Panic Disorder Essay, Research Paper
You become terrified for no apparent reason; your heart feels as though it will beat right out of your chest; you sense an overall feeling of doom and you get dizzy. Am I dying, or am I just crazy? If you are crazy, then so are 2.4 million other people in the United States. Panic disorder, one of many anxiety disorders, is a serious and potentially debilitating illness. This illness is treatable, however, only one-third of those who suffer will actually be treated.
What is panic disorder? Panic disorder is characterized by panic attacks, which are periods of intense fear, or discomfort, in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes:
Palpitations, pounding heart
Sweating
Trembling or Shaking
Sensations of shortness of breath or
smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Dizziness, unsteadiness, light
headed, or fainting
Feeling of unreality
Fear of losing control
Fear of dying
Numbness or tingling sensations
Chills or hot flushes
To be diagnosed as panic disorder, the attacks must be recurrent and unexpected. At least one of the attacks must be followed by at least one month, or more, of one, or more, of the following:
Persistent concern about having
another attack
Worry about the implications of the
attack or its consequences; heart
attack, going crazy, losing control
A significant change in behavior
related to the attacks
True panic attacks resulting from panic disorder are not due to any physiological effects of a substance, or to any general medical condition such as hyperthyroidism. Because the physical symptoms of panic disorders are so intense, many patients fear they are dying and are taken to emergency rooms. Most of those who are treated at emergency rooms will be discharged without ever knowing what was wrong with them. Many patients fear the attack will last indefinitely, however, in reality most panic attacks peak within ten minutes and then quickly go away. It does seem to the sufferer that those few minutes are forever due to their overwhelming fear. Because the attacks are such horrible experiences, most panic disorder patients will then develop anticipatory anxiety, which is known as fear of the fear. They not only fear the panic attack, itself, but also the anticipation of it. They will obsess over the possibility they will have more attacks. Even the slightest physical symptom can set off the anticipatory anxiety and create the fear of fear.
In any given month, 5 tenths of our population, or 1 million people will exhibit symptoms of panic disorder. This condition will affect at least one out of every 75 people worldwide during their lifetime. Two thirds of the sufferers will be women. Panic disorder typically begins in the late teen years, or the early to mid- twenties, however, the disorder can develop in childhood, middle age or the later years. Panic disorder also appears to be somewhat heredity; 15 to 17 percent of patients who have close relatives with panic disorder also have the disorder themselves.
The first attack is often preceded by a stressful event – the death of someone close, the breakup of a marriage, an illness, a new job, or a move to another area. However, any event that causes stress, even a positive one such as marriage, or the birth of a child, can trigger an attack. After the first attack, the frequency of the attacks can range from several times a day, to once or twice a week, to just once a year. Some people never have a second attack. No matter how often, or seldom, the attacks occur, most people will develop the fear of fear.
One third of people with panic disorder also have agoraphobia, or fear of open places. One half of those with panic disorder will also have an episode of clinical depression at some point in their lives. Twenty percent of people with panic disorder have attempted suicide. People with panic disorder often turn to alcohol and/or drugs to alleviate their mental and physical symptoms. Thirty six percent of people with panic disorder have a history of substance abuse. Physical ailments associated with panic disorder include mitral valve prolapse, irritable bowel syndrome, migraines and asthma.
No one has yet determined what actually causes panic disorder, however, there are many theories. Most researchers believe there is a combination of factors to blame. The following are brief summaries of those theories:
Behavioral – people become conditioned to panic whenever they are in a situation similar to the one that caused the initial attack. Behaviorists believe treatment must involve relearning, or reconditioning.
Cognitive – incorrect thinking can trigger panic attacks because sufferers focus on anxiety provoking thoughts and assume the worst possible outcome. Cognitive theorists believe that people with panic disorder have a system of false beliefs about themselves and the world. The goal of therapy is to recognize the distortions and to correct them.
Biological – panic attacks are caused by a disturbance in the neurotransmitters, which regulate the transmission of impulses between neurons – - – some people may have nervous systems that are hypersensitive – - – hyperventilation is excessive in patients who suffer from panic disorder – - – an abnormal gene is involved.
