Panic Disorder

Panic Attacks Can Be Terrifying
Panic Attacks Can Be Terrifying

Panic Disorder and Panic Attacks are Remarkably Frightening and Upsetting

Here’s the thing about panic disorder.  It’s just not possible to believe that the experience of a panic attack, that does not harm you and where the medical outcome is trivial, can be so horrible in the moment.  It seems little comfort to people to tell them that a panic attack won’t kill them.  In the middle of one you’re both terrified that you’re dying and wishing you could just die to make it stop.  Well, maybe not wishing you could die.  That goes a bit too far.  But it is true that, frightening as they seem, especially the first few attacks, one can eventually come to bear them and later to control them.

And it’s also true, and good news, that they are not medically dangerous or fatal.  Once a person understands what the panic attacks are and has a few attacks they can become less frightening.  Each attack does go away at some point without the help of a health care provider even though you might seek an emergency room with the first few. 

What Is Panic Disorder? – What Are Panic Attacks?

No one knows.  There was a scientist in the 1920s, W. B. Cannon, that studied what a person’s (or an animal’s) body did when scared and ready to fight or run away.  He called it the fight or run response.  Journalists consider themselves clever, however, so later writers called it the “fight or flight” response.  When threatened and needing to choose between fighting or running, stress hormones are released.  The heart rate speeds up and the heart pounds.  To push the blood supply more to the large muscle groups, the body slows blood flow to the gut for digestion.  The body is readied for a maximal burst of physical energy output.  But in truth, in 2020, medical science has not completely outlined all the brain nerve circuits and hormones involved.

So, A Panic Attack Seems to Be…

A panic attacks seems to be all the energy and juices that go into Cannon’s fight or run reaction but without the threat of a tiger ready to devour you.  The threat feeling rises from somewhere deep within you and boom, the attack hits.  Often the person is not aware of the source of this feeling of threat, just the panic attack reaction.

Well, Okay, Yes, But…

It’s not so simple as, “Okay, now I get it.”  Despite a person having had panic attacks and knowing what is happening, no one wants to have an attack.  Most certainly no one wants to have a panic attack in a public place or while driving.  As a result, the person with untreated panic disorder tends to go out less, socialize less, and starts to become a loner.  They might narrow life to going only go to work or school.  Other joys of social life shrink.  The presence of panic disorder can easily become socially crippling.

Here’s a First-time Panic Attack Story

A woman, healthy and relatively calm, is walking quickly down the stairs to the subway after a tense job interview.  Suddenly she has a severe pain in her chest and feels dizzy.  She grabs the metal stair rail, feeling nauseated, and then her vision goes weird.  Everything seems to look small and far away then everything starts to go black.  She can’t catch her breath and starts to fall despite her death grip on the metal handrail.  “Oh, God, what’s happening, I must be dying”, she thinks, “I must be having a heart attack, dying of a heart attack”.  She tries to fumble in her purse for her cell phone but can’t think and can’t see what she’s doing.

One of the people coming down the stairs sees her struggling, breathing hard, and sweating profusely.  This Good Samaritan calls 911.  He stays with her.  The chest pain has eased but her breathing is still labored.  She’s still confused when the paramedics arrive.  They get her in the ambulance and rush off to the ER.  The medical tests begin.  Three hours later she’s feeling better though still upset and shaken by the whole experience.  The ER doctor comes in to talk with her.  The tests were all normal.  He smiles and says, “You’ve had a panic attack.”

What the Book of Diagnoses Says about Panic Disorder

One system used to categorize medical diagnoses is DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and Panic Disorder is in there (See “A Bit of Medical History” below).  DSM 5 even gives it a diagnosis code number, 300.01.  Here’s a link that lists the specific signs, symptoms, and other criteria that a doctor needs to see to make the diagnosis:

https://www.medscape.com/answers/286227-14544/what-are-the-dsm-5-criteria-for-diagnosis-of-panic-disorder

What Do These Signs, Symptoms, and Criteria of Panic Disorder Look Like?

The story above of the woman having her first panic attack provides a good description.  The person is overcome suddenly, and often for no apparent reason, with overwhelming anxiety and fear.  If there was a stressor (in her case, maybe the job interview) it seems like it should be in the past and irrelevant.  They feel that they have lost control of themselves.  While not officially listed, many people are terrified that they are going immediately and irreversibly insane.  The person might think she’s dying.  These thoughts might be present especially during the first several attacks.  It does not make sense to them later, perhaps even feels silly, but in that moment of frightening terror it feels as if insanity is real and right now.  Then, surviving the first few, there’s always the worry that there’ll be another attack.

