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The Sensible Psychology Dictionary Psychiatric Diagnoses in Plain English

Panic disorder

DSM Classification

(The psychiatry bible)

An individual who suffers recurrent Panic Attacks may be diagnosed with this Anxiety Disorder

Criteria for Panic Attack

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

  1. palpitations, pounding heart, or accelerated heart rate
  2. sweating
  3. trembling or shaking
  4. sensations of shortness of breath or smothering
  5. feeling of choking
  6. chest pain or discomfort
  7. nausea or abdominal distress
  8. feeling dizzy, unsteady, lightheaded, or faint
  9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
  10. fear of losing control or going crazy
  11. fear of dying
  12. paresthesias (numbness or tingling sensations)
  13. chills or hot flushes

Sensible Psychology Definition

Having intermittent panic attacks over an extended period (weeks, months, even years)

It is not panic itself (the firing of the ‘fight or flight’ response – an essential survival mechanism) which makes this a ‘disorder’. It is the fact that these attacks occur outside of any ’emergency’ situation.

When panic attacks are produced by very specific triggers (such as the sight of a spider) they are said to be ‘phobias’.

Panic attacks and the ‘exercise response’

Panic attacks are surprisingly common.(1)

‘Panic attack’ is a somewhat misleading term, since nothing gets ‘attacked’. A car alarm that goes off when there is no need isn’t ‘attacking’ the car. It’s ‘trying’ (yes, I know, it doesn’t really have any intent) to protect the car. But it’s getting it wrong. It’s responding to something which isn’t a car thief, or a collision, but might be a wiring fault.

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The metaphor of ‘attack’ carries all sorts of negative connotations, and using that word can itself disempower sufferers and make them feel even more helpless and frightened of their condition.

We prefer to use an analogy that describes the sudden feeling of panic as an ‘inappropriate exercise response’. During times of panic your body does all that it can to quickly get you into ‘exercise mode’. It helps you

  1. breathe more quickly to get more oxygen to your muscles
  2. raise your heart rate to pump blood faster
  3. pump blood away from your stomach into your large muscles
  4. produce more sweat to keep you cool
  5. temporarily shut down appetite, and
  6. get moving
  7. (unless you are physically trapped, in which case it may shut down energy in a bid not to waste it).

Now all these physical changes are great, and feel perfectly natural, if, say, you happen to be running on a treadmill in the gym, or playing an energetic game of squash. But if you’re sitting in a traffic jam and you are breathing as if you are running a race, or if you’re in a business meeting and sweating like you’re doing an aerobics class, then it feels weird. It’s an ‘inappropriate exercise response’ – not as catchy a name as ‘panic attack’, of course, but somewhat more accurate. Of course it will feel strange to have your body behaving as if you are doing intense exercise when you are not.

Panic and the human body

Fortunately, human bodies are pretty ‘economical’, which means that if you stay in the situation and don’t actually get physically harmed (because it’s a trip to the mall, for example), then pretty soon your mind will switch off the panic response and tag it as ‘false alarm’ as it doesn’t want to waste energy on nothing.

However, when people (perfectly understandably) flee a situation in which they are panicking, then it’s as if the unconscious mind wrongly concludes that this shopping mall (or whatever situation it may have been) must really be physically threatening (why else did you run from it?) and then proceeds to build an even greater fear around this situation in future.

The brain and body want to switch off panic as soon as possible because panic is a big drain on energy. This is why if a ‘panicker’ acts normally – continues to talk, or carry out their work, or stroll along looking in the shop windows, or chew gum (which, by the way, makes you produce saliva, which sends the signal to your brain that conditions are non-threatening enough for you to eat, because why else would you be salivating?), then panic ebbs away pretty fast.

Adjusting the panic alarm

We don’t need to get rid of panic – any more than a car needs to have its alarm removed – but we may need to help re-calibrate its sensitivity so that it only ‘goes off’ when this is really necessary.

All the physical changes that occur during panic are geared toward helping us survive a physical threat:

  1. we breathe quicker and higher in the chest (for sprinting or fighting – or both)
  2. we sweat to keep the body cool during the anticipated physical activity
  3. our heart pumps pump quickly so our muscles can get enough blood to power them
  4. our pupils dilate so we can get more information into our brains as to what other threats might be out there
  5. our minds race so that if it’s a real emergency we can make quick decisions (which feels very weird in a work meeting!)
  6. we may feel the need to vomit or defecate (nature’s way of making us a less appetising meal for predators!)

If we breathe too rapidly, we may feel short of breath or get pins and needles in the arms or numbness. These symptoms are not dangerous but can seem dramatic.

Panic attacks: not all in the body

People with panic disorder also know that their panic is not just a physical response but also a psychological one.

Panic attacks seem to come out of the blue, but actually tend to arise from high background stress levels. So someone who has, say, been having a tough time at work, is sleeping poorly, arguing with their spouse, getting worried about the health of a parent and so on, can find themselves suddenly tipped over into panic one day by some final straw. They may not even have consciously noted the rising stress, so that the panic seems baseless and inexplicable to them. And frightening. Especially if it then starts to happen again and again.

The onset of a panic attack is abrupt and rapid (usually reaching a peak within ten minutes). They can be extremely distressing and frightening for the sufferer. Often the presence of one symptom can lead directly to another (e.g. palpitations lead to fear of having a heart attack).

The eight core fears behind most panic attacks are:

  1. dying from a heart attack
  2. dying from suffocation
  3. having a stroke
  4. fainting
  5. having a nervous breakdown or ‘going crazy’
  6. losing control
  7. feeling so weak that you cannot move or might fall down
  8. believing you are going to be embarrassed or humiliated

First is worst

The first panic attack is often the worst, because the individual is so shocked by what’s happening and may not even know that it is a panic attack. They may seek urgent medical help, fearing that they are having a heart attack or stroke. When emergency room staff tell them there’s nothing wrong, they can find it hard to believe that such major distressing physical symptoms have no direct physical cause.

Fearing the fear

Many people with phobias or panic disorder ‘fear the fear’ – that is, they worry excessively about when the next ‘attack’ is coming. People who have panic attacks often start avoiding the things they think triggered the panic, and then stop doing the things they used to do or going to the places they used to go. In this way panic disorder can start to greatly reduce quality of life.

Treatments for panic disorder

Panic is commonly treated with anxiolytics (anti-anxiety agents) (see Drugs and medications and/or psychotherapy, especially Cognitive Behaviour Therapy (CBT) , an approach which focuses on helping people examine what they think and do with a view to changing their unhealthy habits of mind and behaviour.

The sensible psychology approach

A panic attack is a horrible and frightening experience, so reassurance is extremely important. Sufferers need to know that panic itself is natural, but the response mechanism needs to be ‘re-set’ so that it doesn’t ‘go off’ when not required (which for many people is most of the time). This can be done using hypnosis.

Any traumatic memories of past panic attacks should be ‘de-conditioned’ (this can be done safely and quickly using the Rewind technique ) so that past memories no longer cause future panic.

Basic skills in managing panic attacks and anxiety levels must be taught and regularly practised. This allows sufferers to take back control and stop being a ‘helpless victim’.

As panic attacks do not, in fact, ‘come out of the blue’, it is vital to assess wider lifestyle to determine how it may be contributing to the difficulties, and to determine how best to reduce general stress levels. Such assessment should also include dietary factors and the possible impact of side effects from medication.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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Notes:

  1. Between 1 and 4 people in 100 have panic disorder at some stage in their life. See Panic Disorder on the website of the Institute of Psychiatry, Kings College London.

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