Anxiety and Panic
Panic attacks are intense periods of fear or feelings of doom developing over a very short time frame — up to 10 minutes — and associated with at least four of the following:
- Sudden overwhelming fear
- Palpitations
- Sweating
- Trembling
- Shortness of breath
- Sense of choking
- Chest pain
- Nausea
- Dizziness
- A feeling of being detached from the world (de-realization)
- Fear of dying
- Numbness or tingling in the limbs or entire body
- Chills or hot flushes
Panic attacks and panic disorder are not the same thing. Panic disorder involves recurrent panic attacks along with constant fears about having future attacks and, often, avoiding situations that may trigger or remind someone of previous attacks. Not all panic attacks are caused by panic disorder; other conditions may trigger a panic attack. They might include:
- Mitral valve prolapse
- Hypoglycemia
- Hyperthyroidism
- Heart attacks
- Social phobia
- Agoraphobia (fear of not being able to escape, such as flying in an airplane or being in crowds)
Generalized anxiety disorder is excessive and unrealistic worry over a period of at least six months. It is associated with at least three of the following symptoms:
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability or explosive anger
- Muscle tension
- Sleep disturbances
- Personality changes, such as becoming less social
Phobic disorders are intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack. Social phobia and agoraphobia are examples of phobic disorders.
Post-traumatic stress disorder — or PTSD — was considered to be a type of anxiety disorder in earlier versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. But in 2013, PTSD was reclassified as its own condition. It describes a range of emotional reactions caused by exposure to either death or near-death circumstances (such as fires, floods, earthquakes, shootings, assault, automobile accidents, or wars) or to events that threaten one’s own or another person’s physical well-being. The traumatic event is re-experienced with fear of feelings of helplessness or horror and may appear in thoughts and dreams. Common behaviors include the following:
- Avoiding activities, places, or people associated with the triggering event
- Difficulty concentrating
- Difficulty sleeping
- Being hypervigilant (you closely watch your surroundings)
- Feeling a general sense of doom and gloom with diminished emotions (such as loving feelings or aspirations for the future)
Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness should not be automatically attributed to anxiety and require evaluation by a doctor.
Panic Attack Symptoms
Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. People experiencing a panic attack may believe they are having a heart attack or they are dying or going crazy. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms:
- “Racing” heart
- Feeling weak, faint, or dizzy
- Tingling or numbness in the hands and fingers
- Sense of terror, or impending doom or death
- Feeling sweaty or having chills
- Chest pains
- Breathing difficulties
- Feeling a loss of control
Panic attacks are generally brief, lasting less than 10 minutes, although some of the symptoms may persist for a longer time. People who have had one panic attack are at greater risk for having subsequent panic attacks than those who have never experienced a panic attack. When the attacks occur repeatedly, and there is worry about having more episodes, a person is considered to have a condition known as panic disorder.
People with panic disorder may be extremely anxious and fearful, since they are unable to predict when the next episode will occur. Panic disorder is fairly common and affects about 6 million adults in the U.S. Women are twice as likely as men to develop the condition, and its symptoms usually begin in early adulthood.
It is not clear what causes panic disorder. In many people who have the biological vulnerability to panic attacks, they may develop in association with major life changes (such as getting married, having a child, starting a first job, etc.) and major lifestyle stressors. There is also some evidence that suggests that the tendency to develop panic disorder may run in families. People who suffer from panic disorder are also more likely than others to suffer from depression, attempt suicide, or to abuse alcohol or drugs.
Fortunately, panic disorder is a treatable condition. Psychotherapy and medications have both been used, either singly or in combination, for successful treatment of panic disorder. If medication is necessary, your doctor may prescribe anti-anxiety medications, certain antidepressants or sometimes certain anticonvulsant drugs that also have anti-anxiety properties, or a class of heart medications known as beta-blockers to help prevent or control the episodes in panic disorder.