Panic Disorder

We all feel anxious at times and panic can be a good thing in emergencies, but when it interferes with our normal life it can be quite frustrating.

What is a panic disorder?

Panic attack is a malfunction of the body’s natural fight-or-flight response.

This is an automatic response that is triggered when the body faces danger in some form. This mechanism helped us survive during the cave man years, it’s what we relied on when we used to hunt in the jungle and came face to face with a dangerous beast. Our body prompts us either to fight, or to run (flight).

This response kept us humans alive before we hunted and gathered our way to the top of the food chain. If someone tried to attack us, we either grabbed our weapons and started attacking or we ran away – fight or flight

The body releases hormones such as adrenaline, epinephrine, glycogen, cortical, nor epinephrine, and others flood the body’s cells through into the bloodstream, which results in the symptoms of a panic attack: our heart beats faster in order to plump more blood to important organs (the muscles, lungs, and brain); our rate of breathing speeds up to increase our intake of oxygen; and our alertness intensifies.

The main five symptoms of a panic attack include a rapid heart rate, hyperventilation, chest pain, nausea and headaches. It’s easy to see how an unfortunate person suffering a panic attack for the first time, can end up think (s)he’s having a heart attack!

This response is not useful in daily life, but when it is triggered for no serious reason, it is termed as a panic attack.

If you have had a panic attack on one occasion or a few times you do not have panic disorder. But if you’ve been having panic attacks repeatedly, then you have a panic disorder.

Causes of Panic Disorder:

• Gamma-aminobutyric acid (GABA) receptor dysfunction is thought to play an important role in panic disorder pathophysiology.
• Caffeine: Increased intake of coffee can provoke feelings of anxiety
• Stuffy environment: A hot close room can set off feelings of discomfort
• Stress : For example losing a job or a significant relationship is coming to an end
• Depression: Depression has been revealed to be an anxiety producing situation in and of itself and about 67% of people with depression suffer from comorbid anxiety disorders.
• Family history of anxiety disorders
• Deficiencies in particular vitamins and minerals

Physical conditions that can mimic panic disorder

• Hyperthyroidism.
• Hypoglycaemic episodes
• Paroxysmal cardiac dysrhythmia.
• Mitral valve prolapse.
• Myocardial infarction.
• Recurrent small pulmonary emboli.
• Epileptiform disorders, particularly temporal lobe epilepsy.
• Withdrawal from alcohol/sedatives/opiates.
• Paroxysmal vestibular disorders, e.g. Ménière’s disease
• Complex partial seizures
• Hypoglycemia
• Drug effects
• Angina
• Asthma
• Irritable bowel
• Colitis
• Hypertension
• Hiatal hernia
• Vertigo
• Post concussion syndrome
• Postural hypotension
• Heart arrhythmia
• Hyperventilation syndrome

Panic Coping techniques:

If you are suffering from panic disorder you may be looking for a way to overcome it. Feeling anxious can frequently be an extremely frustrating thing for people. If a friend is having a party that you really want to go to but you are afraid because of social anxiety, you are probably looking for a way to overcome it.

People vary in how often they experience anxiety and in which kinds of situations. Overcoming anxiety depends on the person and the situation. In some cases it can be relatively easy—just a matter of time passing for many individuals, and yet for some people anxiety can become a very difficult, painful and even disabling problem that is chronic in nature

Research has shown that cognitive behavioral therapy (CBT) can be highly effective for several anxiety disorders (1)

Components of Cognitive Behavior Therapy for Anxiety :

Anxiety management skills

May involve controlled breathing, relaxation and other calming techniques

Social skills training

May involve verbal and nonverbal skills that facilitate social effectiveness, such as initiating and maintaining conversation, making appropriate eye contact and asserting oneself appropriately

Cognitive restructuring

Involves learning to identify, challenge and change fearful thinking that overestimates social threat, underestimates one’s ability to manage social demands and catastrophizes the consequences of social miscues

Gradual exposure to feared situations

Involves gradual reentry into feared social situations to reduce the anxiety that they engender

Depending on the degree of anxiety some support methods might prove to be more effective than others.

