Panic Disorder Symptoms
Panic disorder is an unexpected, sudden episode of intense anxiety
that may or may not include symptoms such as chest pain, rapid beating
heart, shortness of breath, lightheadedness (not dizziness), abdominal
pain, diarrhea, urgency to urinate, numbness and tingling in the
hands and feet, and possible sweating. The symptoms may be so severe
that one may feel they are having a heart attack. A person who experiences
an anxiety attack may go on to develop a phobia. Because they are
unsure what is happening, they may begin drawing a correlation between
the anxiety experienced and what appears to be the precipitating
event, for example driving an automobile, or driving over a bridge.
They may then create a phobia by linking the anxiety to the activity.
The person may begin to avoid many situations, may even become agoraphobic,
not wanting to go into crowds because of the severity of their anxiety,
hence a panic disorder is born.
Panic disorder is very common, affecting approximately 3 million
Americans in any given year. Women are two to three times more likely
to experience panic disorders than men. It is very common, usually
striking in young adulthood, before the age of 25.
Causes of Panic Disorder
There is evidence the heredity does play a role. However the exact
cause is unknown. This author’s dissertation was on the correlation
between panic disorder and mitral valve prolapse. Mitral valve prolapse
is a congenital malformation, which is not a serious condition,
but may cause sharp, fleeting electrical chest pain which only lasts
for a second or two, which may trigger a panic disorder. Some research
shows that the chorda tendinea of the papillary muscles becomes
mildly ischemic, which causes the sharp chest pain. This has not
been confirmed. My dissertation did show that chemotherapy, combined
with cognitive behavior treatment had the highest effective cure
rate of panic disorder in individuals with mitral value prolapse.
It is important to note that individuals with panic disorder do
not necessarily have mitral valve prolapse, and vice-versa. Mitral
valve prolapse does not necessarily cause panic disorder, but there
is an association between the two.
Panic disorder can coexist with other illnesses such as depression
and substance abuse. Approximately 30-45% of individuals with panic
disorder do go on to abuse alcohol. This makes total clinical sense
since they are trying to self medicate to decrease the panic disorder
they are having. Around 20% do above other substances. Marijuana
is a typically abused substance for these individuals. Some abuse
cocaine, although a few studies have shown that panic disorder may
be elicited in individuals who frequently abuse cocaine. It is very
unusual for a pre-existing panic disorder patient to begin abusing
cocaine, as symptoms similar to panic disorder may result.
When ruling out a diagnosis of panic disorder, or any mental illness,
it is important to rule out any physiological cause. Certain conditions
can mimic panic disorder, such as hyperthyroidism, brain tumors,
adrenal tumors, and heart arrhythmias. Other conditions to rule
out include Cushing syndrome, hypokalemia (decreased potassium),
hypoglycemia (low sugar), rule out anemia (iron deficiency), and
substance abuse, i.e. caffeine, alcohol, cocaine, amphetamines.
So what happens when an individual has a panic disorder or panic
attack? An attack begins when a trigger elicits a panic response.
This trigger may manifest itself in a variety of ways, from a visual
or auditory stimuli, a memory, nightmare or dream (panic disorder
may occur in the middle of the night, not to be confused with night
terrors). Oftentimes one of the first symptoms is an awareness of
rapid heartbeat, or fear of impending doom or even death. Once the
individual is aware that their heart rate is racing rapidly, the
cycle continues, and actually feeds upon itself. The sympathetic
nervous system is triggered, the individual may become diaphoretic
(sweaty), and the fight or flight mechanism takes over. At this
point, it is very difficult for the individual to stop the cycle.
Because the sympathetic nervous system has been triggered, they
may have an urgency to go to the bathroom, they may hyperventilate,
possibly creating numbness or tingling in their fingers and possibly
toes. Rapid heart rate may create the feeling of light-headedness
possibly to the point of passing out. Passing out can be helpful,
as it will slow the heart rate down. However it can be dangerous
as the individual may hit their head, possibly with ensuing head
trauma.
Panic Disorder Treatment
Cognitive behavioral treatment is very effective, and is also effective
in treating phobias. A cognitive behavioral therapist who practices
this discipline would be effective, in combination with medication.
A variety of medications have proven very effective. Among these
are low dose Beta blockers, SSRI’s (Selective Seratonin Reuptake
Inhibitors). These are excellent because they have fewer side effects
than the older anti-depressants. Anti-anxiety medication such as
the Benzodiazepines can be very effective with few side effects.
However they may cause drowsiness, and the potential exists for
addiction, especially if there is a history of alcohol or drug abuse.
This author has used Buspirone, in the family of drugs called Azipirones.
This medication is excellent. It acts similarly to the Benzodiazepines.
However there are a few side effects, and I have had individuals
complain of drowsiness on this medication, but I have continued
to use it with a good cure rate.
I do not like placing patients on medication for greater than 6
months to one year, and I insist that they be involved in individual
therapy combined with medication. Medication alone is a Band-aid
approach only, which pretty much can stop any panic disorder, but
if the individual doesn’t learn how to stop the cycle by utilizing
breathing techniques, meditation, or learn to mitigate the stimulus-response
cycle that is occurring, then the patient will continue to have
recurrent panic disorder when the medication is halted.
An example of a good treatment modality to decrease the cycle in
both panic disorder and anxiety attacks is the double breath technique.
This technique described below is very effective if performed correctly
in reducing heart rate, and also is used to distract or stop the
mind from obsessing or ruminating over the current events, which
have triggered the panic attack.
- I advise that they place their hand on their belly, because
they want to make sure they are doing a “belly breath,”
where they will see their hand rise and fall if their hand is
on their belly or abdomen, as opposed to having their chest move
up and down.
- Next step is to inspire through their nose. They can either
tap their hand, or count in their head, “one-thousand one,
one-thousand two, one-thousand three” as they inspire through
their nose.
- Whatever their inspiration count, they will then slowly breathe
out through their mouth, not their nose, and double the inspiration
count when expiring. In other words, if they inspire through their
nose with a count of 4 (one-thousand one, one-thousand two, one-thousand
three, one-thousand four), then they need to count out 8 when
they expire through their mouth, thereby doubling that number.
- The whole time, they are watching the hand on their abdomen
rise up and down.
This technique takes a lot of practice. The eventual goal is to
build up to a 5-10, inspiring to a count of 5, and expiring with
a count of 10. This is a very relaxing technique. It will knock
out a rapid heart rate. Counting also helps distract the individual
from the current cycling. I have had very good success using this
technique in sessions.
|
