Once an individual has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the avoidance and level of nervousness about the possibility of having another attack may reach the point at which the mere idea of engaging in the activities that preceded the first panic attack triggers future panic attacks, resulting in the person with panic disorder potentially being unable to drive or even step out of the house (agoraphobia). Thus, there are two types of panic disorder, panic disorder with or without agoraphobia. Like other mental health conditions, panic disorder can have a serious impact on a person's daily life unless the individual receives effective treatment.
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including anxiety disorders. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, new psychotherapies, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe.
Anxiety disorders reflect disorders that share a general feature of excessive fear (i.e. emotional response to perceived or real threat) and/or anxiety (i.e. anticipation of future threat) and demonstrate behavioral and functional disturbances as a result. Panic attacks are a feature that can occur in the context of many anxiety disorders and reflect a type of fear response.
At least 6 million Americans suffer from panic attacks and panic disorder both conditions classified as anxiety disorders. According to the Anxiety and Depression Association of America (ADAA), about 2-3% of Americans experience panic disorder in a given year and it is twice as common in women as in men. Panic disorder typically affects individuals when they’re in their 20s but is also seen in young children, adolescents, and older adults.
Shortness of breath and chest pain are the predominant symptoms. People experiencing a panic attack may incorrectly attribute them to a heart attack and thus seek treatment in an emergency room. Because chest pain and shortness of breath are hallmark symptoms of cardiovascular illnesses, including unstable angina and myocardial infarction (heart attack), a diagnosis of exclusion (ruling out other conditions) must be performed before diagnosing a panic attack. It is especially important to do this for people whose mental health and heart health statuses are unknown. This can be done using an electrocardiogram and mental health assessments.

People who have panic attacks typically spend a lot of time worrying about having more attacks and often make seemingly unreasonable lifestyle changes in an attempt to avoid circumstances that will trigger future attacks. They may avoid situations that, they feel, have precipitated previous episodes or environments where they would not be able to escape easily if another attack should occur.

I almost had a breakdown yesterday, I got mad at my sister. She told me we’d hang out then later she bailed me. I was so mad I poured all her body lotion in the sink, I was looking for her Victoria’s Secret perfume so I could break it into pieces but couldn’t find it. (Yes, I think I have anger issues too, might need anger management). I was already frustrated with my new job. I am slightly a perfectionist and I’m having a hard time with work I’m not too familiar with. I almost broke down or did broke down but hid it very well. My heart can’t stop pounding the whole day, whole night. I went to sleep since I was so tired but I woke up in the middle of the night with my heart beating so loud and fast. Until in the morning I can’t control it. I have a feeling I need to visit my psychiatrist again. I miss talking to her though. But the medications are so expensive it makes me depress more.

Panic disorder is characterized by uncontrollable, recurrent episodes of panic and fear that peak within minutes. Panic attacks are accompanied by physical manifestations, such as heart palpitations, sweating, and dizziness as well as the fear of dying or becoming insane. Worry about having an attack may lead to additional anxiety and avoidance behaviors or to other problems in functioning.

Had my first panic attack today and wanted to be sure about what I was experiencing. I sat there crying hysterically, hyperventilating, chest shaking, my hands went very numb. Took me about 10 minutes to get sort of calm, sat in the shower for about half an hour afterwards to fully calm myself down. Every time I tried to focus on my breathing and taking longer breaths I would start hyperventilating again. Felt like I was choking, awful awful experience.

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.[18] However, panic attacks experienced by those with panic disorder may also be linked to or heightened by certain places or situations, making daily life difficult.[19]
A form of psychotherapy called cognitive behavioural therapy (CBT) has been found by several studies to be the most effective treatment for panic attacks and panic disorder. During CBT, you will work with a therapist on relaxation training, restructuring your thoughts and behaviors, mindfulness, exposure treatment, and stress reduction. Many people that suffer from panic attacks start to notice a reduction within weeks, and symptoms often decrease significantly or go away completely within several months.
CBT is a short-term treatment designed to help patients identify inaccurate and negative thinking in situations that cause anxiety like panic attacks. CBT can be used in one-on-one therapy or in a group therapy session with people facing similar problems. CBT primarily focuses on the ongoing problems in a patient's life and helps them develop new ways of processing their feelings, thoughts and behaviors to develop more effective ways of coping with their life. In patients who suffer from PTSD, CBT can take on a trauma-focused approach, where the goal is to process and reframe the traumatic experience that lead to the symptoms. On average, the length of treatment is around 10-15 weekly one-hour sessions depending on the type and severity of symptoms.
Some people have only one or two attacks and are never bothered again. Panic attacks can occur with other psychiatric disorders. In panic disorders, however, the panic attacks return repeatedly and the person develops an intense fear of having another attack. Without help, this "fear of fear" can make people avoid certain situations and can interfere with their lives even when they are not having a panic attack. Therefore, it is very important to recognize the problem and get help.

