Panic Attacks

We all feel anxious and panicky at times. However, Panic Disorders are acute anxiety attacks which are characterized by extreme fear which is usually inappropriate to the situation. Most of the time, it simply occurs out of the blue with no apparent trigger.

What is Panic Disorder?

Panic Disorder is a condition in which you continuously and regularly suffer from symptoms designated as ‘panic attacks’. We all feel anxious at times and we can panic once in a while. This is a natural response to certain situations. However, when people suffer from Panic Disorder they feel anxiety and panic regularly and the attack can happen at any time without any life threatening situation. It is different from everyday nervousness. It is a more intense fear which is totally inappropriate to the situation. It can occur simply ‘out of the blue’ with no apparent trigger most of the time!

Depending on the severity of your condition, you can experience panic attacks frequently or infrequently. It is common for some people to have one or even two such attacks per month while others may experience the same multiple times in a given week/or a day.

These attacks may occur suddenly and they may also subside in a few minutes. In some people these can be so intense and uncomfortable that the person lives in fear of panic attack! More usually, the person feels certain that the reason for the attack is some physical illness, like a heart disease. People who have such attacks begin to avoid the situations that they feel may bring on the next attack. This may lead to severe restriction in day-to-day functioning and life style.

Why do people have panic attacks?

It is usually difficult for the family members of a person affected with panic disorder to understand why there should be such an inappropriately strong reaction to something minor. It is easy to lose patience with someone under the circumstances. The reason for someone developing this disorder are to be found in the person’s life experiences and personality, because of which, a wrong way of coping with stress has come about. Sometimes, there is some event in the past that has frightened the person or made him or her anxious. After this, even the idea of the situation taking place again, makes the person anxious and panicky. To make matters more complicated, the person begins to feel anxious about feeling anxious!

Is Panic Disorder a common problem?

Approximately two persons in every hundred suffer from this problem and it occurs twice as often among women as it does in men.  It can happen more commonly in those in constant high strung situations or living in highly stressful social situations.

What are the symptoms of Panic Disorder?

During a Panic attack, you may feel many different symptoms that may feel very scary and the mind could be filled with worrying thoughts. You may feel that a disaster is about to happen and you are about to collapse. Feeling high amounts of anxiety normally also precipitates these symptoms.

Panic attacks generally occur when the human body feels intense psychological and physical symptoms. People who suffer from panic attacks often feel lot of fear, as they become apprehensive and anxious. In addition, these feelings are accompanied by:

• Feelings of nausea
• Profuse sweating
• Trembling or shaking
• Heart palpitations
• Hot flushes
• Chest pain
• Need to urinate
• Cold and clammy hands
• Feeling that one cannot breathe properly and choking sensation
• Feeling dizzy or light-headed
• Fear of dying
• Fear of losing control

How to diagnose panic attacks?

If a person has a panic attack, doctors may need to do some investigations to rule out physical problems after which the person may be diagnosed as having a Panic Disorder. Certain people suffer Panic attacks in response to particular situations. Panic Disorder can only be diagnosed after the ‘attack’ sets in and not in anticipation, although physical problems, including heart conditions could be ruled out before.

You should speak with your doctor and describe the symptoms to him or her. Your doctor will want to know how often the symptoms occur, and in what situations they occur, as well as how recovery happens.  A good history by the person and those around, and in some persons, investigation can help reach the diagnosis early.

What causes Panic Disorder?

The true cause of panic attacks is not fully understood or known. However, there are a number of physical as well as mental factors that can cause panic attacks including:

• Genetic factors

If a family member suffers from panic disorders then there is a greater risk that other family members will also develop the problem.

• Neurotransmitters

It is presumed that an imbalance of certain chemicals in the brain, called neurotransmitters, can increase the risk of developing panic attacks disorder although there are no tests to prove it.

• Being too sensitive towards carbon dioxide

Certain experts believe that when a person breathes air that contains high levels of carbon dioxide it can cause panic attacks (as happens in hyperventilation).

• Having calamitous thoughts

There are some who theorize that panic attacks are brought on when a person interprets physical symptoms in a calamitous manner and this triggers a response in the nervous system that causes a panic attacks.

