Anxiety crisis: symptoms, causes and treatment.

A concept from clinical psychology and linked to anxiety disorders.

Anxiety disorders are among the most prevalent mental disorders in society worldwide. in society worldwide. These are of different types, and can become significantly disabling to the life of the person who suffers from them.

In this article we will talk about panic attacks or anxiety crisesvery common in the different anxiety disorders. Currently, in the 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.

Crisis of anguish: characteristics

Anxiety attacks, also called panic attacks or panic or anxiety attacks, are included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The DSM-5 includes panic attacks as a specifier of any other disorder, and not so much as a disorder in itself (in the DSM-IV-TR the panic attack was considered as an independent "disorder", the so-called panic disorder or panic attack).

On the other hand, the ICD-10 (International Classification of Diseases) requires, in order to diagnose a panic attack, that at least one of the symptoms be: palpitations, tremors, dry mouth, or sweating..

Symptoms

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

• Palpitations, pounding of the Heart or acceleration of the heart rate.
• Sweating.
• Trembling or shaking.
• Sensation of difficulty breathing or choking.
• choking sensation
• Chest pain or discomfort.
• Nausea or abdominal discomfort.
• Sensation of dizzinessinstability, dizziness, lightheadedness or fainting.
• Chills or sensation of heat.
• Paresthesias (numbness or tingling sensation).
• Derealization (feeling of unreality) or depersonalization (detachment from oneself).
• Fear of losing control or of "going crazy".
• Fear of dying.

On the other hand, the most frequent somatic symptoms in the crisis of anguish are: first of all palpitations are: first of all palpitations, followed by dizziness-dizziness and tremors (they are common in both children and adults).

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

Types of panic attacks

The sudden onset of fear or discomfort can occur from a state of calm or, conversely, 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 do not present the 4 symptoms are called "limited asymptomatic attacks".

Differences in clinical and non-clinical population

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

As for the differences, we found that:

• Clinical patients have unexpected seizures, while non-clinical patients have them more in social situations. non-clinical patients suffer them more in social (evaluative) situations. (evaluative) situations.
• Clinical patients express more catastrophic more catastrophic cognitions.

Causes

There are different types of causes that have been referred to in an attempt to explain the appearance of anxiety crises. 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

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

2. Learning

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

3. Cognition

The cognitive models allude to aspects more related to how we process informationfor example, referring to "fear" networks or brain structures 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 treatment. a multicomponent cognitive-behavioral treatment, which includes the following componentswhich includes among its components

• Live exposure to interoceptive stimuli.
• Cognitive restructuring.

On the other hand, they are considered to be treatments with good efficacy: 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 anxiety attacks:

• The exposure treatment through virtual reality (for panic disorder with agoraphobia)
• Intensive sensation-focused therapy (Baker Morissette's)
• Augmented cognitive-behavioral therapy for panic (Levitt's).

Bibliographical references:

• WHO (2000). ICD-10. International classification of diseases, tenth edition. Madrid. Panamericana.
• Caballo (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Siglo XXI.
• Belloch, A.; Sandín, B. Y Ramos, F. (2010). Manual de Psicopatología. Volume I and II. Madrid: McGraw-Hill.
• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.