Obsessive-compulsive and related disorders are characterized by obsessive, intrusive thoughts (e.g. constantly worrying about staying clean, or about one's body size) that trigger related, compulsive behaviors (e.g. repeated hand-washing, or excessive exercise). These behaviors are performed to alleviate the anxiety associated with the obsessive thoughts. These types of disorders can restrict participation in everyday life and/or generate significant distress, for instance, by making it difficult to leave the house without many repetitions of a compulsive behavior (e.g. checking that the doors are locked). Periodically experiencing worry or having a few "idiosyncratic" habits does not constitute an obsessive-compulsive or related disorder. Instead, these disorders are characterized by unusually high levels of worry and related compulsive behaviors, in comparison with a typical range of individuals.
It's important to note that everyone feels anxiety to some degree regularly throughout their life - fear and anxiety are adaptive and helpful emotions that can function to help us notice danger or threat, keep us safe, and help us adapt to the environment. Anxiety disorders represent states when fear or anxiety becomes severe or extreme, to the extent that it causes an individual significant distress, or impairs their ability to function in important facets of life such as work, school, or relationships. It is also important that risk factors don't at all imply that anxiety is anyone's fault; anxiety disorders are a very common difficulty that people experience. In this section, we will review risk factors for anxiety disorders. There are many potential risk factors for anxiety disorders, and most people likely experience multiple different combinations of risk factors, such as neurobiological factors, genetic markers, environmental factors, and life experiences. However, we do not yet fully understand what causes some people to have anxiety disorders.

Social Anxiety Disorder;Fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating, often times leading to avoidance of social situations and severe distress when participation in social situations can't be avoided. [2]

Acupuncture is a treatment derived from traditional Chinese medicine. It consists of inserting very thin needles into the body in targeted areas. To date there is very little evidence that acupuncture can significantly treat generalized anxiety, although there are currently ongoing research trials for PTSD. One study did find that acupuncture can reduce pre-operative anxiety.

Panic attacks and panic disorder are not the same thing. Panic disorder involves recurrent panic attacks along with constant fears about having future attacks and, often, avoiding situations that may trigger or remind someone of previous attacks. Not all panic attacks are caused by panic disorder; other conditions may trigger a panic attack. They might include:
For me it’s knowing or believing I don’t have enough time to finish an assignment, and then I feel like a failure. Right now, I’m doing the most difficult assignment of my life, and if I don’t finish it on time, my graduation will be delayed. This is on top of all my other responsibilities. And to think that I’m supposed to have an accommodation for extra time. Ha! The university and the state don’t care. They just want me to fail so I have to dish out more money to line the pockets of the corporation that assigned this required project.
In people with anxiety disorders, the brain circuitry that controls the threat response goes awry. At the heart of the circuit is the amygdala, a structure that flags incoming signals as worrisome and communicates with other parts of the brain to put the body on alert for danger. Early life events, especially traumatic ones, can program the circuitry so that it is oversensitive and sends out alarms too frequently and with only minor provocations. Survival mandates a system for perceiving threats and taking quick, automatic action, but those with anxiety see threats where there are none, perhaps because emotional memories color their perceptions.

Once someone has had a panic attack, he or she may develop irrational fears, called phobias, about the situations they are in during the attacks and begin to avoid them. That, in turn, may reach the point where the mere idea of doing things that preceded the first panic attack triggers terror or dread of future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. If this occurs, the person is considered to have panic disorder with agoraphobia.

