UNERSTANDING PANIC DISORDERS

Timothy P. Pagano
PC11 / 12-12-98

Fear, heart palpitations, terror, a sense of impending doom, dizziness, fear of fear. These are the words used to describe a panic disorder. But there is great hope: treatment can benefit virtually everyone who has this condition. It is extremely important for the person who has to learn about the problem and the availability of effective treatments and to seek help. The encouraging progress in the treatment of panic disorder reflects recent, rapid advances in scientific understanding of the brain. In fact, the President and the U.S. Congress have declared the 1990s the Decade of the Brain. In addition to supporting intensified research on brain disorders, the federal Government is working to bring information about these conditions to the people who need it.
The National Institute of Mental Health (NIMH), the Federal agency responsible for conducting and supporting research related to mental disorders, mental health, and the brain, is conducting a nationwide education program on anxiety disorder, a group of illnesses. The program’s purpose is to educate the public and health care professionals about the disorder and encourage people with it to obtain effective treatments. To continue , in a panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations and dizziness) that occur repeatedly and unexpectedly in the absence of any external threat. These “panic attacks,” which are the hallmark of panic disorder, are believed to occur when the brain’s normal mechanism for reacting to a threat—the so-called “fight or flight” response—becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.
In the United States, between three and six million will have panic disorder at some time in their lives. The disorder typically begins in young adulthood, but older people and children can be affected. Women are affected twice as frequently as men. While people of all races and social classes can have panic disorder, there appear to be cultural differences in how individual symptoms are expressed. Typically, a first panic attack seems to come “out of the blue,” occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control. The symptoms usually lasts several seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour.
Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks. In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear called anticipatory anxiety or fear of fear, can be present most of the time and seriously interfere with the person’s life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has a panic attack while driving may be afraid to get behind the wheel again. People who develop these panic-induced phobias will tend to avoid situations that they fear will trigger a panic attack, and their lives may be increasingly limited as a result. Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, the attacks continue and cause much suffering.
Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a physician yields no indication of a life-threatening condition. Panic disorder may progress to a more advanced stage in which the person becomes afraid of being in any place or situation where escape