Panic Attack

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A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than 30 minutes. Symptoms include trembling, shortness of breath and sensations of choking or smothering. The disorder is strikingly different from other types of anxiety in that panic attacks are very sudden, appear to be unprovoked, and are often disabling.

Most who have one attack will have others. People who have repeated attacks, or feel severe anxiety about having another attack are said to have panic disorder.

Introduction

Most sufferers of panic attacks report a fear of dying, "going crazy", or losing control of emotions or behavior. The experiences generally provoke a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, a feeling of impending doom, thoughts of doom, tunnel vision, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance.

The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks are often experienced by sufferers of anxiety disorders, agoraphobia, and other psychological conditions involving anxiety, though panic attacks are not always indicative of a mental disorder. Up to 10 percent of otherwise healthy people experience an isolated panic attack per year.

A person with a phobia will often experience a panic attack as a direct result of exposure to their trigger. These panic attacks are usually short-lived and rapidly relieved once the trigger is escaped. In conditions of chronic anxiety one panic attack can often roll into another one, leading to nervous exhaustion over a period of days.
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Symptoms

The symptoms of a panic attack appear suddenly, without any apparent cause. They may include:

* racing or pounding heartbeat
* sweats
* chest pains
* dizziness, lightheadedness, nausea
* difficulty breathing (dyspnea)
* tingling or numbness in the hands, face, feet or mouth
* flushes to the face and chest or chills
* dreamlike sensations or perceptual distortions (derealization)
* disassociation - this can be the perception that one is not connected to the body or even disconected from the realm of space and time (depersonalization)
* terror -- a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
* fear of losing control and doing something embarrassing or of going crazy
* fear of dying
* feeling of impending doom
* trembling or "shivering"
* crying

A panic attack typically lasts for several minutes and is one of the most distressing conditions that a person can experience in everyday life.

The various symptoms of a panic attack can be understood as follows. First comes the sudden onset of fear with little or no provoking stimulus. This then leads to a release of adrenaline (epinephrine) which cause the so-called fight-or-flight response where the person's body prepares for major physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to carbon dioxide levels lowering in the lungs and then the blood. This leads to shifts in the pH of the blood which then leads to many of the other symptoms such as tingling or numbness, dizziness and lightheadedness. Anyone who hyperventilates for a while can demonstrate this. For the person with a panic attack who does not know this, these symptoms are often further evidence to their mind of how serious the condition is. An ensuing spiral of chemical adrenalin release fuels worsening physical symptoms and psychological distress.
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Induced phobias

People who have had a panic attack -- for example while driving, shopping in a crowded store, or riding in an elevator -- may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder may be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus panic disorder can have as serious an impact on a person's daily life as other major illnesses -- unless the individual receives effective treatment.
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Occurrence

Panic disorder is a serious health problem in the United States. It is estimated that 1.6 percent of the American population has panic disorder. It typically strikes in young adulthood; roughly half of all people who have panic disorder develop the condition before age 24. Women are twice as likely as men to develop panic disorder.

Panic disorder tends to continue for months or years. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. It does not usually go away unless the person receives treatments designed specifically to help people with panic disorder.
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Treatment

Panic disorder is real and potentially disabling, but it can be controlled with specific treatments. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for heart disease or some other life-threatening medical illness. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions.

Others often try to reassure persons having a panic attack that they are not in great danger. Expressions such as "nothing serious," "all in your head," or "nothing to worry about" may give the incorrect impression that there is no real problem and that treatment is not possible or necessary.

Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70 to 90 percent of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.

In addition, people with panic disorder may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. About 30% of people with panic disorder abuse alcohol and 17% abuse drugs, such as cocaine and marijuana, to alleviate the anguish and distress caused by their condition. Recent research also suggests that suicide attempts are more frequent in people with panic disorder.
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Causes

Panic disorder has been found to run in families, and this may mean that inheritance (genes) plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it.

Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, a major life stress, or certain medications. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.

Studies in animals and humans have focused on pinpointing the specific brain areas involved in anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small but complicated structure deep inside the brain called the amygdala.

Hypoglycemia may also cause panic attacks. In this condition the receptors for insulin do not respond properly to insulin, interfering with the transport of glucose across the membranes of cells. The brain depends on a steady supply of glucose -- its only source of energy. When there is a sudden fall in blood sugar levels the brain sends a hormonal signal to the adrenal glands to pour adrenaline into the system. This hormone functions to raise blood sugar levels by converting glycogen into glucose, thus preventing brain starvation, but it is also a panic hormone that is responsible for attacks of fear. The non-drug treatment for this is the adoption of the hypoglycemic diet.

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Panic Attack

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