panic disorder

Panic disorder: description

Typical of a panic disorder are recurrent, unpredictable panic attacks. The panic disorder is also referred to by physicians as episodic-paroxysmal anxiety. The term paroxysmal comes from the Greek and can be translated as “savage”.

What are panic attacks?

Panic attacks are sudden onset attacks of severe anxiety associated with a variety of physical symptoms, including tremors, sweating and palpitations, and anxiety-enhancing thoughts. Frequent ideas are about to suffer a heart attack, to stifle or to faint. The threatening interpretation causes those concerned to die from the symptoms. Although the panic attacks last only a short time, but are very intense and exhausting.

Panic disorder with agoraphobia

Often panic attacks occur in connection with the mental disorder agoraphobia. For example, patients may be afraid to travel on public transport, visit a movie theater or cinema, or go shopping in the supermarket. You can no longer visit these places without accompaniment (avoidance behavior). If the patients do not even dare to go out alone, this has serious consequences, such as job loss and loneliness.

Panic disorders associated with agoraphobia are more common than pure panic disorders. Diving panic attacks as part of depression, they are not associated with a panic disorder, but seen as a result of depression.

Panic attacks in children

Even children and adolescents can already develop an anxiety and panic disorder. Although parents suffer from panic attacks, many children take on the fearful behavior of them. Experts have shown experimentally that toddlers shrink from uncertain situations when their mother has a fearful expression. This behavior shows that the gestures and facial expressions of the parents strongly influence people at a young age. Increased anxiety increases the risk of the child developing a panic disorder later. Even children who suffer from separation anxiety, more likely to experience panic attacks.

Therapy is often successful in children and adolescents with panic disorder. Left untreated, the mental illness can be chronic and have a very negative impact on children’s development. Above all, the social consequences are grave, because the children retire for fear of ever further. As with adults, mental health problems usually add to a panic disorder, including depression, other anxiety disorders, and addictions.

In children and adolescents, it usually makes sense to include the parents in the therapy. Because anxiety disorders in children are based in some cases on disturbed relationships within the family. Even if this is not the case, parents can learn in therapy how to support their children.

Panic attacks: how many are affected?

About two to four percent of the population suffer panic disorder in their lives with panic attacks. The beginning is usually between the 15th and 24th year of life. In women, the panic disorder is diagnosed at least twice as often as in men.

Panic Attacks: Symptoms

According to the ICD-10 classification of mental disorders, the following symptoms are characteristic for a panic disorder or for panic attacks:

• A panic attack is a single episode of intense anxiety that begins abruptly and reaches its maximum within minutes. The panic attack lasts only a few minutes.
• In a panic disorder, at least one of the following symptoms always occurs: changes in heart rate and palpitations, sweating, tremors and dry mouth.
• Other common chest and abdominal symptoms include: difficulty breathing, tightness, chest pain, nausea, and discomfort in the stomach.
• The mental symptoms include dizziness, insecurity, weakness and drowsiness. The anxiety and physical symptoms are so severe that those concerned are dying.
• As the panic attacks arise out of the blue, many are afraid of losing control or worrying about going crazy.
• Often the sufferers perceive themselves or the environment as unreal and strange. Experts refer to these phenomena as depersonalization or derealization.
• In addition, patients complain in a panic attack symptoms such as hot flashes or chill, feeling numb or tingling.

Panic Disorder: Symptoms of nocturnal panic attacks

Up to 40 percent of patients with panic disorder also experience panic attacks regularly at night. A secure explanation for this phenomenon does not exist yet. It is difficult to explain because panic attacks do not occur during the dream phases at night. Sleep panic attacks are not a reaction to nightmares.

Experts therefore believe that panic is learned during the day in response to physical changes, such as rapid heartbeat. This trained reaction then automatically expires at night.

Panic Attacks: Causes

The causes of panic disorders are not fully understood. It is now clear that genetic factors play a role. It is also known that a disturbed messenger substance activity in certain brain regions promotes the development of the disease. These and the following factors combine in the development of panic attacks.

