Panic attacks are a serious condition experienced by one in every 75 people. The exact causes are unclear, but there appears to be a link with major life transitions that are potentially stressful: finishing education, marriage, the birth of a first child and so on. There is also some evidence of a genetic predisposition — if a family member has suffered from panic disorder, you yourself are at a raised risk of developing it, particularly when going through a difficult period in life.
A panic attack is a sudden surge of overwhelming fear that comes without warning and without an obvious cause. It is far more intense than the feeling of being "stressed" that most people experience. The symptoms include:
- a very rapid pulse
- difficulty breathing, a sense of "not being able to get enough air"
- an almost paralysing feeling of terror
- dizziness
- light-headedness or nausea
- trembling, sweating, choking, chest pain
- hot flushes or sudden chills
- numbness in the fingers or toes ("pins and needles")
- fear of going mad or of dying
During a panic attack these symptoms seem to come from nowhere, in situations that appear harmless — they can even happen during sleep.
What else is seen during an attack
- It comes on suddenly, with no warning and no way of controlling it.
- The fear is many times more intense than it would be in a genuinely dangerous situation.
- It passes within a few minutes — the body cannot sustain the "fight or flight" response for longer than that. Repeated attacks, however, can go on for hours.
A panic attack is not dangerous, but it can be deeply frightening, because the person experiences things as though they are "out of control". Panic disorder is alarming because of the attacks themselves and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from social impairment to a complete inability to face the outside world.
The phobias that people with panic disorder develop do not come from a fear of actual objects or events, but from the fear of another attack. In these cases people avoid certain objects or situations because they are afraid those things will trigger another attack.
Sometimes people see 10 or more doctors before being diagnosed correctly, and only one in four people with the disorder receives adequate treatment. This is why it is important to know the symptoms and to make sure you get the right help.
Many people have the occasional panic attack, and if you have had one or two there is probably no cause for concern. The main symptom of panic disorder is a persistent fear of future attacks.
What causes panic attacks — the mind, the body, or both?
Body
There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had panic disorder or another emotional disorder, such as depression. Panic disorder may also be due to a biological malfunction, although no specific biological marker has yet been found. All ethnic groups are vulnerable to panic disorder. For unknown reasons, women are twice as likely to have the disorder as men.
Mind
Stressful life events such as a recent loss or separation can trigger panic disorder. Some researchers compare life stress to a thermostat: under stress your resistance falls, and if there is a physical predisposition, it is triggered and causes a panic attack.
Both
The physical and psychological causes of panic disorder work together. Although attacks may initially appear "out of nowhere", the sufferer can end up contributing to them by reacting to the physical symptoms of the attack.
For example, if a person with panic disorder has a rapid heartbeat caused by drinking coffee, exercise or certain medicines, they may interpret it as a symptom of an attack and, through their anxiety, actually bring the attack on. On the other hand, coffee, exercise and some medicines do sometimes trigger panic attacks. One of the most troubling things for a sufferer is never knowing how to isolate the different triggers. This is why proper therapy for panic disorder focuses on all its aspects — physical, psychological and physiological.
Panic disorder responds very well to treatment, and a range of therapies is available. Once treated, panic disorder does not lead to lasting complications.
Without treatment, panic disorder can have serious consequences
The immediate danger is that it can often lead to a phobia, because after a panic attack you may begin to avoid situations like the one you were in when it occurred.
Even if such phobias do not develop, quality of life can be seriously impaired by untreated panic disorder. Research has shown that people with panic disorder:
- are more prone to alcohol and drug misuse;
- are at greater risk of a suicide attempt;
- spend more time in emergency departments;
- spend less time doing things they enjoy, exercising or taking part in other rewarding activities;
- tend to be financially dependent on others;
- report feeling emotionally and physically less healthy than people without panic disorder;
- are afraid to drive far from home.
Panic disorder can also have negative economic effects. One study cites the case of a woman who gave up a well-paid job requiring a daily commute for one close to home. Other sufferers report losing their jobs and having to rely on public support or family members.
How can panic disorder be treated?
A combination of cognitive and behavioural therapies is the best treatment for panic disorder. In some cases medication may also be appropriate.
