Panic Attack

September 20, 2011

A panic attack is intense fear in the absence of real danger, which lasts for a period of time (usually 10-30 minutes) and then stops. The fear is accompanied by at least four of the following symptoms: (a) heart racing, pounding, or skipping beats, (b) sweating, (c) trembling or shaking, (d) difficulty breathing, (e) feeling of choking, (f) chest pain, (g) nausea or upset stomach, (h) dizziness, (i) a sense that the external world is strange or unreal (derealization), or a sensation of detachment from one’s own body or experience (depersonalization), (j) fear of losing control or “going crazy,” (k) fear of dying, (l) odd sensations (pins and needles, tingling, or numbness in parts of the body), or (m) chills or hot flushes. Panic attacks come on suddenly and rise to a peak within about 10 minutes.

Panic attacks are the main feature of panic disorder, but they can also occur in other conditions such as posttraumatic stress disorder. Attacks can come daily, weekly, or at longer intervals, and may come in bursts of more frequent attacks with attack-free periods in between. Some people become afraid of having a panic attack in public or somewhere that may be difficult or embarrassing to escape from. This can develop into agoraphobia, in which public places are avoided or endured only with extreme anxiety.

Panic attacks are real. Panic attacks happen when the body’s “fight or flight” response is activated even when there is no real danger. Adrenalin is released into the bloodstream, so an attack feels real—and biochemically, it is real. Someone having a panic attack feels that something terrible is happening or that she is going to die. A natural response is to try to figure out why she feels this way. A person suffering from panic attacks may believe that the attacks indicate an undetected life-threatening illness, and may not be reassured by repeated medical evaluation. She may change her behavior to avoid places and situations that trigger the attacks. She may fear that panic attacks mean that she is “going crazy.” Panic attacks are not caused by weak character. While one part of the brain may understand that “this is only a panic attack,” another part of the brain is convinced that there is imminent danger.

Panic disorder consists of recurrent unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack, worry about what the attack means, or behavioral change as a result of the attacks. To diagnose panic disorder, the panic attacks cannot be caused by another condition such as hyperthyroidism, excessive caffeine intake, drug use (cocaine or amphetamines), alcohol withdrawal, or another mental disorder. Symptoms like loss of consciousness, loss of bladder or bowel control, slurred speech, loss of memory are not typical of panic disorder and suggest there must be another underlying condition.

A person who only has panic attacks in one or a few specific situations probably has a different disorder. For example, social phobia is a disorder in which panic attacks are caused by social situations such as attending a party. Posttraumatic stress disorder involves panic attacks that are triggered by events that bring a previous traumatic experience to mind. Panic attacks can also be caused by medical conditions such as asthma, hyperthyroidism, and others. There are no laboratory tests that diagnose panic attacks or panic disorder, but laboratory tests can help rule out underlying causes of panic attacks.

Between 0.5% and 1.5% of the population has panic disorder in any given year. It usually begins between the late teens and mid-30s. Panic disorder is twice as common in women than men. It affects all ethnic groups. Having a close relative with panic disorder raises the chance of developing panic disorder, but most people with panic disorder do not actually have affected family members. Compared to the general population, people with panic disorder have higher rates of depression and other anxiety disorders at some time in their life. A person with panic attacks may selftreat the intense anxiety with alcohol or other drugs, and can develop a substance-abuse problem as a result.

Untreated, panic disorder can continue for years. Fortunately, treatment is available that can help almost everyone with panic attacks. Antidepressant medications (either tricyclics or selective serotonin reuptake inhibitors) reduce or eradicate symptoms but may take a few weeks to work. Valium-type medications (benzodiazepines) work immediately, but have more side effects and can be addicting. Sometimes a benzodiazepine will be used for a few days or weeks along with an antidepressant until the antidepressant takes effect. Talking therapies are also effective, but may take longer to work. Cognitive-behavioral therapy for panic disorder is the best studied, but other kinds of therapy may work too. Treatment of agoraphobia (fear of open or public places) may involve careful exposure to anxiety-provoking situations as part of the treatment. After the panic attacks are eliminated, medication is usually continued for a year or so to prevent relapses.

SEE ALSO: Anxiety disorders, Mood disorders, Phobia, Posttraumatic stress disorder, Substance use

Suggested Reading

  • Bemis, J., & Barrada, A. (1994). Embracing the fear: Learning to manage anxiety and panic attacks. Hazelden Information Education.

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