Traumatic childhood experiences

Scientists believe that often traumas in early childhood are the cause of a later anxiety disorder. In childhood experience studies, panic patients have reported more frequent neglect, sexual abuse, loss of a parent, alcohol abuse by the parents and violence in the family. However, stress in adulthood, such as divorce or the death of a relative, can also contribute to panic disorder.

anxiety

People with increased anxiety are at particular risk of developing panic attacks. They often interpret physical reactions to stress or stress as life-threatening. As a result, they aggravate the physical symptoms and the anxiety swings.

avoidance behavior

The avoidance behaviors that sufferers develop cause the fear to be sustained and the panic attacks return. Also, the carrying of medication or the constant accompaniment by other people makes the problem worse. Those affected think that they only survived the situation because they would have had help in an emergency. Unless they find that the panic can be overcome without help, the panic disorder remains.

stress

High levels of stress (for example, as a result of partner conflicts, unemployment, existential concerns) can promote the onset of a panic disorder. With constant internal tension often only a small trigger (for example, the purchase in a crowded supermarket) is sufficient to initiate the vicious cycle of fear, which finally leads to a panic attack.

Substances that trigger panic attacks

Substances such as alcohol, caffeine and various medications also promote the onset of panic attacks. Especially cigarettes often do not have the supposed calming effect: nicotine usually has a stimulating effect on the body. If you are already in a state of inner agitation anyway, smoking a cigarette will further increase the unrest. The degree of tension that triggers the panic attack is reached faster. If anxiety attacks occur frequently, a panic disorder develops.

Panic Attacks: Examinations and Diagnosis

If you suspect a panic disorder, you can first visit your family doctor. He will have a conversation with you and will conduct various examinations to rule out the physical causes of the condition.

Panic-like conditions can also occur in connection with physical illnesses. These diseases include:

• Arrhythmia
• Herzenge (angina pectoris)
• Hyperthyroidism (hyperthyroidism)
• Hypoglycemia (hypoglycemia)
• bronchial asthma
• Chronic obstructive pulmonary disease (COPD)
• Sleep Apnea Syndrome
• epilepsy
• caffeine intoxication
• Drug use, especially cocaine, amphetamines, ecstasy, hallucinogens and opiates

For an accurate diagnosis of panic disorder and to determine if there are any other mental disorders, the family doctor will refer you to a therapist or psychosomatic clinic.

Through questioning and questionnaires, a doctor or psychologist can differentiate the panic disorder from other anxiety disorders. A panic attack test is, for example, the Hamilton anxiety scale (HAMA), which the doctor fills out in conversation with the patient (third-party assessment forms).

But there are also self-assessment sheets, with the aid of which the anxiety patient himself can describe his complaints more concretely (State Trait Anxiety Inventory, STAI). The following questions could be asked by the therapist for the diagnosis of panic disorder:

• Do you sometimes experience seizures of severe anxiety?
• Does the anxiety occur together with physical symptoms such as tremors, shortness of breath or dry mouth?
• Are you afraid of another seizure after an anxiety attack?
• Is there a specific trigger for the anxiety attacks?

It is only a panic disorder if the panic attacks are not related to particular exertion or dangerous situations. In addition, they do not refer to a particular object, such as a phobia, but occur in different situations.

The severity of the panic attacks varies from person to person. If the victims experience four panic attacks within four weeks, it is called a moderate panic disorder. If four panic attacks per week occur within one month, it is a severe panic disorder.

Panic Attacks: Treatment

Experts recommend cognitive behavioral therapy and the use of medication to treat panic disorder with panic attacks. Alternatively, Psychodynamic Psychotherapy shows success. In addition to the therapy, sports and self-help groups are a useful support.

Cognitive behavioral therapy

The first step of a panic attack therapy is usually the detailed education of the patient about the mental disorder (psychoeducation). The person concerned is familiarized with the typical features of panic disorder. Already the knowledge that many people suffer from the same symptoms and that the physical symptoms of the disorder are part of them already scares the unknown.

In the next step, the patients will deliberately cause a panic attack. For example, the patient is prompted to breathe quickly and deeply, or to turn in a circle to create dizziness. It may seem paradoxical to purposely bring about the dreaded situation. However, this intervention contains two important aspects. For one thing, for the first time, the patient has control over when the panic attack starts. On the other hand, he learns that the physical symptoms are not caused by a heart attack, but can be triggered by breathing alone.

