Panic disorder: symptoms, causes and treatment

The term "anxiety crisis" is something we all probably know about. In fact most people have experienced one or seen someone do it in their lifetime. But in some cases these crises occur relatively frequently and generate a great fear of suffering them again, which in turn makes situations to be avoided. We are talking about those with panic disorder.

• Related article: "The 16 most common mental disorders"

Panic disorder

The so-called panic disorder is one of the most common types of mental disorder, characterized by the appearance recurrent sudden and unforeseen panic attacks (the subject may be calm or in a situation of anxiety before their appearance).

Panic attacks, also known as panic attacks, are the appearance of sudden and temporary episodes of feelings of distress, malaise and fear of high intensity that can have a variable duration and that usually generate a maximum peak of activation within a few minutes and resolved in around fifteen minutes (although sometimes they can last hours).

During these attacks, a wide variety of symptoms appear, among which the tachycardia, profuse sweating, tremors, hyperventilation and a feeling of suffocation, hyperthermia, numbness, chest pain, intestinal discomfort and psychological symptoms such as fear of dying or having a heart attack, the idea of ​​losing control over your own body or even going crazy and possibly dissociative symptoms such as derealization (feeling that what is happening is not real) or depersonalization (strangeness with the very existence of the subject).

After the anxiety attack (s), the concern appears for a month or more that they may reappear or that the same sensations will be experienced at some point. The subject anticipates the occurrence of such attacks and this generates great fear and anguish, a fear that causes a state of great tension in the subject and it can lead to the implementation of mechanisms and behaviors that make it possible to avoid either these sensations or the possible appearance of new attacks. Thus, if for example the panic attack gave us in the subway, it is likely that we will avoid using public transport again.

This will generate consequences of different magnitude that will alter your day-to-day life to a greater or lesser extent, both personally, socially and at work. The functionality and daily life of the person with this problem will be limited by panic and the avoidance of circumstances that may generate it. In fact, it is common for the subject to also end up suffering from depressive problems or even of substance use and abuse.

Anxiety attacks as non-pathological

Experiencing a panic attack is certainly an extremely unpleasant and aversive experience. As we have said, it is common for the fear of dying or going crazy to appear. In addition, many symptoms are somewhat reminiscent of a heart attack, reinforcing the idea that something very serious is happening and panic and anxiety increase and symptoms reinforce earlier described.

Despite this, it must be borne in mind that panic attacks are not per se an indication of any disorder unless they occur on a very recurring basis and generate avoidance in anticipation of their idea. In fact, a relatively high percentage of the world's population will suffer an anxiety attack or panic attack at some point in their lives. This is especially frequent in demanding companies with a high level of demand., which is common today.

But despite what has been said, they should be taken into account when evaluating psychopathology, since it is not uncommon for them to appear both in panic disorder and in other mental problems.

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

Relationship with agoraphobia

Panic disorder has traditionally been closely linked to another psychological problem called agoraphobia, in that there is fear and anxiety at the idea of ​​being exposed to places where escape would be difficult or may not receive help in the event of a panic attack or other embarrassing situations (Although the majority of the population considers that it is the fear of open spaces, in reality the underlying fear and what would cause avoidance of these and other types of spaces would be this).

This is because it is very common for agoraphobic subjects to anticipate anxiety and panic attacks and avoid such situations. In fact, although they are currently diagnosed separately until a few years ago, a distinction was made between panic disorder with or without agoraphobia.

• You may be interested: "Agoraphobia: the fear of losing control (causes, symptoms and treatment)"

Confusion with heart problems

One of the most common fears that arise at the time of having a panic attack is that of being about to die due to a heart attack. This is a logical confusion, considering that many of the symptoms are similar to angina pectoris or heart attack: tachycardia, chest pain, sweating ...

However, it must be taken into account that there are differences between panic attack and heart attack. Among them they stand out that in the heart attack, unless other problems appear or anxiety arises, there is no hyperventilation or feeling of loss of body control. The pain is different and tends to be more generalized, in addition to while in heart attack there is a link with exertion, in anxiety this does not occur. The duration of symptoms is also different. In any case, it is advisable to go to a medical center.

What is the cause?

As with other disorders, the exact cause of why some people develop panic disorder and others do not are not fully known.

The appearance of the first crisis may be due to situational factors, while some authors propose that recurrence, anticipation, and concern for panic attacks are give to the generation of negative and aversive interpretations of bodily sensations not linked to the anxiety.

The fact that some sensations are interpreted as anxiety generates fear and anxiety, which ultimately ends up generating the appearance of a crisis.

Likewise, the possible influence of genes is also speculated, being anxiety disorders generally more frequent in families with previous cases. The learning of role models or previous experiences may also have some influence.

Treatment and therapy

Panic disorder is a highly disabling problem for the sufferer and tends to be chronic if left untreated. Fortunately, studies carried out on this anxiety disorder indicate that the most common and recommended treatments available tend to be highly effective, specifically of more than 80% of recoveries.

One of the most frequent and effective treatments is, as with phobias, the exposition. This technique is based on putting the subject in situations in which he gradually experiences situations that he avoids and generate anxiety so that you can reduce the level of fear and anxiety in the face of these and the avoidance that they usually suppose.

It is important to note that exposure should be gradual, being necessary to agree with the patient a hierarchy of feared situations to gradually reduce the anxiety generated. In the case of panic disorder, we are talking so much about situations that they avoid for fear of having a panic attack and work at the interoceptive level, including exposure to feelings related to panic (for example, hyperventilation).

Another of the most effective treatments, which can be given together with the previous one, is the cognitive restructuring. In this case, we intend to combat the dysfunctional thoughts and beliefs that have generated and / or maintain the problem. It seeks to de-catastrophize the situation and to change the negative interpretations of bodily sensations so that they are not attributed to the event of an anxiety crisis. Behavioral experiments are also used in which the patient is asked to carry out tests to check if their thoughts and hypotheses about what is happening (being in a certain way a small exposure) are adjusted or not to reality.

Teaching relaxation techniques can be used to reduce the level of anxiety and anguish or learn to control it, being very useful for the patient.

Drug use

Sometimes psychotropic drugs are also used, and it is common for them to be prescribed benzodiazepines and tranquilizers or even some antidepressants such as SSRI. The use of these drugs can be useful to reduce the level of anxiety, but it is necessary to combine it with psychotherapy so that the subject learns to modify their beliefs and stop avoiding situations and sensations, so that relapses do not occur after withdrawal of the drug.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
• National Institute of Mental Health (s.f.). Panic disorder: when fear runs out. [online publication]. Available in: https://www.nimh.nih.gov/health/publications/espanol/trastorno-de-panico-cuando-el-miedo-agobia/index.shtml#pub8