The ‘ panic attack is an event characterized by intense anxiety, rapid heartbeat, shortness of breath and fear of dying or going crazy. It can occur at any time and is often associated with periods of severe stress and fatigue. When panic attacks occur frequently over a short period of time then it is called panic disorder. The panic disorder is a disorder in the DSM-5 present in the chapter of anxiety disorders, along with generalized anxiety disorder , phobias and other specific anxiety disorders. Treatment generally involves the use of anxiolytic (symptomatic) or antidepressant drugs, the use of relaxation techniques, clinical interviews and psychotherapy.
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Contents of the article [ hide ]
- Panic attacks
- Panic Attack Symptoms
- Panic Attack and DSM-5 Diagnosis
- Causes of panic attacks
- How long does a panic attack last?
- Consequences of panic attacks
- Panic attack with agoraphobia
- Panic Disorder Treatment
- Pharmacological treatment of panic disorder
- Panic attack cure
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The panic attacks are episodes during which the sufferer is prone to severe anxiety and fear very intense, no apparent danger. The term ” panic ” derives from the name of the god Pan , the god of pastures and nature. The god Pan was a frightening being, in fact he had a half human and half goat body. The myth tells that the god Pan used to suddenly attack the nymphs of the wood, during the afternoon, to possess them, arousing in them a very lively and blocking terror, precisely the “fear panic”.
The term “ panic attacks ” originates from this myth . The panic attacks were very strong anxiety , arising mostly unexpectedly and causing intense fear of losing control, going crazy or dying. During the attacks, there are numerous physical symptoms that alarm the subject, such as difficulty in breathing with chest tightness, chest pain, tachycardia and dizziness.
Panic Attack Symptoms
The symptoms of panic attack concern both psychic and physical aspects. The main symptoms of panic attack are:
- fear of losing control
- intense sweating
- feeling of suffocation
- chest pain
- sense of dizziness and dizziness
- tingling or numb sensations in the limbs
It is not necessary for all these symptoms to be present during an attack , in fact often the manifestation of a panic attack can differ from person to person. The frequency with which panic symptoms occur generally defines the severity of the disorder.
In fact, it is possible that panic attacks occur with a relative low frequency, for example one per month. In more severe cases, the attacks can be different within the same day. When a person is the victim of frequent panic attacks then it is called panic disorder .
Panic Attack and DSM-5 Diagnosis
The panic disorder is a disorder in the DSM-5 in this chapter of anxiety disorders. It is a disorder characterized by the presence of recurrent panic attacks (at least two, although there are usually many more attacks) defined as “unexpected” . The term “unexpected” means that, apparently, there are no triggers for the attack.
In a panic disorder the attacks can appear as a bolt from the blue, in some cases when the individual is relaxing or even while sleeping. According to the DSM-5, the diagnosis of panic disorder is possible if at least 4 of the following symptoms are present:
- palpitations or tachycardia
- feeling short of breath or fatigue in breathing
- feeling of suffocation
- retrosternal pain
- nausea or abdominal pain
- dizziness, feeling dizzy, light-headed or faint
- chills or hot flashes
- paraesthesia (tingling or numb sensations)
- derealization (feelings of unreality) or depersonalization (feeling separate from oneself)
- feeling of loss of control or “going crazy”
- fear of dying
Also, after the attacks, the person has persistent fear and worry of having other panic attacks for at least a month. This also causes a reduction in the subject’s quality of life. For example with the significant reduction of social or working life.
Causes of panic attacks
The causes of panic attacks can be very different. Typically the first attack occurs during a particularly stressful time for the individual. Stress can be due to an acute event or to the presence of numerous concomitant factors. The main causes of a panic attack can be:
- serious illness
- major changes in life (marriage, work, separations)
- periods of overwork or poor rest
- conflicting relational situations
- role changes (e.g. retirement)
- financial issues
After the first attack, the individual usually develops a strong worry and lives in a constant state of apprehension. “If the first attack was unexpected then it could come back again without any warning . ” This thought is very common among those suffering from panic attacks and leads the subjects to remain in a state of constant tension, in a sort of anticipatory anxiety, of “fear of fear” which leads to increasing stress levels and therefore favoring future attacks. A vicious circle is then established, where it is the “fear of having a panic attack ” that feeds the anxiety. Anxiety turns into panic and a new attack occurs.
In other cases, panic attacks are caused by a more serious disorder. The major depression , the eating disorders , the post-traumatic stress disorder are some of the disorders that can present in comorbidity, a panic disorder.
How long does a panic attack last?
A panic attack typically lasts between five and twenty minutes, although it can occasionally last longer. However, the duration generally does not exceed one hour. During this period of time the anxiety levels are very high and the subject is convinced that his own safety is at serious risk.
