Panic attacks

Panic attacks are instant and intense, mounting physiological arousal, fear and discomfort. The start of these episodes is typically abrupt, and may have no obvious triggers. Panic attack suffers would like nothing more than to stop panic attacks before they start.

Although these episodes may seem to be random, they are a subset of a response commonly referred to as fight or flight that occur out of context. This response feeds the body with hormones, particularly epinephrine (adrenaline), that help it in defending against harm. Experiencing a panic attack is said to be one of the most scary, frightning things in a person's life.

According to the American Psychological Association, the panic attack symptoms usually last about thirty minutes. However, panic attacks can last as little as 15 seconds, while sometimes panic attacks may put together a cyclic series of episodes, lasting for a longer period, sometimes hours. Usually those afflicted will experience anticipatory anxiety and limited symptom attacks in between attacks, in situations where attacks have happened previously.

Panic attacks are commonly linked to agoraphobia and the fear of not being able to get out of a bad situation. Many people who experience panic attacks feel confined and unable to free themselves.

The effects of a panic attack are different from person to person. Some, notably first-time sufferers, might call for emergency services. Many who have a panic attack, mostly for the first time, may think they are having a heart attack or a nervous breakdown.

Contents

Descriptions

Sufferers of panic attacks often think they may be dying, "going crazy", or experiencing a heart attack or "flashing vision", feeling faint or nauseated, breathing heavy, or losing control. These feelings may promote a strong urge to escape the place where the attack began (a consequence of the sympathetic "fight or flight" response).

A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms could include trembling, dyspnea(shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations, sweating, nausea, dizziness, light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking, and derealization. These physical symptoms are associated with alarm in people prone to panic attacks. This results in increased anxiety, and forms a positive feedback loop.

Often the shortness of breath and chest pain are the main symptoms, the sufferer incorrectly appraises this as a sign of a heart attack. This can result in the person experiencing a panic attack seeking treatment in an emergency room.

Panic attacks are distinguished from other forms of anxiety by their intense symptoms and their sudden, episodic nature. They are often experienced with anxiety disorders and other psychological conditions, although panic attacks are not always indicative of a mental disorder.

Triggers and causes

• Long-term, predisposing causes — Heredity. Panic disorder has been found to be present in families, and this may mean that inheritance plays a strong role in determining who will get it. However, many people who have no family history of the disorder still do develop it. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overly cautious view of the world expressed by parents and continued stress over time have been found to be causes.

• Biological causes — obsessive compulsive disorder, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma and inner ear disturbances (labyrinthitis). Vitamin B deficiency from a lacking diet or caused by periodic depletion due to parasitic infection from tapeworm can trigger of anxiety attacks. This could be beneficial information for people wanting to stop anxiety attacks.

• Phobias — People will often have panic attacks as a direct result of exposure to a phobic object or situation.

• Short-term triggering causes — Significant personal loss, which could be an emotional attachment to a romantic partner, life transitions, significant life change, stimulants such as caffeine or nicotine, or other drugs such as marijuana and psilocybin, can be triggers.

• Maintaining causes — Avoidance of panic provoking situations or environments, negative self-talk ("what-if" thinking), mistaken beliefs ("these symptoms are harmful and/or dangerous"), withheld feelings, no assertiveness.

• Lack of assertiveness — A growing body of evidence supports the idea that people who suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also usually un-assertive. This un-assertive way of communicating seems to contribute to panic attacks while being consistently present in those that are have panic attacks.

• Medications — Sometimes panic attacks may be a side effect of medications such as Ritalin (methylphenidate) or even fluoroquinolone type antibiotics. These may be a temporary side effect, only happening when a patient first starts a medication, or could keep happening even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage, or type of drug. Nearly the entire SSRI class of antidepressants can cause more anxiety in the beginning of use. It is not uncommon for inexperienced users to have panic attacks while ccoming on or off the medication, especially ones prone to anxiety.

• Alcohol, medication or drug withdrawal — Various substances both prescribed and unprescribed can be a cause of panic attacks to develop as part of their withdrawal syndrome. Alcohol withdrawal and benzodiazepine withdrawal are very well known to cause these effects as a rebound withdrawal symptom of their tranquillising properties.