Even though the panic anxiety, fear , social discomfort, embarrassment are uncomfortable to deal with in the beginning, they will not kill you.

The effective path to take her is to help the body adapt to the panic response and train the body to perceive the panic situation as normal.

You may first do this in small steps and them go on to bigger challenges. You will notice that the symptoms reduce in their severity with repeated exposure and the body adapts to the stimulus.

Panic attacks are very unpleasant, to say the least. You cannot turn a blind eye to your physical symptoms, fearful thoughts, or uncomfortable experiences, but you dont want to encourage this false alarm being triggered in your body again and again and cause you needless anxiety.

Below is an exercise to help you. Before you practice these exercises, its advised that you get a thorough health check up done by your doctor so you can be doubly sure that there is nothing wrong with your body and thus also rule out any other contributing illness.

Identifying:

List the situations that cause you to feel panic:

1. _________________________
2. _________________________
3. _________________________

• What triggers your panic attack?
• What emotions do you feel when you are faced with a panic attack?
• What behaviors do you engage in during the panic attack?
• What physical sensations do you experience? ( Dizziness? Palpitaions ? Tremors ?)
• What meanings do you give these experiences?
• Are you overestimating the risk in these situations? Is this bad event likely to happen in reality ?
• What situations do you avoid to stop panic attacks being triggered?
• If you face these situations, how will you benefit from them?
• What safety behaviors do you indulge in when you have panic attacks?

Taking control:

• What irrational unrealistic thoughts are associated with your panic attack that you need to stop?
• What behaviors can you try to resist when you face a panic attack?
• What physical sensations can you accept without trying to stop or control them ?
• Are you willing to drop your safety behaviors and expose yourself to the triggering stimulus for small periods of time?

The steps:

1. Rate your level of discomfort on a scale of 1-10
2. Make a decision to expose yourself to panic causing situations for short periods of time.
3. Repeat to yourself affirming statements such as “I can handle this” over and over again when you are facing the situation.
4. Practice deep breathing during this situations .
5. Take tiny steps and first expose yourself for small periods of time. 20 minute exposure sessions can be a good beginning target. [For example if you face panic attacks while trying to go to your workplace. Practise the above steps until you reach the office, (10% of the goal), stay there for 20 minutes, you can return home if you feel discomfort.
6. The next step would be to stay at the office for a longer period of time (20% of the goal).
7. Keep increasing the length of exposure gradually until you’re able to handle the situation completely and your body develops an appropriate adaptation response

Medications:

1. SSRIs, or Selective Serotonin Reuptake Inhibitors. This class of drug includes Celexa, Zoloft, Prozac and Paxil. There are very effective in the treatment of Panic attacks.
2. SNRIs or Serotonin Norepinephrine Reuptake Inhibitors. Among this class of drug we find Cymbalta and Effexor. These are used when SSRIs don’t work.
3. Central Nervous System Depressants: They are mostly benzodiazepines and they have a sedative nature. These drugs provide short term relief from symptoms. Xanax and Klonopin are among the drugs used for this class, but great care must be taken due to their highly addictive nature.
4. Tricyclic Antidepressant (TCAs): TCAs in small doses canbe used for long term treatment of anxiety disorders. TCAs can have unpleasant, even dangerous, side effects, and if these are prescribed by your doctor, you should keep in close follow up with him/her and report any side effects you may encounter.

Self help tips:

Don’t anticipate a panic attack, if you notice panic disorder symptoms on the inside then you want to shift your focus to the environment around you gradually. The single most important piece in the puzzle, the surest way to virtually guarantee that you will suffer from another panic attack is the moment you are convinced that you are about to have one.

For more information and tips on panic attacks, read the best treatment methods  on panic attacks.

If you find this article useful, do “like” us and give your valuable feedback. Your comments are a pat on our back..