How Panic Disorder Is Usually Treated

The silver lining to this panic black cloud is that there are many good treatments for panic disorder.  There are a whole variety of therapies that do not involve medication and several good medicines that help greatly.  Just taking an anxiety pill by itself is far less helpful than a good, prescribed medicine linked with one of the effective available therapies.  There’s more treatment information on our Panic Disorder Treatment page.

https://www.neuroscirandd.com/panic-disorder-treatment/

First the Medicines for Panic Disorder

The medicines typically tried first are from a family of medicines that usually come to mind for treating depression, the SSRIs (selective serotonin reuptake inhibitors).  Panic disorder is not depression.  It just so happens that these medicines work for both.  Another family of medicines that was originally developed for depression, the “tricyclics” or TCAs, also at times work really well for panic disorder.  Finding the best medicine for you depends both on what works best and what are that medicine’s side effects.  There is also a whole group of medicines that come to mind for anxiety.  These are popular medicines (like Valium, Xanax, and Ativan) that are used just to relieve anxiety in the moment but they might not be as safe for ongoing, long-term use.  The medical concern with them is a risk of abuse and addiction.  There are some people who become badly trapped by these anti-anxiety medicines.

Many People Like the Therapies

All sorts of therapies are available to help treat panic disorder.  These therapies help people to have fewer and fewer, and less severe, panic attacks over time.  And, when they do feel a bit of a panic the attack is milder.  There are “tricks of the trade”, special ways of doing things, that when learned, practiced, and used can be quite helpful to make panic attack less frequent and milder.  One well-known therapeutic technique is CBT, or Cognitive Behavioral Therapy.  It’s really popular and often works well.  It’s a therapy that’s makes rational sense to many people who see themselves as reasonable and logical and don’t want “psychotherapy”.  Then there are relaxation skills, supportive group therapy, and individual interpersonal psychotherapy.  Try more than one method, find what helps you the most, and make it yours.

And Now for a Bit of Medical History… 

In the writings of ancient Greek and Roman doctors and philosophers are descriptions of disorders that could be, and likely were, anxiety and panic.  The way the human body reacts has changed little in 2500 years and it’s likely that people then suffered much the same as we do.  Then there’s the hundreds of years of the Dark Ages, the usual gap in medical information and scientific progress when the Catholic Church took over.  After the Dark Ages, medicine became an interest of many bright men and women.  It’s called the Enlightenment of the Renaissance.

In the 1700s a diagnosis appears, “panophobia”, that might well have referred to what we now call panic disorder and other anxiety disorders.  Medical case reports appear that seem to describe panic attacks, but these episodes are called “melancholy” or the “vapors and melancholia” by the doctors of that period.  Just as now, anxiety and depression seem to have been mixed together in these early days of “modern” medicine.  The specific diagnosis of Panic Disorder did not become an “official” diagnosis until 1980, with the publication of DSM III (the Diagnostic and Statistical Manual of Mental Disorders, Third Edition).

Did You Know That…  Earl Campbell had Panic Disorder?

Earl Campbell (age 64 in 2020) is a great athlete.  He’s a famous football running back, 5 feet 11 inches and 232 pounds.  He played for the Houston Oilers and New Orleans Saints.  He was a 1977 Heisman Trophy winner and was the No. 1 pick of the 1978 NFL draft.  During his football career he was NFL Most Valuable Player three times and All-Pro eight times.  Campbell became the centerpiece of Houston’s offense during the late 1970s and early 1980s.

In 1989, at age 34, his panic disorder was finally diagnosed.  His panic attacks included chest pain and the typical paralyzing fear.  Also typical, he thought he was dying of a heart attack.  It took him a year to understand what was happening to him.  As is typical of most of us, he had never heard of panic disorder.  Campbell was quoted as saying, “The thing about it is if you have it, there’s some help available.  There are people who understand what’s going on with you and you have to deal with it.”  After he understood and learned how to manage his panic disorder he began to educate others about it.  He commented, “‘I’m still scared about it, but I’m not as scared as I used to be.  There was a period of time where I had my problems.  I lived in the house with sunshades on and crying.”

Helpful links:

Panic Disorder: When Fear Overwhelms – National Institutes of Health

Panic Disorder at Medline Plus

Understanding the Facts: Panic Disorder – Anxiety and Depression Association of America

Panic Attacks and Panic Disorder – The Mayo Clinic

Answers to Your Questions about Panic Disorder – American Psychological Association

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