• Hyperventilation syndrome — Breathing from the chest usually causes overbreathing, exhaling excess carbon dioxide in relation to the amount of oxygen in one's bloodstream. Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness which may trigger panic attacks.

• Situationally bound panic attacks — Associating certain situations with panic attacks, due to experiencing one in that same situation, can create a cognitive or behavioral predisposition to having panic attacks in certain situations (situationally bound panic attacks). It is a form of classical conditioning.

• Pharmacological triggers — Certain chemical substances, usually stimulants but also certain depressants, can either contribute pharmacologically to a constellation of provocations, and thus invoke a panic attack or even a panic disorder, or directly induce one. This includes caffeine, amphetamine, alcohol and many more. Some sufferers of panic attacks also report phobias of specific drugs or chemicals, that thus have a merely psychosomatic effect, thereby functioning as drug-triggers by non-pharmacological means.

• Chronic and/or serious illness — Cardiac conditions that can cause sudden death such as Long QT syndrome; CPVT or Wolff-Parkinson-White syndrome can also result in panic attacks. This is particularly difficult to manage as the anxiety relates to events that may occur such as cardiac arrest, or if an Implantable cardioverter-defibrillator is in situ, the possibility of having a shock delivered. It can be difficult for someone with a cardiac condition to distinguish between symptoms of cardiac dysfunction and symptoms of anxiety. In CPVT, anxiety itself can and does trigger arrythmia.Current management of panic attacks secondary to cardiac conditions appears to depend heavily on Benzodiazepines; Selective serotonin reuptake inhibitors and/or Cognitive Behavioural Therapy. Although often this group of people experience multiple and unavoidable hospitalisations as without an electrocardiogram it can be difficult to differentiate between symptoms of panic attack and cardiac symptoms in those with these types of diagnosis.

Physiological considerations

While the various symptoms of a panic attack may feel that the body is failing, it is in fact protecting itself from harm. The various symptoms of a panic attack can be understood as follows. First, there is very often (but not always) the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response wherein the person's body prepares for strenuous physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation) which may be perceived as shortness of breath (dyspnea), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH (respiratory alkalosis or hypocapnia), which can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness. A panic attack can cause blood sugar to be drawn away from the brain and towards the major muscles. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood.

Symptoms

DSM-IV Diagnostic Criteria for Panic Attack

A discrete period of intense fear or discomfort, in which four (or more) of the symptoms listed below developed abruptly and reached a peak within 10 minutes:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Derealization (feelings of unreality) or depersonalization (being detached from oneself)

• Fear of losing control or going crazy

• Fear of dying

• Paresthesias (numbness or tingling sensations)

• Chills or hot flashes

Agoraphobia

Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty traveling from this "safe place". The word "agoraphobia" is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as "a fear of the marketplace" usually applies to any or all public places; however the essence of agoraphobia is a fear of panic attacks especially if they occur in public as the victim may feel like he or she has no escape and be very embarrassed of having one publicly in the first place. This translation is the reason for the common misconception that agoraphobia is a fear of open spaces, and is not clinically accurate.

People who have had a panic attack in certain situations may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where certain individuals with panic disorder are unable to drive or they may not even be able to step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place. It should be noted that upwards of 90% of agoraphobics achieve a full recovery. Agoraphobia is actually not a fear of certain places but a fear of having panic attacks in certain places.

It is important to note that agoraphobia is by no means a hopeless situation. Sufferers often do not realize that they have experienced these same situations before and nothing terrible occurred. Successful treatment is possible with the right combination of therapy and medication.