The panic attack naturally goes into remission. In fact, the symptoms disappear after about twenty minutes, leaving the subject in a state of profound dismay and alarm. Through breath control techniques it is however possible to limit the duration of the attacks or prevent their onset.
Consequences of panic attacks
In general, those who suffer from panic attacks develop psychological consequences both on a cognitive and emotional level, and on a behavioral level. Sufferers of panic attacks may develop concerns about their physical health (patients may think that the attacks are due to some serious life-threatening illness) or they may develop problems in the social sphere and in personal autonomy.
Some people may be concerned about finding themselves alone during an attack (for example, they may avoid using a car) and therefore have no one to ask for help. They therefore tend to reduce and avoid situations in which they are forced to be alone. Or, on the contrary, they may be worried about having panic attacks in situations and contexts where there are many people, for fear of being negatively judged by others, so they tend to isolate themselves and not leave the house.
Panic attack with agoraphobia
One consequence of panic attacks can be the development of agoraphobia, an anxiety disorder found in DSM-5. Although the etymology suggests that agoraphobia is the fear of open spaces (from the Greek αγορά : square and φοβία : fear) in reality the term is used to describe the fear connected to different places. Specifically, with the term agoraphobia we mean fear:
- to use public transport (trains, buses, taxis etc.)
- open spaces (shopping centers, bridges etc.)
- closed spaces (shops, cinemas etc.)
- of standing in line or in the middle of a crowd
- to be alone outside the home
It is generally possible that panic disorder is associated with agoraphobia . In fact, often the fear of having attacks in public contexts, or the fear of not having immediate support, leads people to avoid certain situations or contexts. Avoidance, however, reinforces fear and feeds it, thus leading to the development of agoraphobia .
Panic Disorder Treatment
The treatment of panic disorder and the management of panic attacks can include different therapeutic modalities. Generally, treatments can be pharmacological, psychotherapeutic, or integrate pharmacotherapy and psychotherapy.
However, the first fundamental step is to accept that you have a problem and get help. These ailments, although not serious, can hardly be cured on their own. In fact, the intervention of a professional is necessary to help find the most effective therapeutic strategy. Treating a panic disorder , asking for help as soon as possible, prevents the disorder from becoming chronic and prevents the vicious circle of fear from setting up.
Once the problem has been accepted, the specialist will indicate the next steps. Generally when faced with a panic disorder or frequent panic attacks , it may be necessary to exclude causes of an organic nature (for this reason it is advisable to refer first to your doctor). Once the psychological nature of the attacks has been ascertained, treatment can begin.
Pharmacological treatment of panic disorder
For the treatment of panic disorder it is possible to intervene with appropriate psychopharmacological therapies. There are several classes of drugs that are used successfully in the treatment of panic disorder and in the management of panic attacks . One type of drugs used are benzodiazepines. Benzodiazepines are symptomatic drugs (they act on anxiety symptoms) leading to a rapid remission of panic attacks . But often, if the causes of panic disorder are not understood and addressed, on discontinuation of benzodiazepine treatment, the disorder may recur. They are also drugs that can lead to tolerance and addiction. For more information on addiction to benzodiazepines you can read: Addiction to benzodiazepines .
Other classes of drugs used for panic attacks are antidepressants. Currently, SSRIs are favored, called “new generation antidepressants” which, compared to the old antidepressants, are better tolerated and have fewer side effects.
In choosing a drug therapy it is however essential to rely on your trusted psychiatrist, as the therapies require careful supervision by a doctor. Furthermore, the evaluation by a specialist can help to identify any disorders comorbid with panic disorder (eg a depressive disorder), allowing to set up a better and more effective drug therapy.
Panic attack cure
For the treatment of panic disorder and for the management of panic attacks it is possible to undertake a course of psychotherapy. One of the possible psychotherapies useful in these cases is cognitive behavioral therapy , which has been shown to be effective in treating these disorders. Through relaxation exercises, breathing management and control, combined with work on dysfunctional thoughts and ideas, it is possible to overcome panic disorder and rediscover a sense of well-being and self-efficacy.
A fundamental part of the treatment process is psychoeducation. Psychoeducation consists in providing clinical information on panic attacks , on their harmlessness and on the mechanisms that often maintain and sustain the disorder.
Information is provided on strategies to control the disorder (e.g. breathing into a paper bag helps reduce the intensity of panic symptoms), major fears are addressed, and many myths are debunked (e.g. panic attack) is not dangerous or does not mean that the subject is going crazy). In addition, the main maladaptive strategies of the subject are addressed and the patient is helped to regain possession of his daily life.