Panic attack: symptoms, causes and treatment

Anxiety disorders are one of the most prevalent mental disorders in society worldwide. These are of different types, and can significantly disable the life of the person who suffers them.

In this article we will talk about panic attacks or panic attacks, very common in different anxiety disorders. Currently, in DSM-5, they are considered a specifier of any other disorder. They are defined as the sudden appearance of fear or intense discomfort, which reaches its maximum expression in minutes

• Related article: "The 7 types of anxiety (characteristics, causes and symptoms)"

Panic crisis: characteristics

Panic attacks, also called panic attacks or panic or panic attacks, are listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders). DSM-5 includes panic attacks as a specifier of any other disorder, and not so much as a disorder itself (in the DSM-IV-TR did consider the panic attack as an independent “disorder”, the so-called panic disorder or panic. attack).

On the other hand, the ICD-10 (International Classification of Diseases) requires, to diagnose a panic attack, that at least one of the symptoms is:

palpitations, tremors, dry mouth, or sweating.

Symptoms

DSM-5 defines a panic attack as the sudden onset of intense fear or discomfort, which reaches its maximum expression in minutes. During this time, 4 (or more) of the following symptoms occur:

• Palpitations, pounding of the heart, or racing heart rate.
• Sweating
• Shaking or shaking.
• Feeling of shortness of breath or suffocation.
• Feeling of suffocation
• Pain or discomfort in the chest.
• Nausea or abdominal discomfort.
• Feeling dizzy, unsteadiness, lightheadedness, or fainting.
• Chills or feeling hot
• Paresthesias (numbness or tingling sensation).
• Derealization (feeling of unreality) or depersonalization (separating from oneself).
• Fear of losing control or "going crazy."
• Affraid to die.

On the other hand, the most frequent somatic symptoms in panic attacks They are: first palpitations, followed by vertigo-dizziness and tremors (they are common in both children and adults).

Children, unlike adults, have less cognitive symptoms (fear of going crazy, for example).

Types of panic attacks

The sudden appearance of fear or discomfort can occur from a state of calm or, on the contrary, from a state of anxiety. On the other hand, panic attacks are very common in different anxiety disorders.

According to the DSM, it is possible to diagnose a panic attack in the absence of fear or anxiety, which is defined as "Cognitive or alexithymic panic attacks".

Attacks that fail to present all 4 symptoms are called "limited asymptomatic seizures."

Differences in clinical and non-clinical population

It is known that panic attacks also occur in non-clinical population (without mental disorder), as well as in clinical population (with mental disorder). These attacks are similar in the similar physiological experience, in that they occur in times of stress and that there is a similar family history of panic attacks.

Regarding the differences, we find that:

• Clinical patients present with attacks of an unexpected type, whereas non-clinicians suffer more in social situations (evaluative).
• Clinical patients express more catastrophic cognitions.

Causes

We find different types of causes that have been referred to in an attempt to explain the appearance of panic attacks. These are, broadly speaking, of 3 types (although in most cases there is an interaction between several of them that end up causing the disorder).

1. Biological

The biological hypotheses allude to a certain predisposition to anxiety disorders, as well as aspects neurobiological (GABA alterations, locus coeruleus hyperactivity, hypersensitivity of the serotonin, etc.), neuroendocrine and psychophysiological aspects.

2. Learning

Learning theories refer to classical conditioning, to bifactorial Mowrer model (which includes operant and classical conditioning as originators and maintainers of anxiety), Eysenck's law of incubation, and Seligman's theory of preparation.

3. Cognition

Cognitive models refer to aspects more related to how we process information, referring for example to brain networks or structures of "fear" and a selectivity to attend to aversive stimuli, among others.

Treatment

The disorder of choice for treating panic disorder or panic attacks is a multicomponent cognitive-behavioral treatment, which includes among its components:

• Live exposure to interoceptive stimuli.
• Cognitive restructuring.

On the other hand, treatments with good efficacy are considered: Barlow's panic control treatment, and Clark's cognitive therapy.

As slightly less effective treatments, we find:

• Öst's applied relaxation.
• The exposure therapy.
• Pharmacotherapy (SSRI).

Finally, in the experimental phase, there are three types of treatments with favorable data to treat panic attacks:

• The exposure treatment through virtual reality (for panic disorder with agoraphobia)
• Intensive therapy focused on sensations (from Baker Morissette)
• Increased Cognitive Behavioral Therapy for Panic (from Levitt)

Bibliographic references:

• WHO (2000). ICD-10. International Classification of Diseases, Tenth Edition. Madrid. Pan American.
• Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. XXI century
• Belloch, A.; Sandín, B. And Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.