lessen the severity of panic attacks. When people find that their panic attacks are less frequent or less severe, they may worry less about future attacks, and they may be able to face situations they have been avoiding. There are several different kinds of medications doctors may use to treat panic disorder, depending on the person's age and condition.

Therapy

A treatment that often works well for panic disorder is cognitive-behavioral (COG-ni-tiv-bee-HAY-vyor-al) therapy, which helps people change specific unwanted behaviors and faulty thinking patterns. People are taught that thoughts such as "I am going to have a panic attack" can be replaced with thoughts like "This is only uneasiness. It will pass." They also may learn to use slow, deep breathing to help ward off the rapid, shallow breathing that many people experience during panic attacks. In another technique, the therapist may have people intentionally bring on some of the sensations of a panic attack. For example, people may exercise to raise the heart rate. Then the therapist can teach them how to cope better with these physical sensations. For example, instead of thinking, "I am having a heart attack," a person may be taught to think, "It is only my heart beating fast. I can handle it."

In this way, cognitive-behavioral therapy focuses on helping people learn to relax when they feel panic. People are taught to understand the thought processes behind their panicky feelings and the way the body physically reacts to stress. Then the therapist can help the person find ways to respond better when they feel the symptoms of a panic attack.