Panic attack
Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, otherwise defined as a rapid, irregular heartbeat, sweating, chest pain or discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a sense of impending doom or loss of control. Typically, these symptoms are the worst within ten minutes of onset and can last for roughly 30 minutes, though they can vary anywhere from seconds to hours. While they can be extremely distressing, panic attacks themselves are not physically dangerous.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines them as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur." These symptoms include, but are not limited to, the ones mentioned above.
Panic attacks function as a marker for assessing severity, course, and comorbidity of different disorders, including anxiety disorders. Hence, while panic attacks cannot be applied to all disorders found in the DSM, they are a common comorbidity.
Panic attacks can be caused by an identifiable source, or they may happen without any warning and without a specific, recognizable situation.
Some known causes that increase the risk of having a panic attack include medical and psychiatric conditions, substances, and psychological stress.
Before making a diagnosis, physicians seek to eliminate other conditions that can produce similar symptoms, such as hyperthyroidism, hyperparathyroidism, heart disease, lung disease, and dysautonomia, disease of the system that regulates the body's involuntary processes.
Treatment of panic attacks should be directed at the underlying cause. In those with frequent attacks, counseling or medications may be used, as both preventative and abortive measures, ones that stop the attack while it is happening. Breathing training and muscle relaxation techniques may also be useful.
Panic attacks often appear frightening to both those experiencing and those witnessing them, and often, people sometimes think they are having heart attacks due to the symptoms. However, while they do not cause much immediate physical harm, they may be a predictive risk factor for cardiac and other illnesses.
Previous studies have suggested that those who suffer from anxiety disorders are at higher risk of suicide.
In Europe, approximately 3% of the population has a panic attack in a given year, while in the United States, they affect about 11%. Panic attacks are more commonly diagnosed in females than males and often begin during late puberty or early adulthood. Panic attacks can continue on and off for a lifetime, or appear only infrequently. Young children are less commonly affected.
Signs and symptoms
When people experience a panic attack, it usually comes on very suddenly and unexpectedly with a wide range of symptoms that tend to last, on average, a few minutes, but in infrequent cases can last for several hours. Typically, the symptoms of panic attacks reach their worst intensity in the first minute, then gradually subside over the next several minutes. During this time, people often feel intense fear that something catastrophic will happen despite there being no immediate danger. The frequency of panic attacks varies between individuals, with some people experiencing a panic attack as frequently as every week, while others could have one panic attack per year. The features that help define a panic attack are the collection of symptoms that accompany a panic attack. In panic disorder, panic attacks can occur unprompted; meaning there can be no obvious triggering event that causes the panic attack. Panic attacks can occur together with other anxiety disorders as well and can be associated with triggering events, such as someone with social anxiety disorder being in a difficult social situation, such as public speaking, with a co-occurring panic attack.Panic attacks are associated with many different symptoms, with a person experiencing at least four of the following symptoms: increased heart rate, chest pain, palpitations, difficulty breathing, choking sensation, nausea, abdominal pain, dizziness, lightheadedness, numbness or tingling, derealization, depersonalization, fear of losing control, and fear of dying.
These physical symptoms are typically concurrent with panic attacks in people who are prone to panicking. This results in increased anxiety and forms a positive feedback loop, meaning that the more a person with a panic attack has panic events, the more they experience feelings of "anticipatory anxiety" which serve to worsen their panic attacks. Panic attacks are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature.
Chest pain
People can experience a wide range of symptoms during their panic attacks; they tend to be very intense and frightening and the common symptoms of difficulty breathing and chest pain can sometimes cause people to believe they are having a heart attack, leading them to go to the emergency department. Because chest pain and difficulty breathing are commonly symptoms of some sort of heart disease, there is medical importance in ruling out life-threatening reasons for their symptoms. A heart attack occurs when there is a blockage in the arteries going to the heart, causing less blood to get to the heart tissue, and ultimately causing the heart tissue to die. This would be evaluated in the emergency department with an electrocardiogram and by measuring a hormone called troponin, which is released from the heart tissue during times of stress on the tissue.Causes
Panic attacks can be caused by a mix of factors. Biological factors that may lead to or be caused by panic attacks include psychiatric disorders such as post-traumatic stress disorder and obsessive–compulsive disorder, heart conditions, low blood pressure, and an overactive thyroid. Imbalance of the norepinephrine system, which is responsible for coordinating the body's fight-or-flight response, has been linked to panic attacks as well.Panic disorder tends to arise in early adulthood, though it can occur at any age. It is more commonly diagnosed in women and in individuals with above-average intelligence. Research involving identical twins has shown that if one twin has an anxiety disorder, the other is likely to have one too.
Panic attacks may also occur due to short-term stressors. Major personal losses, like the end of a romantic relationship, life transitions such as jobs or moving, and other significant life changes may trigger a panic attack. Individuals who are naturally anxious, need a lot of reassurance, worry excessively about their health, have an overcautious view of the world, and have cumulative stress are more likely to experience panic attacks, which may actually cause some of those symptoms. For adolescents, social transitions, such as changes in classes and schools, may also be a contributing factor.
People often experience phobias as a direct result of panic attacks triggered by exposure to specific fears. A situation can become associated to panic if someone has had a previous reaction before in similar contexts, but more often panic is triggered by fear of entrapment in a potentially phobic environment such as a plane.
Psychoactive substances may also induce panic attacks. For example, discontinuation or reduction in the dose of a drug can cause panic attacks. Other psychoactive substances that are commonly known to be associated with panic attacks include cannabis and nicotine.
Panic disorder
A panic attack is an isolated episode of intense fear or discomfort that peaks within minutes. People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked. However, panic attacks experienced by those with panic disorder may also be linked to or heightened by exposure to certain places or situations, making daily life difficult.If a person has repeated and unexpected panic attacks, this could be a potential sign of panic disorder. According to the DSM-5, panic disorder can be diagnosed if a patient has not only recurrent panic attacks but also experiences at least a month of anxiety or worry about having additional attacks. This concern may lead to the person to modify their behavior to avoid situations that triggered the attack. Panic disorder can be diagnosed if the patient has another disorder at the same time.
Patients affected by panic disorder can struggle with depression and a diminished quality of life. Compared to the general population, they are also at increased risk for substance abuse and addiction.
Agoraphobia
Panic disorder frequently presents with agoraphobia, which is an anxiety disorder where the individual presents with fear of a situation from which they cannot leave or escape, especially if a panic attack occurs. People who have had a panic attack in certain situations may develop phobias of these situations and begin to take measures to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house, preferring the safety of remaining in a known place. At this stage, the person is said to have panic disorder with agoraphobia.In Japan, people who exhibit extreme agoraphobia to the point of becoming unwilling or unable to leave their homes are referred to as hikikomori. This term is used to describe both the person and the phenomenon. According to some Japanese psychiatrists, hikikomori can be caused by panic associated agoraphobia, or by withdrawal due to social anxiety. After first being defined by the Japanese Ministry of Health, Labor, and Welfare, a national research task force refined the definition as "the state of avoiding social engagement with generally persistent withdrawal into one's residence for at least six months as a result of various factors".