Panic disorder

People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.^[10]

Panic attacks while pregnant

When a woman gets pregnant her body goes through many different kinds of changes. Hormone levels will be on the rise as the body prepares to sustain life for both the mother and the fetus. It is typical for women to experience fear and worry when they are pregnant. They will fear for the health of their unborn child. They will worry about the possibility of having a miscarriage if they don't do everything just right. All of these fears are common, although usually unfounded. Nature has a way of taking care of the innocent and keeping them safe. A miscarriage is more than likely a sign that something is seriously wrong and the fetus is not healthy enough to live. With the drastic change in hormone levels many women find that they suddenly suffer from anxiety and panic attacks. You may have never had an anxiety attack or a panic attack in your life until you become pregnant and all of a sudden you find that your fears are out of control. There is no way to know how your body will react to the increase in hormones. Everybody reacts differently and until you have been there you just can't tell how it will go. Increased levels of hormones are making all kinds of changes in your body but these changes are necessary for a normal pregnancy and delivery. If you find that you suddenly experience anxiety and panic attacks during pregnancy you should immediately discuss this with your doctor. For nine months your body will be undergoing changes and that is a long time to deal with severe anxiety and panic. Now, more than ever, it is important for you to eat a healthy diet and get regular exercise. The delivery process is called labor for a reason. Your body needs to be in good physical shape to endure this process. This will also help the fetus grow strong and healthy if the mother stays healthy. The things you eat will also go to feed the baby so you need to take care to eat foods that provide nourishment to the baby. If you experience a lot of anxiety and panic your doctor will probably recommend that you give up caffeine entirely. Caffeine is a stimulant that flows through the bloodstream and into the bloodstream of the baby. It is possible for the baby to feel stressed at the same time the mother does. Avoid taking pain killers or other types of medicine unless your doctor approves it. Remember, everything that enters your bloodstream will also enter the baby's bloodstream. Do something you enjoy every day. This could be a long soak in the tub or a shopping trip to look for baby items. If it makes you feel good it will help you relax. If you follow these simple guidelines you will probably not have any reason to become anxious or panicky. Remember that pregnancy is a normal process that women experience every day. You may have to learn a few techniques to help you get through those hormonal periods but when you look at the end result you will know that it is all worth it. In this article we have explored panic attacks during pregnancy. This information is but a tip of the iceberg when it comes to panic attacks during pregnancy. In my free eCourse - The mystery of the 7th Solution, I show you deep strategies that will eradicate your panic attacks and anxiety disorders fast! Ty Lamai is a Panic Attacks During Pregnancy expert. Visit http://www.analyze-more.com/panic-attack-info.html today for more great information on Panic Attacks During Pregnancy and get a FREE 10-day mini eCourse titled: The Mystery Of The 7th Solution! (Limited copies available.)

Panic attacks at night

Panic attacks when sleeping are probably the biggest mysteries when it comes to panic disorder symptoms. No one can actually pinpoint the exact cause of these disorders. For the longest time, it has been confused with nightmares, and specialists have thought that the anxiety syndromes are caused by vivid bad dreams. However, it has been found out more recently that these attacks at night don't occur during the REM phase when people actually dream. These nocturnal panic attacks actually occur in either in phase I or phase IV of sleep, so there might be a deeper reason for these attacks than mere bad dreams. More difficult to manage Compared to daytime panic attacks, nocturnal panic attacks are harder to manage simply because you can't consciously narrow down the thought that triggered the panic attack in the first place. When you experience a panic attack while you're awake, you're in a better position to regain control of your mind. When you're asleep, you have a lot less control than that, and before you know it, you wake up in a cold sweat with your heart racing, not remembering why you're so afraid in the first place. Possible causes Specialists believe that panic attacks at night are caused by the fear of having nightmares and not nightmares themselves. When you've convinced yourself that you're going to die in your sleep because of a nightmare before you even get to sleep, it's most likely that you'll program your mind to overreact to the littlest stimulation. Other causes, of course, include stress, poor eating habits, and lack of exercise. Specialists agree than people suffering from hormonal imbalances are most likely to experience nocturnal panic attacks compared to people who are healthier. Treatments If you're having trouble sleeping at night because you can't seem to stay calm, one of the best drinks to have is chamomile tea. It just eases your nerves, and it can also possibly lessen your chances of experiencing nocturnal panic attacks. If it bothers you too much, though, and it's occurring to often, you should see therapist about it. They can teach you cognitive exercises, or hypnotize you into sleeping better at night. Of course, the best way to treat this sleeping disorder is by living a healthier lifestyle. People who take in too much sugar and caffeine in their diets tend to suffer from panic attacks in general. You should cut down on coffee and soda and other unhealthy foods that can be causing the attacks.

