Panic Disorder
PANIC DISORDER
What is a Panic Attack?
A panic attack is an intense episode of fear that occurs suddenly and spontaneously, without a real danger or any apparent cause, and is accompanied by severe physical symptoms.
Symptoms such as sudden palpitations, trembling, sweating, chest pain, a feeling of tightness in the chest, shortness of breath, a sensation of choking, dizziness, increased blood pressure, numbness or tingling, chills, hot flashes, abdominal pain, nausea, and frequent urination may occur. These physical symptoms may be accompanied by a fear of death, thoughts of dying, fear of going crazy or losing control, and feelings of detachment from one’s body or surroundings.
At its core, a panic attack involves misinterpreting harmless bodily sensations—such as palpitations or sweating—as signs of an impending catastrophe (e.g., a heart attack or brain hemorrhage). In other words, the mind triggers a false alarm. Symptoms usually intensify within about 10 minutes and subside on their own after 20–30 minutes, though rarely they may last up to an hour. Panic attacks can even occur during sleep and wake a person up; experiencing panic attacks during sleep is a significant indicator for diagnosis.
Because the terms “panic” and “attack” are strong and expressive, many people use them loosely to describe distress. As a result, individuals who feel anxious, worried, or startled may say “I have panic attacks,” leading to the misconception that panic disorder is more common than it actually is.
Difference Between Panic Attack and Panic Disorder
Many people (about 10%) may experience one or two panic attacks in their lifetime due to various reasons (such as intense exercise, earthquakes, certain medications, stimulants, cardiac arrhythmias, or excessive caffeine intake). This does not necessarily require treatment. However, if panic attacks occur without a clear cause, recur frequently, create persistent fear of having another attack for at least one month, and lead to avoidance of activities, this condition is called “panic disorder.” Panic disorder is a medical diagnosis and should be treated by a psychiatrist.
Prevalence:
The likelihood of experiencing at least one panic attack in a lifetime: 10%
Prevalence of panic disorder in the general population: 2–3%
It is twice as common in women as in men.
It is also twice as common among people living in urban, high-stress environments compared to those in rural areas.
The typical age of onset is between 25–45 years.
Frequency of Attacks:
Some individuals may experience 1–2 attacks per month, while others may have 3–5 attacks per day.
Anticipatory Anxiety:
Panic attacks are sudden and unpredictable episodes of intense fear. After an attack subsides, the most significant concern becomes the fear of having another one. This persistent fear is called “anticipatory anxiety.”
A person with anticipatory anxiety constantly monitors their body, searching for signs that an attack might occur. Their mind becomes preoccupied with bodily and environmental cues—they check their breathing, listen to their heartbeat, monitor their pulse, and scan for signs of dizziness.
Causes of Panic Attacks:
- Although attacks appear spontaneously, individuals often experience psychological stress weeks or months beforehand, such as loss of a loved one, separation, financial crisis, work-related problems, family conflict, humiliation, or emotional distress.
- Genetic factors also play a role. If there is a high sensitivity to anxiety in the family, environmental triggers may more easily lead to panic attacks.
- Imbalances in certain neurotransmitters in the brain may contribute to panic attacks. These imbalances can be treated with medication.
- Caffeine, alcohol, and substance use.
- Rapid and shallow breathing.
How Panic Disorder Affects Life:
Panic disorder can turn life into a kind of “open prison.” Individuals begin to avoid places or situations where they experienced their first panic attack. For example, if the first attack occurred while driving, they may avoid driving altogether. They may feel unable to go anywhere alone and may always want someone with them in case they need help.
They avoid places where they think they might not receive help or might not be able to escape easily if an attack occurs. This is called agoraphobia and is seen in about 10% of individuals with panic disorder. They may avoid elevators, public transportation, or cinemas, or prefer sitting near exits.
They may withdraw from social environments and stop exercising to avoid triggering an attack. They become familiar with nearby healthcare facilities and choose locations accordingly. Self-medication or alcohol misuse may develop, and there may be misuse of addictive prescription medications. Work and academic performance may decline.
Should Someone Having a Panic Attack Go to the Emergency Room?
A panic attack can be extremely frightening and overwhelming. Individuals may think they are having a heart attack because the symptoms are similar. Therefore, many people go to the emergency room. Since panic attacks can mimic many medical conditions, tests are often necessary to rule out physical illnesses. In the emergency department, evaluations such as ECG, blood tests, and other examinations are performed. If no physical illness is found, the patient may be given a calming injection and referred to a psychiatrist. Similarly, patients who consult a cardiologist and receive normal results are often referred to psychiatry.
Once a person is diagnosed with panic disorder by a psychiatrist, it is not necessary to go to the emergency room for every panic attack. This is because panic attacks are self-limiting, typically lasting 10–30 minutes and resolving on their own.
How is Panic Disorder Treated?
- During an attack, regulating breathing is essential. Instead of rapid, shallow breathing, slow and deep diaphragmatic breathing should be practiced. This is often taught in therapy sessions.
- The person should remain calm and remind themselves that the attack is not harmful and will pass soon.
- Attention should be redirected away from bodily sensations. When thoughts like “Is my heart racing?” arise, mental exercises such as naming objects and colors in the room can help shift focus.
- Antidepressants and anti-anxiety medications may be prescribed to correct neurotransmitter imbalances. These are not addictive and should be used regularly for 12–18 months under psychiatric supervision for lasting results.
- Cognitive Behavioral Therapy (CBT) is applied by psychiatrists to restructure distorted thoughts and replace them with more functional ones.
- Regular sleep is essential.
- Avoid alcohol, smoking, and caffeine, as they can worsen overall health and trigger attacks.
Can Panic Disorder Be Cured?
With regular treatment, it can be fully managed and resolved. However, there is always a possibility of recurrence.
Psychiatrist Dr. Arzu Dalmış