Panic Disorder: Symptoms, Causes and Treatment

As one of the most common mental disorders, it is very likely that you are going to suffer from it sometime.

The term "anxiety attack" is something we are probably all familiar with. In fact, most people have experienced one or have 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 causes situations to be avoided. We are talking about those people who suffer from a panic disorder..

Panic disorder

The so-called panic disorder is one of the most common types of mental disorder, which is characterized by the recurrent appearance of sudden and unexpected panic attacks (the subject being able to be calm or in an anxious situation before their appearance).

Panic attacks, also known as anxiety attacks, are the occurrence of sudden, temporary episodes of the appearance of sudden and temporary episodes of feelings of anguish, discomfort and fear of high intensity, which can have a variable and fear of high intensity that can have a variable duration and that usually generate a maximum peak of activation in a few minutes and resolve in about fifteen minutes (although sometimes they can last for hours).

During such attacks, a wide variety of symptoms appear, including tachycardia, profuse sweating, tremors, hyperventilation and a feeling of being suffocated, hyperthermiaThe symptoms of anxiety include: numbness, chest pain, intestinal discomfort and psychological symptoms such as fear of dying or having a Heart attack, the idea of losing control over one's own body or even of going crazy, and possibly dissociative symptoms such as derealization (feeling that what is happening is not real) or depersonalization (strangeness with the subject's own existence).

After the anxiety crisis or crises, there is concern for a month or more that they may occur again or that the same sensations may be experienced again at some point. The subject anticipates the occurrence of such attacks and this generates great fear and anguish, a fear that provokes a state of great tension in the subject and may even provoke the implementation of mechanisms and behaviors to avoid these sensations or the possible occurrence of new attacks. Thus, for example, if the panic attack hit us in the subway, it is likely that we will avoid using public transportation again.

This will generate consequences of different magnitude that will alter their daily 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 end up also suffering from depressive problems or even substance or even substance use and abuse.

Anxiety attacks as something 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 to some extent reminiscent of those of a heart attack, which reinforces the idea that something very serious is happening and increases panic and anxiety and reinforces the symptoms described above.

Nevertheless, it should be borne in mind that panic attacks are not per se indicative of any disorder unless they occur on a very recurrent basis and generate avoidance in anticipation of their occurrence. In fact, a relatively high percentage of the world's population will suffer at some point in their lives some anxiety crisis or panic attack. This is especially frequent in demanding societies with a high level of exigency, which is frequent nowadays.which is frequent nowadays.

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

Relationship with agoraphobia

The panic disorder has traditionally been seen closely linked to another psychological problem called agoraphobia, in which fear and anxiety occurs at the thought of being exposed to places where escape would be difficult or might 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 provoke 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.

Confusion with heart problems

One of the most common fears that arise at the moment of suffering 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 a heart attack. many of the symptoms are similar to angina pectoris or a myocardial infarctiontachycardia, chest pain, sweating?

However, it should be noted that there are differences between panic attack and heart attack. Among them are that in a 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. while in infarction there is a link with exertion, in anxiety this does not occur.. The duration of the symptoms is also different. In any case it is advisable to visit 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 is not fully known.

The onset of the first attack may be due to situational factors, while some authors propose that the first panic attack may be caused by a combination of factors.Some authors propose that the recurrence, anticipation and preoccupation with panic attacks are due to the generation of negative and aversive interpretations of bodily sensations not related to anxiety.

The fact that some sensations are interpreted as anxiogenic generates the appearance of fear and anxiety. The fact that some sensations are interpreted as anxiogenic generates the appearance of fear and anxiety, which ultimately leads to the appearance of a crisis.

There is also speculation about the possible influence of genes, with anxiety disorders generally being more frequent in families with previous cases. Learning from role models or previous experiences may also have some influence.

Treatment and therapy

Panic disorder is a highly disabling problem for the sufferer and often has a tendency to become chronic if left untreated. Fortunately, the studies conducted on this anxiety disorder indicate that the most common and recommended treatments available tend to have a very high efficacy, specifically over 80% of the available treatments.more than 80% of recoveries.

One of the most common and most effective treatments is, as with phobias, exposure. This technique is based on putting the subject in situations in which he/she experiences little by little situations that he/she avoids and that generate anxiety so that he/she can reduce the level of fear and anxiety before these situations and the avoidance that they usually involve.

It is important to keep in mind that the exposure must be gradual.It is necessary to agree with the patient on a hierarchy of feared situations in order to gradually reduce the anxiety generated. In the case of panic disorder, we are talking both about situations to avoid for fear of suffering a panic attack and interoceptive work, including exposure to sensations linked to panic (e.g. hyperventilation).

Another of the most effective treatments, which can be given together with the previous one, is cognitive restructuring. In this case we try to combat the dysfunctional thoughts and beliefs that have generated and/or maintain the problem. The aim is to de-catastrophize the situation and 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 perform tests to check whether his thoughts and hypotheses about what is happening (being in a way a small exposure) are in line with reality or not.

Teaching relaxation techniques can be used to lower the level of anxiety and distress or to learn to control it, which is very useful for the patient.

Use of drugs

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

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
• National Institute of Mental Health (n.d.). Panic disorder: when fear exhausts. [published online]. Available at: https://www.nimh.nih.gov/health/publications/espanol/trastorno-de-panico-cuando-el-miedo-agobia/index.shtml#pub8