Treatment

Panic disorder can be effective treated with a variety of panic attack treatments including psychological therapies, medication, and self-help techniques, with the evidence that cognitive behaviour therapy has the longest duration of effect, followed by specific selective serotonin reuptake inhibitors.

Dealing with panic attacks

Since panic is a condition that the mind and emotions control, it is quite essential to start treating the person from within. No medication can ultimately stop the panic attacks, only the will of the individual can put a halt on it and by utilizing natural and healthy choices. Here are some of the safest and natural ways to Deal with panic attacks: 1. A healthy diet can help ease and reduce the occurrence of panic attacks. If you are a person who loves caffeinated food and beverages, you should start avoiding them at the onset of panic attacks. Alcoholic drinks, coffee, tea and sodas can increase heart palpitations that can lead to panic attacks. Choose your food intake and make sure they do not induce or aggravate panic attacks. 2. In conjunction with a healthy diet, you should as well have a lifestyle change. If you can go healthy all the way, then do it. Having a healthy lifestyle keeps the heart healthy and the body and mind well balanced, which in turn helps reduce the risk of panic attacks. Living an active and healthy lifestyle can help you gain peace of mind by keeping you physically busy throughout the day on a regular basis. Take gym classes a few times a week or go outdoors for a walk or hike to remove tension. A healthy body leads to a healthy mind, and it is important that these two are well balanced and coordinated. 3. Smoking does not help. Some people might say that smoking helps them relieve stress, hence, relieves panic attacks. If you can avoid smoking, by all means, do so. There is no direct connection between smoking and relieving panic attacks. 4. Rest and re-charge after a day's work. Don't push yourself too much just because you need to work overtime or cram overnight for a thesis project. Whatever you do, always put enough time for sleep and rest. The human body needs sufficient rest and sleep to replenish the used up energy. If you lack all these, your body will collapse. Avoid stressing yourself too much and forget about all the pressures once you hit the sack.

Panic Attacks in Children

Did you know that like adults, there is panic disorder in children, too? Yes, there is. This simply goes to show that panic does not choose those it will attack. They can target any age and any gender. With this, it is always good to know a bit more about the panic attacks in children. The Causes Attacks happening in children are basically caused by almost the same things as those in adults. They can be caused by a situation, such as when they suffer from PTSD or Post-Traumatic Stress Disorder. The attacks can also be due to a condition such as depression. One cause in children that you should pay attention to is poisoning. Children, by nature, are inquisitive. No matter what their age is, they are naturally curious over a lot of things. Because of this, they are prone to accidents such as poisoning. There are a lot of toxic chemicals that can be found in your household that not only causes poisoning, but can also trigger panic attacks. These chemicals are most often the ones that cause problems such as difficulty in breathing. Once problems such as these are experienced by the child, panic understandably follows. As a result, an attack soon ensues. The Signs and Symptoms When panic attacks children, bear in mind that it carries with it the same signs and symptoms as those that affects adults. Manifestations such as trembling, shortness of breath, feeling dizzy, feeling faint, and faint are just some of the things that a child with can experience. In children with the disorder, bear in mind that age is a major issue. Why? For one thing, the younger the child, the more difficult it is for them to communicate what is happening to them. Children, especially the really young ones, find it hard to describe and explain fully what they are feeling. As a result, understanding and treating the problem as well as coming up with a diagnosis becomes difficult. Another factor that comes against age is that children are seldom known to have them. In fact, many people do not even know or not aware that even kids can have panic attacks. If the adults are not aware of it, so do the children. Because of this fact, many children get only home treatments, which, by the way, are mostly wrong modes of treatment. Why? Adults address the manifestations only not realizing that it is all because of fear. The best thing that any adult can do with the signs and symptoms in children is to recognize them. Recognize the attacks and take note of what is really causing it. This is a very critical part since you can never know if whether the signs and symptoms are due to an illness or because of fear. With this, the best thing that you can do is take the child to the hospital. In this way, you are taking him away from the source of his anxiety as well as have access to medical attention in case the child really is having an illness. When panic attacks children, always be cautious in approaching it. Get medical help just to be on the safe side.