The first part of therapy is largely informational; many people are helped simply by understanding what panic disorder is and how many others suffer from it. Many people with panic disorder worry that their attacks mean they are "going mad" or that the panic could cause a heart attack. "Cognitive restructuring" — changing the way of thinking — helps people replace those thoughts with a more realistic and positive way of looking at the attacks.
Cognitive therapy can help the patient identify the things or situations that cause attacks. In some cases it may be a particular thought, a situation, or something as subtle as a slight change in heart activity. Once the patient understands that the panic attack is separate and independent from the thing that provoked it, it begins to lose some of its power.
The behavioural components of therapy may consist of what one group of doctors called "interoceptive exposure". This is similar to desensitisation in the treatment of phobias, but what it focuses on is exposure to the actual physical sensations someone feels during an attack.
People with panic disorder fear the attack itself more than specific objects or events; their "fear of flying", for example, is not that the plane will crash but that they will have an attack in a place, such as an aircraft, where they cannot be helped. Others will not drink coffee or go into a hot room because they are afraid it may bring on the physical symptoms, such as a rapid pulse.
Interoceptive exposure can help them go through the symptoms of an attack (raised heart rate, hot flushes, sweating and so on) in a controlled setting and learn that these symptoms do not necessarily develop into a full-blown panic attack. Behavioural therapy is also used to deal with situational avoidance. One very effective treatment for phobias is in vivo exposure, which in the simplest sense means breaking a fear-inducing situation into small manageable steps and working through them one by one until the hardest is mastered.
Relaxation techniques can further help someone get through an attack. These include controlling the breath and positive visualisation. Some experts have found that people with panic disorder tend to have a slightly higher than average breathing rate, and learning to slow it down can help some of them cope with an attack and may also prevent future ones.
In some cases medicines may be needed. Anti-anxiety medicines may be prescribed, as well as antidepressants, and sometimes even heart medicines (such as beta blockers) used to control an irregular heartbeat. (See also: psychotropic medicines and the dependence their use can cause.)
A support group, sharing with others who have panic disorder, can be very useful for some people. It cannot take the place of therapy, but it can be a useful addition.
Bear in mind, though, that panic disorder, like any other emotional disorder, is not something you can diagnose or treat yourself. An experienced clinical psychologist or psychiatrist is the person best qualified to make the diagnosis, just as they are best qualified to treat the disorder.
Alternatives
Essential oils
Natural products that may help you cope with panic attacks. Wild orange oil has a calming effect. Elevation on the solar plexus; Balance on the soles of the feet and the temples. During the day, Peace in a diffuser; in the evening, Balance, Elevation and Peace again. Lavender, frankincense and copaiba oils internally or on the pulse points. See the full range of essential oils.
CBD (cannabis oil) is also mentioned in this context; it is not a product we offer.
Natural supplements and vitamins
Pine pollen and a B-complex support the nervous system. A blend of essential oils in a gelatin capsule: Serenity.
Progesterone therapy
In women over 35, progesterone levels begin to fall. This is the hormone that calms, helps us take on stress, and plays a role in metabolic regulation and in the control of nerve cell viability. Research shows that progesterone supports the normal development of neurons in the brain and that the hormone has a protective effect on damaged brain tissue. Progesterone increases the function of serotonin receptors in the brain, so an excess or deficiency can lead to significant neurochemical problems. This gives an explanation of why some people turn to substances that increase serotonin activity, such as nicotine, alcohol and cannabis, when progesterone levels fall below optimal.
The problem can often be addressed with bioidentical progesterone in the second part of the cycle. Bioidentical progesterone is sold across most of Europe under the brand name Utrogestan. It should also be distinguished from the synthetic progestins found in contraceptive pills, which do not have the same effect on GABA receptors and so do not calm the nervous system.
This is prescription medication and hormone therapy — it is decided and monitored by a doctor, never started on your own.
Panic disorder does not need to disrupt your life.
If you are having thoughts of suicide, seek help immediately — speak to a doctor or call 112. This article is informational and does not replace medical care.
Sources: American Psychological Association · Progesterone (Wikipedia) · Women's Health
Photo by Aliaksei Lepik on Unsplash.