• Sudden traumatic life events with feelings of inability to cope, loneliness, orcatastrophe.
• Certain factors such as stressful lifestyle, certain food additives, and abuse of caffeine, alcohol, nicotine or other stimulant drugs can all contribute to Panic disorder.

Sometimes certain physical illnesses or medication used for some disorders may cause, worsen, or precipitate panic attacks. Sometimes physical illnesses like Mitral Valve Prolapse Syndrome or Hyperthyroidism may present similarly but careful checking can distinguish between these.

When to seek help?

• If the attacks are affecting your daily routine
• If you feel the need to have a constant companion for comfort.
• If you cannot be in certain situations that are a must, or are a source of livelihood
• If the symptoms have started causing social withdrawal or depression
• If the episodes make a person fear for his/her life and all the physical tests and investigations are normal
• If you are constantly reaching the emergency room of the hospital or ICU

When to seek professional guidance?

Although self-help measures can help you reduce your Panic Disorder, there are times when the attacks become so severe and recurring that you will need to seek professional help. If you experience many physical anxiety symptoms then you should get a medical/psychological professional to check you.

How can I help myself to deal with Panic attacks?

If you have a panic attack then you will feel a lot of anxiety, and you are also worried about when the next attack will happen.  Realizing that you have a treatable condition and not focusing on your symptoms will greatly help.

The best way of handling such an attack is by riding it out and not by looking for distractions. You should learn face the fear head-on and not run away from it as this will improve your chances of recovering from the situation. As the anxiety begins to ease up, you can turn your attention back to your surroundings and you should resume doing the things that you were doing prior to the attack.

Regular exercising and practicing some Relaxation techniques like deep breathing regularly can help you cope better with stresses in your life and reduce your anxiety.. Aerobic exercises in particular can help you manage your stress better.  Thus, walking, cycling and swimming at low pace for short periods and gradually building it up helps. Exercising also helps to improve you mood and it will also enhance your self-confidence as well.

Develop a balanced lifestyle free of any addictions, proper work –life balance, adequate rest, and time to enjoy and relax.

You can also take medications to beat your panic attack.  These are for short periods to reduce the intensity of symptoms and help the person work on self and the situations to manage the symptoms. Anti-depressants as well as Cognitive Behavioral Therapy (CBT) are the two most oft used treatments to beat panic attacks.

The person with panic attacks may become addicted to medication or Alcohol to reduce the symptoms.  The medication should only be used under medical supervision.  It is also necessary to avoid tobacco, caffeine and other stimulants or cannabis as these may precipitate or worsen panic attacks.  It may also be necessary to treat any associated physical conditions or relook at medications as a person is taking.

Treatment of panic attacks

The panic attacks disorder is treatable. It is usually a learned response to stress actual or perceived, and it can be ‘un-learned’. The psychiatrist or psychologist treating the problem will work out a programme of behavior change during which the person is exposed to the panic producing situations. He or she will be helped to face the situation with relaxation techniques.

Cognitive Behavioral Therapy or CBT identifies as well as changes your negative way of thinking and is most effective in treating Panic Disorder. It helps to ‘re-frame your thinking to a less disastrous view of situations. Through the technique of Imaginal Exposure you will be taught to face the various situations without fears of having an ‘attack’ in a gradual manner.After completing this type of therapy, you will have become free of panic attacks disorder and more importantly you can continue to remain that way.

In some cases, especially with severe anxiety, a course of Medications may be used to control the symptoms. The medication can reduce the severity and frequency of the panic attacks and generalized anxiety, and does not allow the episode to progress. It also reduces the intensity of your symptoms allowing the psychological help to show better results.

The mental health specialist should also guide the family through Family counseling on how to handle the attacks. The support of the family helps a person to divert the thoughts from anxious situation and feel mastery over the situation. They should be told not to trivialize the symptoms or show indifference. They can motivate you to seek help early on and help in avoiding addictions and leading a healthy lifestyle.

It is best to treat the problem at the earliest as the anxiety keeps becoming generalized over a period of time leading to avoidance of situations. The most important factor is for the person to feel in control and to feel mastery over the situation. It has to be a continuous process and slowly, self-confidence comes back and panic attacks disappear.