Panic Disorder: Symptoms, Causes, and Treatment

Panic disorder is common among young and middle adults, especially in cultures like the USA. This disorder has only recently gained the attention of academicians. The DSM-5-TR classification of psychological disorders describes that in "panic disorder, the individual experiences recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks, or changes his or her behavior in maladaptive ways because of the panic attacks (e.g., avoid exercise or unfamiliar locations)."

What is Panic Disorder?

APA defines panic as "a sudden, uncontrollable fear reaction that may involve terror, confusion, and irrational behavior, precipitated by a perceived threat," whereas it considers panic or anxiety attack as "a sudden onset of intense apprehension and fearfulness in the absence of actual danger, accompanied by the presence of such physical symptoms as heart palpitations, difficulty breathing, chest pain or discomfort, choking or smothering sensations, sweating, and dizziness" and when these attacks become abnormally dysfunctional, they result in what clinicians call panic disorder.

Symptoms

Following are some of the significant symptoms of panic disorder:

Imperative for diagnosis (at least some of these are present): palpitation, sweating, trembling, shortness of breath (or its sensation), chest pain, feeling choked, nausea, dizziness, chill, paresthesias (lack of sensation in extremities), derealization, fear of losing control/ going mad and fear of death.
Fear/worry about having panic attacks.
Maladaptive behavior in response to panic attacks (e.g., avoidance of exercise).
May come unexpectedly.
May not be associated with the anxiety-provoking stimuli alone.
Last for a few minutes and rarely for a longer period of times.

Causal and Prognostic Factors

Following are the major factors :

Cultural

Impacts the perception of any symptoms or situation as panic and anxiety-provoking, i.e., cultural expectation.
Culture-specific concepts of distress are very closely associated with panic attacks, like 'Ataque de nervios' among Latin Americans, 'soul loss' among Cambodians, and 'hit by the wind' in Vietnamese.

Personal

Neurotic personality (proneness to the experience of negative effect).
Sensitive to anxiety (leading to negative perceptions and emotions towards anxiety).
Harm or risk avoidance personality.
History of limited symptoms of panic attack/s.
Negative appraisal of a previous panic attack (not a common risk factor).

Genetic and Physiological

Certain genes increase vulnerability to the disorder.
Children of people with anxiety, depression, and bipolar disorder are more prone.
Physiological conditions like asthma are associated with it.

Environmental

Perception of stressors in months preceding the first panic attack.
Chronic life stress, trauma, and childhood stress (affect the severity of panic disorders).
Parental overprotection and lack of emotional attachment.
Economic distress.
Smoking.

Gender

This disorder is more likely to occur and relapse in women. Further, females also experience a greater impact on their health and wellbeing due to the disorder.
The high expression of MAOA-uVNTR alleles in women has been associated with a greater incidence of this disorder.

Others Features and Impact of Panic Disorder

The average age for onset of this disorder has been reported to be 34.7 years, implying this disorder's higher prevalence in adults. The existence of this disorder is rare in childhood and even rarer in old age. Studies show attentional bias towards threatening stimuli among people with panic disorder, but panic at times may also occur in the absence of actual stimuli. The disorder varies in severity and frequency, as well as whether the panic attacks are expected or not. However, it has been reported that attacks become more expected and follow a known course over time. Further, as it develops, it associates with suicidal thoughts and tendencies. Additionally, childhood and past negative experiences increase the likelihood of suicide among such individuals.

Panic disorder has been seen to impact an individual's social as well as physical and psychological health. Observations show that it greatly impacts one's occupation and academics, leading to unemployment, job loss, and dropout in severe cases (due to frequent absence from work or place of education). The disorder has also been associated with greater morbidity and lower quality of life.

Treatment of Panic Disorder

Like any other psychological disorder, this disorder requires the help and guidance of licensed and experienced clinicians for treatment. The treatment plan includes psychological interventions, pharmacological methods, or both.

Psychological Interventions

Cognitive Behavior Therapy (like exposure therapy)
Psychodynamic approach
Eye movement desensitization and reprocessing
Group therapy
Marital and family therapy

Pharmacological Interventions

Selective serotonin reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitors
Tricyclic antidepressants
Benzodiazepines
Other antidepressants (like Monoamine oxidase inhibitors, Trazodone, Bupropion and bupropion sustained release, Nefazodone, Mirtazapine and Reboxetine)
Other agents (like Anticonvulsants, Antipsychotic agents, Antihypertensives, Inositol and Buspirone)

Combined Treatment

includes the use of both pharmacological and psychological intervention.

Conclusion

Before concluding, it is important to highlight that this disorder should not be confused with and diagnosed in case of a limited-symptoms panic attack, anxiety disorder due to other medical conditions, substance-induced panic attacks, and other mental disorders with panic attacks as an associated feature (e.g., other anxiety disorders and psychotic disorders). Further, this disorder frequently co-occurs with other anxiety disorders (especially agoraphobia and illness anxiety disorder), major depressive disorder, bipolar disorders, and mild alcohol use disorder.

Given its commonality, one often finds it difficult to believe that something as normal as panic can also be a disorder. More specifically, it is not panic in itself that is a disorder but is the defining characteristic of this disorder that manifests in strange ways creating distress and dysfunction. Thus, panic disorder can be highly maladaptive and lead to a negative impact on one's life and, therefore, should be consulted and treated by a practitioner for its resolution.