What happens in panic disorder, exactly?

What is it?

Panic disorder is an anxiety disorder that is characterized by intense periods of extreme anxiety during recurrent and often unexpected panic attacks.  These attacks last on average from 5 to 20 minutes.

During an attack the person usually senses uncontrollable fear. This can be fear of losing control, going crazy, and dying. Physical symptoms include having a rapid heartbeat, sweating, trembling, feeling dizzy, and finding it hard to breathe.

About 4.7% of the US adult population suffer from panic disorder at some point in their lives. The disorder typically onsets in young adulthood. Women are twice as likely as men to develop it, and it is associated with high intelligence.

What causes it?

The exact causes of panic disorder are not known, but genetics play a big role. Panic disorder is also associated with other mental illnesses and being genetically predisposed to alcoholism. Panic disorder is often triggered by a stressful life event, like physical illness.

What happens during it?

The amygdala is a part of the brain that contains many different nuclei. These nuclei play an integral role in the processing of fear. The amygdala receives information from the cortex, where higher cognitive functions are performed, and after processing it sends the information to many other parts of the brain. The dysfunction of any link in this network could lead to excessive fear and anxiety, and that is why the amygdala is thought to be associated with panic disorder. This theory is further supported by the fact that the amygdala of patients with panic disorder is often smaller than normal. The amygdala regulates our fight-or-flight response, which is very useful if in immediate danger, but the incorrect function of this mechanism can be very disabling in everyday life.

There are some people who believe that the panic attacks in panic disorder are triggered when the body mistakes normal sensations to life-threatening ones. When an anxious person starts to experience that their heart beats faster than normal, for example, they might assume that there is something wrong with it and that they are at a risk of dying. Feeling like this makes many also feel out of control, which can further lead to panic. Being mistaken about bodily sensations in this way is referred to as anxiety sensitivity, and people with high anxiety sensitivity are much more likely to also have panic disorder.

When a person is having a panic attack, they first feel fear. The body interprets this as a call to prepare for action: the physical reaction is the same as it would be if you saw a lion running towards you. In this situation you need to be able to run for your life, and because your muscles need a lot of oxygen in order to be able to release the energy needed for sprinting, your heart starts beating faster and your breathing becomes more frequent. You also start sweating to remove any excess heat that is a side product of releasing the energy. Normally carbon dioxide is produced as a side product of releasing the energy in the muscles and you breathe it out at the same rate as you breathe oxygen in. Because in a panic attack you are in fact not running away from a lion and producing lots of carbon dioxide, your rapid breathing leads to lowered levels on carbon dioxide in the blood, which in turn can lead to symptoms like dizziness and numbness.

How can it be treated?

While there is no absolute cure for panic disorder, the symptoms can often be successfully managed. The most effective treatment has been identified to be cognitive behavioral therapy – the vast majority of patients recover from their panic attacks within 12 weeks of starting this therapy. The goal of cognitive behavioral therapy is to help the patients to reorganize the thoughts and feelings that they have with regards to the source of their anxiety. The patients are encouraged to gradually face their fears so that they understand how irrational those fears are.

Another useful approach is to simulate the symptoms of a panic attack (running in place to get the heart to beat fast, and breathing intentionally very frequently to cause dizziness, for example), so that the patient’s brain learns that it is not necessary to associate fear with these sensations. This obviously has its limits though, since the terror the patients experience often causes the symptoms and not vice versa.

Some medications can be useful when they are combined with therapy: often because of their sedating properties. No two cases of panic disorder are identical and because of this no two lines of treatment should be identical. As with any mental illness, it can’t be stressed enough how important it is to address the individual needs of each patient.



Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598964/, en.wikipedia.org/wiki/Panic_disorder, http://www.nhs.uk/Conditions/Panic-disorder/Pages/Treatment.aspx, https://en.wikipedia.org/wiki/Panic_attack, http://emedicine.medscape.com/article/287913-clinical, https://en.wikipedia.org/wiki/Anxiety_sensitivity


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