Cognitive Behavioral Therapy

Cognitive behavioural treatments are considered the first line of treatment. The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are concerned that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. 'Cognitive restructuring' (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.

Medication

If drug therapy is used, the standard is to prescribe an antidepressant, particularly an SSRI (such as paroxetine, sertraline, fluvoxamine, escitalopram or fluoxetine), which after an initial titration period may be effective at reducing anxiety attacks and panic attacks. SNRIs such as Venlafaxine can also be prescribed, but may be addictive and may increase suicide ideation, but have less abuse potential than benzodiazepines. The benzodiazepine class of drugs includes diazepam, lorazepam, alprazolam, and clonazepam are less effective in the long term and are not recommended for the treatment of panic disorder. Benzodiazepines are best avoided to prevent the development of tolerance and physical dependence.

Paper bag rebreathing

Many panic attack sufferers as well as doctors recommend breathing into a paper bag as an effective short-term treatment of an acute panic attack. However, this treatment has been criticised by others as ineffective and possibly hazardous to the patient, even potentially worsening the panic attack. They say it can fatally lower oxygen levels in the blood stream, and increase carbon dioxide levels, which has been found to be a big cause of panic attacks.

It is therefore important to discover whether hyperventilation is truly involved in each case. If it is, then rebalancing the oxygen/CO2 levels in the blood and/or re-establishing an even, measured breathing pattern is an appropriate treatment which may be also achieved by extending the outbreath either by counting or even humming.

Other treatments

All persons experiencing persistent and frequent panic attacks should consult their physicians. However, many experienced sufferers treat panic attacks with some the following methods and techniques:

• Diaphragmatic breathing or abdominal breathing — Breathing slowly through the nose while using the diaphragm and abdomen. Do not breathe through the mouth. Focus on exhaling very slowly. This will correct or prevent an imbalance of oxygen to carbon dioxide in the blood stream.

• Staying in the present — rather than having "what if" thoughts that are future oriented asking yourself, "what is happening now" and "how do I wish to respond to it". (Carbonell, 2004)

• Acceptance and acknowledgement- accepting and acknowledging the panic attack. (Carbonell, 2004).

• Floating with the symptoms — allowing time to pass and floating with the symptoms rather than trying to make them better or fighting them. (Carbonell, 2004)
• Coping statements — repeated as part of an internal monologue

• "No one has ever died from an anxiety attack."
• "I will let my body do its thing. This will pass."
• ""I can be anxious and still deal with this situation."
• "This does not feel all that great, but I can deal with it".
• "I am frightened of being frightened, therefore if I stop worrying about being frightened, then I have nothing to be scared of."

Increased risk of heart attack and stroke

A recent study suggests that menopausal women with panic disorder and many occurrences of panic attacks have a threefold higher risk of suffering heart attack or stroke over the next five years. The researchers believe that panic attacks or more accurately their associated symptoms (chest pain, dyspnea) can be manifestations of undiagnosed cardiovascular disease, or result in heart damage due to cardiovascular stress in patients with panic disorder and many panic attacks over periods of years. However, the study did not find that isolated cases of panic attacks in patients without panic disorder or agoraphobia would lead to immediate heart damage, nor did it prove that the correlation between panic disorder and strokes was causal, or that it couldn't be attributed to the cardiovascular effects of panic attack medication that many panic disorder patients receive, such as SSRIs and benzodiazepines. For example one study albeit in the elderly found that the consumption of benzodiazepines combined with analgesics in elderly men is correlated with a greater chance of dying of ischaemic heart disease in a small study. The study doesn't say if this is to be blamed on the benzodiazepine drug in this case nitrazepam, the analgetics or their combination.

Limited symptom attack

Many people being treated for panic attacks begin to experience limited symptom attacks. These panic attacks are less comprehensive with fewer than 4 bodily symptoms being experienced.

References

Wikipedia

More info on panic attacks in children

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