Panic disorder
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Panic disorder
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Panic disorder
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panic disorder p. 586
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Tanner Marshall, MS
At some point you’ve probably heard someone say or joke about “having a panic attack,” but panic attacks are very real situations where someone experiences a sudden period of intense fear or discomfort, believing that something bad’s going to happen and that there’s some imminent threat or danger.
These feelings are often so intense that they’re accompanied by physiological symptoms like heart palpitations, dizziness, or shortness of breath.
These symptoms peak within the first 10-20 minutes, but some might last hours.
Sometimes patients having a panic attack might feel as though they’re having a heart attack or some other life-threatening illness.
Panic attacks can happen even in familiar places where there are no real threats, which makes them unpredictable, which can further increase anxiety about when the next panic attack is going to happen.
The DSM-5 outlines the specific criteria required for diagnosis of a panic attack.
Patients need to experience the abrupt onset of at least four of the following 13 symptoms: pounding heart or fast heart rate; chest pain or discomfort; sweating; trembling; shortness of breath; nausea; dizziness; chills; numbness; feelings of choking; feelings of being detached from oneself; fear of losing control; and fear of dying.
Admittedly, some of these symptoms might naturally occur together, so they can be very hard to tease apart.
For example, it would be unusual for a person who’s sweating, feeling dizzy, and feeling chills to also not be trembling.
It’s also important to note that some of these are physical symptoms whereas others are mental, like specific thoughts and ideations.
Panic attacks can happen in the context of several mental disorders including depressive disorders, posttraumatic stress disorder, and substance abuse disorders.
They can also, however, happen in the context of a panic disorder, which is basically identified in someone who has panic attacks that are recurrent—meaning 2 or more—and unexpected.
In addition, the DSM-5 says that for somebody to be diagnosed with a panic disorder, they also need to experience persistent worrying or changes in behavior due to their panic attacks.
Summary
Panic disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks, which typically peak within the first 10-20 minutes though some might last hours. A panic attack is a sudden episode of intense fear or discomfort that can include physical symptoms such as heart palpitations, chest pain, sweating, shaking, and difficulty breathing.
Sometimes panic disorder gets so bad that the person stops engaging in activities that they think could trigger an attack, severely hampering their ability to function in day-to-day life.
The management may involve a combination of psychotherapy and medication. Cognitive-behavioral therapy is the most effective psychotherapy for panic disorder. Medications such as antidepressants and anti-anxiety medications can also be helpful.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine" McGraw Hill Education/ Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "Anxiety" The Lancet (2016)
- "Short- and long- term efficacy of cognitive behavioral therapy for DSM-IV panic disorder in patients with and without severe psychiatric comorbidity" Journal of Psychiatric Research (2011)
- "Phenomenology of panic disorder in youth" Depression and Anxiety (2004)
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