What is a Panic Disorder?

Panic Disorder is characterized by repeated panic or anxiety that usually occurs spontaneously or unpredictably: “out of the blue … without warning.” Mild situational (phobic) panic may be present, but usually there is no consistent avoidance. For some reason, when panics happen to occur in public places, sufferers tend to ascribe the panics to being in those places, and they come to avoid public places in the disorder called Agoraphobia with Panic At¬tacks. Avoidance does not occur when panics strike the sufferer in other places, like in bed or in a forest—few if any agoraphobics avoid beds and forests.

Panic is characterized by the sudden onset of symptoms like shortness of breath; palpitations; chest pain or discomfort; choking or smothering sensations; dizziness, vertigo, or unsteady feelings; feelings of unreality; paresthesias (usually numbness and tingling in the hands, feet, or around the lips); hot and cold flashes; sweating; faintness; trembling or shaking; and fear of dying, going crazy, or doing something uncontrolled during an attack. Each of these symptoms can be caused by hyperventilation. Three panics within a three-week period are required to strictly satisfy the requirements for the DSM-llI diagnosis of Panic Disorder, but people with classic symptoms who fail to experience three panics in such a short time may also suffer from a form of Panic Disorder.

Women are somewhat more likely than men to suffer from Panic Disorder. Onset usually occurs in late adolescence or early adult life but may begin somewhat earlier or later. Sometimes people suffer a Panic Disorder which lasts for a short period never to recur; others experience several series of panics separated by panic-free intervals, and a few develop a chronic disorder with frequent panics. Some people use alcohol in an attempt to prevent panics, which is ineffective and may lead to the complications associated with alcohol abuse.

One woman described her Panic Disorder as follows:

My panics, as I’ve learned to call them, began at a time when life was very busy but also very good. I had gotten a promotion with a sizable increase in pay and was on top of the world because I was finally doing what 1 had always wanted to do and knew I could do it very well. I was getting lots of compliments on my productivity and was taking some work home with me. I was drinking more coffee to keep me functioning at my highest level, and probably got up to six or eight cups a day. All in all, it was a great time in every way and my family knew how pleased I was, and some of my success seemed to inspire them to do better too.

The first attack (I’ll never forget it) occurred when I was sitting in the audience at my son’s kindergarten “graduation” ceremony. That was three years ago when I was 26. Suddenly, I felt hot and as though I couldn’t breathe. My heart was racing and I started to sweat and tremble and I was sure I was going to faint. Then my fingers started to feel numb and tingly and things seemed unreal. It was so bad I wondered if I was dying and asked my husband to take me to the emergency room. By the time we got there (about 10 minutes) the worst of the attack was over and I just felt washed out. The doctor checked me over very thoroughly but could find nothing wrong and said he thought I had had an anxiety attack. He told me not to worry about it because it wasn’t dangerous. I tried not to worry but my mind kept saying that anything that extreme had to be dangerous.

The next attack occurred two days later when I was waiting in the checkout line at the grocery store. It wasn’t quite as bad as the first one or maybe I just had an idea what it was. At any rate, I just pulled my cart out of the line and found a place to sit down until it passed. Even though I felt drained, I also felt pretty good that I hadn’t lost control. I began to look for causes of the attacks in the two places I had been and came to the conclusion that the only common feature was that I was sort of stuck in both places and couldn’t get up and get away without making a commotion.

The third attack woke me from sleep. After this attack I went to see my regular doctor who again examined me carefully and called the problem “panic attacks.” He suggested I cut down my coffee intake, which I did quite easily. The fourth attack occurred at work at a time when everything was going perfectly. After this, I realized that if I tried to avoid all the situations where I was having panic attacks, I wouldn’t be able to go anywhere with my family, go to work, or even sleep in my own bed! I decided whatever else happened, I’d have to tough these things out.

That was three years ago. I’ve continued to have panic attacks about once every six months, and I’m darned if I can figure out anything specific that brings them on. I’ve tried exercising and sleeping more, and that certainly made me feel better in general and seemed to improve my mood, but I still have these attacks once every six months or so.

People with Panic Disorder often seek evaluation and treatment from general physicians because they are understandably frightened that they may suffer from a medical malady. By the time they reach a physician, the panic has usually disappeared and the physician can find nothing physically wrong. In the emergency room, a diagnosis of “acute hyperventilation syndrome” is often made, which may initially be gratifying to both doctor and patient but which does little or nothing to ensure a more definitive diagnosis and effective long-term treatment. The patient may feel chagrined that he or she has been alarmed about nothing but leave reassured by a careful examination. When the next panic occurs, help is often sought again, either from the same or another physician. One study found that patients with Panic Disorder had seen an average of 10 physicians before the disorder was finally diagnosed. General anxiety may occur between panics, as may some anticipa¬tory anxiety and avoidance, although if the latter become pronounced, a diagnosis of Agoraphobia with Panic Attacks is made.