Psychoanalytic – unconscious conflicts may cause panic attacks. Repressed feelings because the sufferer feels they are unacceptable may be formed in panic attacks instead. These theorists contend that difficult separations when a person is young may create more susceptibility to anxiety when separations occur in childhood.
These same theorists have created a profile of those persons most likely
to suffer from panic disorder. These individuals are described below and usually have three, or more, of the characteristics:
People who were fearful, nervous and shy as
children
People whose parents were controlling, angry,
frightening, or critical
People who have discomfort with aggression
People who have low self esteem
Women who married men who are passive
and kind
People who have stresses that cause frustration
and resentment preceding the onset of panic
Panic disorder is an extremely difficult illness to diagnose because its symptoms are so far reaching. The symptoms can range from heart palpitations, dizziness and irregular breathing to loss of balance, gastrointestinal disturbances and difficulty swallowing. Sufferers experience problems in multiple parts of the body including the heart, circulatory system, thyroid and respiratory system. In addition, panic disorder is often complicated by depression, generalized anxiety disorder, obsessive-compulsive disorder, or alcoholism, all of which make the diagnosis even more difficult.
Treatment for panic disorder ranges from medication which include tricyclic antidepressants, monoamine oxidase inhibitor antidepressants, selective serotonin reuptake inhibitor antidepressants and benzodiazepine tranquilizers. Medication can be beneficial if you are in severe distress and unable to function. It is also beneficial if your anticipatory anxiety becomes so severe that you begin to avoid certain situations, if you are very depressed, or if you have chronic, severe anxiety. Other treatments range from therapy to humor, to spiritual, to group support. The bottom line is that panic disorder can be successfully treated.
Researchers have found links to other conditions in people who have panic disorders. Patients who suffer from winter depression appear to be at higher risk for panic disorder according to findings from Ohio State University. Researchers at the University of Connecticut have concluded that most individuals who suffer from chronic fatigue also suffer with panic, or other anxiety related disorders. Researchers at the University of Washington analyzed data from persons victimized by childhood sexual abuse and found there was a significantly higher risk for those individuals to suffer from panic disorder. This study was in comparison to persons who had no history of childhood sexual abuse. Additionally, individuals who suffer from mitral valve prolapse, which is a condition that causes the mitral valve to not close properly preventing steady blood flow from the heart to the lungs, also have a higher incidence of panic disorder.
Researchers are also continuing to make progress in discovering more about the causes, diagnosis and new treatments. A study through the United States Air Force Academy suggests that a test that measures anxiety sensitivity may help predict who will develop panic attacks. A simple questionnaire was given to 1,172 recruits who noted how strongly they agreed with questions such as, “It scares me when my heart beats rapidly.” The higher the score, the more likely the cadet was to experience a panic attack during their training. Another theory being studied is the suffocation alarm theory. According to this theory, a monitor called the carotid body, located in the neck, measures the blood levels of both carbon dioxide and oxygen and warns the individual when suffocation is eminent. One of the primary physiologic indicators of suffocation is an increased level of blood carbon dioxide. People with panic disorder may be especially sensitive to even a small rise in carbon dioxide and this monitor can send a false alarm to the brain.
Panic disorder, like most mental abnormalities, has unfortunately been associated with stigma and shame. Doctors, in the past, have failed to realize this is a serious condition affecting many persons throughout the United States and were likely to treat these individuals with complete disregard for their suffering. There is hope, however, and now most of us understand that persons who suffer from panic disorder are no more responsible for their symptoms than people who have heart disease or diabetes. Tremendous progress is being made regarding accurate diagnosis and treatment. It is important to remember that panic disorder can be serious and even fatal for those who go untreated. When panic disorder is properly diagnosed and treated, secondary complications, such as depression and suicidal tendencies can be prevented.
Bibliography
References
Brody, Jane. “Doctors Miss Clues to Mental Disorders. New York Times, Dec. 14, 1994.
Silio, Chi Chi. Answers to Yours Questions About Panic Disorder, American Psychological Association.
Zuercher-White, Elke. An End to Panic. New Harbinger Publications, Oakland, CA, 1995, 35
Weinstock, Lorna & Gilman, Eleanor. Overcoming Panic Disorder. Contemporary Publishing Group, Inc.