Panic disorder is an anxiety disorder that affects about 3.5% of the population. People with panic disorder experience unexpected and repeated panic attacks. They become terrified that they may have more attacks and fear that something bad will happen because of the panic attack (such as going crazy, losing control, or dying).
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Recognizing Panic Disorder with or without Agoraphobia - Do I Have It?
Charlie is a 44-year-old married man with three teenaged sons. He has been on leave from his job as a bank teller for the past 5 months. He had his first panic attack while smoking marijuana for the first and only time in his 20s. At that time, he experienced rapid pounding heart, difficulty breathing, feelings of unreality, and tingling in his fingers. He was terrified and thought that he was dying of a heart attack. He went immediately to the emergency room at the local hospital. Since that time, he has had approximately one panic attack a week, and he often worries about having more panic attacks. Charlie says that he is afraid his panic symptoms mean that he has a heart condition and will die of a heart attack, even though his doctor ruled out any medical problems.
Over the years, Charlie's life has been severely affected by his panic attacks, and he worries about triggering another attack. Charlie had a particularly intense panic attack during a staff meeting that led him to leave work in the middle of the day. Since that time, he has been unable to return to work because he is afraid of having another severe panic attack. He has also quit hiking and jogging, even though he has always enjoyed these activities. He worries that if he is physically active his heart will beat too fast and he will have a panic attack and die. He also avoids drinking coffee, going to movie theatres, or being home alone. More and more, he finds that he needs his wife or brother to accompany him places, since he is afraid he will be unable to get medical assistance if he has another attack. Lately, he has been feeling very depressed about not being able to work. His doctor has prescribed him some anti-anxiety medication, and Charlie only feels safe if he carries it with him at all times.
Sharon is a 38-year-old single mother of two daughters who works as a fitness instructor at a local gym. She had her first panic attack in her teens while watching a horror movie with friends at a local movie theatre. Since that time, she has experienced one to two panic attacks every year. She says that her panic attacks seem to come "out of the blue" in a variety of situations (for example, while waiting in line at the bank, at a shopping mall, or walking alone in the park). However, most of the time she does not have panic attacks in any of these situations. For example, she has been to the movie theatre to watch scary movies many times without any panic attacks.
Sharon had a four-year period during her 20s when she was panic free. The panic attacks started coming back suddenly when she was 29, while eating a spicy meal in a restaurant. She says that when she has a panic attack, she experiences a racing heart, tightness in her chest, dizziness, choking sensations, and dry mouth. She also feels like she may lose control of her bowels. Her main fear is that she is having a stroke, although medical problems have been ruled out. She says that she has a reason to be afraid of dying when she has a panic attack, since stroke and heart disease run in her family.
Recently, Sharon has also wondered whether the panic attacks mean she is losing her mind. She does not avoid doing things that might cause a panic attack, and there has not been a huge negative impact in her life; she is still able to work, take care of her family, and socialize with her friends. However, she is constantly worried about having another attack, even though it has been months since her last panic episode. She says that her worries about having another panic attack in the future are exhausting her, and that she is sick and tired of feeling "on guard" all the time.
What are Panic Attacks?
A panic attack is a sudden rush of intense fear or discomfort, which includes at least four of the following symptoms:
- racing or pounding heart
- shaking or trembling
- shortness of breath or feelings of being smothered
- feeling of choking
- chest pain or discomfort
- chills or hot flashes
- nausea or upset stomach
- dizziness or lightheadedness
- a sense of things being unreal or feeling detached from oneself
- numbness or tingling sensations
- fear of losing control or "going crazy"
- fear of dying
Panic attacks tend to start quickly and reach a peak within 10 minutes. The peak generally lasts for about 5 to 10 minutes before the symptoms start to settle. However, it can take quite some time for all the symptoms to subside.
What is the difference between Panic Attacks and Panic Disorder?
- Panic attacks are fairly common and having one does not mean that you have panic disorder. For example, if you are feeling very stressed or overtired, or if you have been doing excessive exercise, you might have a panic attack. This does not mean that you have panic disorder.
- Panic attacks only become a problem if you are worried about having more attacks, or if you are afraid that something bad will happen because of a panic attack. For example, people worry that they will faint, embarrass themselves, have a heart attack, go crazy, or die.
- Also, it is common for people with other anxiety disorders to have panic attacks, and this is not panic disorder. For example, people with a phobia of dogs might have a panic attack whenever they are near a dog. But in this case, the panic attack is expected, and the person is afraid of the dog, not the panic attack. In panic disorder, the panic attacks are unexpected and unpredictable.
TIP: Symptoms of anxiety and panic can be the result of a medical problem (e.g., thyroid disorder). Therefore, it is important to have a medical check-up to rule out any medical conditions.
What is Agoraphobia?
Many adults with panic disorder also have agoraphobia.
Agoraphobia involves fear and avoidance of situations or places where escape might be difficult, or where help might not be available if you have a panic attack. It is very common for people with panic disorder to become fearful of entering situations where they might have had a panic attack before, or where they think they might have a panic attack in the future. The types of situations that people often avoid include:
- Being alone
- Being away from home (e.g. being far away from your house, traveling out of town, etc.)
- Public or crowded places (e.g. restaurants, malls, theatres, line-ups, etc.)
- Enclosed places (e.g. elevators, tunnels, buses, planes, etc.)
- Driving (riding as a passenger, driving over bridges, driving on the highway, driving in traffic, etc.)
- Open spaces (e.g. fields, parks, etc.)
Once people start avoiding certain situations, they often find themselves avoiding more and more situations until they are avoiding almost everything. Some people with agoraphobia are able to enter these situations, but do so with extreme dread and discomfort.
NOTE: Not everyone who has panic disorder has agoraphobia. Some people are afraid of panic attacks and worry that something horrible will happen as a result of a panic attack, but they do not avoid specific situations or places. Therefore, people can either have panic disorder with or without agoraphobia.
There are some people with agoraphobia who do not have panic disorder. Individuals who have agoraphobia without panic disorder tend to fear having incapacitating or embarrassing panic-like sensations (e.g., loss of bowel control, feeling dizzy, or falling over). However, they don't have a history of experiencing unexpected and repeated panic attacks.
What other Behaviours are Related to Panic Disorder?
Adults with panic disorder will often change their behaviour to feel safer and prevent future panic attacks. Examples include:
- Carrying items such as medication, water, or a cell phone
- Having a companion (e.g. a family member or friend) accompany them places
- Avoiding physical activities (e.g. exercising, sex) that might trigger panic-like feelings
- Avoiding certain foods (e.g. spicy dishes) or beverages (e.g. caffeine, alcohol) because they might trigger panic-like symptoms
- Sitting near exits or bathrooms
- Panic attacks are quite common. In fact, one out of every three adults will experience a panic attack in any given year.
- The average age of onset of panic disorder is 25 years. However, it can develop at any age.
- Women are more likely to have panic disorder than men.
- Individuals with a family history of anxiety or depression are at greater risk for developing panic disorder.
- Between 50-60% of individuals with Panic Disorder also suffer from depression
Panic Disorder:The Facts!
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