In the further course of the panic disorder treatment, the patient should then face his fears again and again. Gradually, the fear then decreases and panic attacks no longer occur. Affected persons who also suffer from agoraphobia and therefore avoid public places, have to go to them.

The same applies to panic attacks while driving, which restrict the mobility of patients. Even this fear can be overcome if the patients manage to get back in a car and drive off. Some clinics even cooperate with driving schools.

To prevent relapse, the therapist prepares the patient for possible panic attacks. If strong symptoms of anxiety return, the person concerned knows how to deal with it and combat the panic attacks.

Psychodynamic psychotherapy

In “Panic Focused Psychodynamic Psychotherapy” the therapist explores the conflicts behind the panic disorder and the significance of the panic attacks. For example, a panic attack can be an expression of suppressed feelings that only come to light through anxiety attacks. In conversation with the therapist, the patient gains access to his subconscious feelings. The panic attacks are less when the patient realizes that unresolved conflicts are the real cause of his fears.

Many panic patients tend to feel helpless and dependent on other people. An important starting point of psychodynamic psychotherapy is therefore to strengthen it in its self-determination and independence (autonomy).

drugs

For the treatment of panic disorders, drugs from the class of antidepressants have proven particularly effective. These include, in particular, newer antidepressants, so-called selective serotonin reuptake inhibitors (SSRIs). They have fewer side effects, however, some cause nausea or sexual dysfunction.

Benzodiazepines are also effective. However, they have a high addictive potential. They should only be taken if the administration of SSRIs was unsuccessful and then only for a short time. In the past, typical antipsychotics (neuroleptics) were also used to treat panic disorders. They are no longer recommended today and rarely used.

Tips against panic attacks:

What helps against panic attacks? The best cure for anxiety is to face fear. By confronting their own fears, sufferers can get rid of the panic attacks. Observe yourself well and try to discover and discard avoidance strategies. For example, it can be that you only go home with medication or in the company of other people. Remember, anything you do not do out of fear weakens you and strengthens your fear.

Control thoughts

What to do about panic attacks if you have already used them? Even if panic attacks occur without notice, they are not helpless. During a panic attack, the familiar signs such as severe palpitations, dizziness or nausea reappear. Remember that you can influence how anxiety develops. What matters is how you evaluate the situation. Instead of assuming life-threatening causes, try to make it clear that the symptoms are uncomfortable but do not put you at mortal danger.

breathing exercises

Be aware that a panic attack lasts at most several minutes. To bridge the time, breathing exercises are a good help with panic attacks. Try to breathe slowly and pay attention to exhaling, because it calms the body. In hyperventilation, for example, you quickly exhale too much carbon dioxide. The discomfort that arises during hyperventilation creates anxiety. By breathing in a bag, you can quickly overcome the hyperventilation and thus the panic attacks. Carbon dioxide accumulates in the bag, so that its contents and normalizes the acidity in your blood.

avoid stress

Make sure your stress level is not too high. Treat yourself in the hustle and bustle of everyday life again and again breaks. Sufficient sleep and no caffeine prevent panic attacks. Sport is also effective against panic attacks. During exercise, you experience similar physical symptoms to panic attacks: the heart beats faster, the breathing changes. They get used to this condition over time and no longer evaluate the symptoms as a danger.

to accept help

Despite many helpful exercises that you can perform alone, it is advisable to seek professional help. With good guidance and guidance, confronting fear is easier. And only by doing so can you ultimately defeat the panic attacks. Self-help groups are a good supplement. Because they provide support not only during, but also after the therapy.

Panic Attacks: Disease Course and Prognosis

If left untreated, panic disorders often persist for years. This can alternate phases of increased and low frequency of anxiety attacks. Especially in connection with a fear of public places (agoraphobia), the panic disorder can greatly restrict the life of the person concerned. Some sufferers eventually leave the house for fear of new anxiety attacks no longer or become depressed.

People with a panic disorder often resort to consultation with a doctor to anxiolytic drugs (anxiolytics) or alcohol to get the fear under control. Alcoholism and dependence on drugs (especially tranquilizers and anxiolytics) can be the result.

With the help of psychotherapy and medications that make the anxiety reaction bearable, a panic disorder can be mastered well. In about 80 percent of patients, the therapy shows long-term success. Above all, it is important to seek medical help in good time, as the panic disorder does not disappear by itself.