A variety of medical and mental health professionals are qualified to assess and treat panic disorders. From purely medical professionals like primary care doctors, emergency room physicians to practitioners with mental health training like psychiatrists, psychologists, and social workers, a variety of health care providers may be involved in the care of panic disorder sufferers. Some practitioners will administer a self-test of screening questions to people whom they suspect may be suffering from panic disorder. In addition to looking for symptoms of repeated panic attacks using what is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), asking detailed questions about the sufferer's history and conducting a mental-status examination, mental health professionals will explore the possibility that the individual's symptoms are caused by another emotional illness instead of or in addition to the diagnosis of panic disorder. For example, people with an addiction often experience panic attacks, but those symptom characteristics generally only occur when the person is either intoxicated or withdrawing from the substance. Someone who has post-traumatic stress disorder (PTSD) may have panic attacks when reminded of trauma they experienced and in a person with obsessive-compulsive disorder, panic attacks may be triggered by their being unable to perform a compulsive behavior. The practitioner will also likely ensure that a physical examination and any other appropriate medical tests have been done recently to explore whether there is any medical problem that could be contributing to the occurrence of panic attacks. That is particularly important since many medical conditions may have panic attacks as a symptom and therefore require that the underlying medical condition be treated in order to alleviate the associated anxiety. Examples of that include the need for treatment with antibiotics for infections like Lyme disease or vitamin supplements to address certain forms of anemia.
The psychotherapy component of treatment for panic disorder is at least as important as medication. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in the long-term management of panic attacks. In overcoming anxiety, cognitive behavioral therapy is widely accepted as an effective form of psychotherapy treatment, for both adults and children. This form of psychotherapy seeks to help those with panic disorder identify and decrease the irrational thoughts and behaviors that reinforce panic symptoms and can be done either individually, in group therapy, in partner-assisted therapy, and even over the Internet. Behavioral techniques that are often used to decrease anxiety include relaxation techniques (like breathing techniques or guided imagery) and gradually increasing exposure to situations that may have previously triggered anxiety in the panic disorder sufferer. Helping the person with anxiety understand how to handle the emotional forces that may have contributed to developing symptoms (panic-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or how to calm down in order to decrease or stop a panic attack once it starts.

"The fight-or-flight system is hardwired for us humans to manage dangerous situations, and those of us with anxiety have an activated fight-or-flight response when the trigger is not really dangerous," says Beth Salcedo, MD, the medical director of The Ross Center for Anxiety & Related Disorders and board president of the Anxiety and Depression Association of America.
Panic disorder is a diagnosis given to people who experience recurrent unexpected panic attacks— that is, the attack appears to occur from out of the blue. The term recurrent refers to the fact that the individual has had more than one unexpected panic attack. In contrast, expected panic attacks occur when there is an obvious cue or trigger, such as a specific phobia or generalized anxiety disorder. In the U.S., roughly 50% of people with panic disorder experience both unexpected and expected panic attacks.
It is not unusual to experience only one or two symptoms at a time, such as vibrations in their legs, shortness of breath, or an intense wave of heat traveling up their bodies, which is not similar to hot flashes due to estrogen shortage. Some symptoms, such as vibrations in the legs, are sufficiently different from any normal sensation that they clearly indicate panic disorder. Other symptoms on the list can occur in people who may or may not have panic disorder. Panic disorder does not require four or more symptoms to all be present at the same time. Causeless panic and racing heartbeat are sufficient to indicate a panic attack.[9]
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used for diagnosis of mental health disorders, and is widely used by health care professionals around the world. For each disorder, the DSM has a description of symptoms and other criteria to diagnose the disorder. The DSM is important, because it allows different clinicians and/or researchers to use the same language when discussing mental health disorders. The first DSM was published in 1952 and has been updated several times after new research and knowledge became available. In 2013, the most recent version of the DSM, the DSM-5, was released. There are a few important differences with its predecessor DSM-IV regarding anxiety disorders. First, Obsessive Compulsive Disorder (OCD) is not part of the anxiety disorders any more, but now has its own category: Obsessive-Compulsive, Stereotypic and related disorders. Second, Post-Traumatic Stress Disorder (PTSD) now also has its own category: Trauma and Stressor-related Disorders.

Antidepressants are medications used to treat symptoms of depression but can also used to treat anxiety symptoms as well. In particular, selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the primary class of antidepressant used to treat anxiety. SSRIs commonly used to treat anxiety are escitalopram (Lexapro) and paroxetine (Paxil, Pexeva). SNRI medications used to treat anxiety include duloxetine (Cymbalta), venlafaxine (Effexor XR).
Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.
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