What is panic disorder?
Criteria to diagnose panic disorder includes experiencing recurring, unexpected panic attacks, with one or more attacks followed by at least 1 month of fear of experiencing another panic attack, or exhibiting significant maladapted behavior related to the attacks.

What is a panic attack?
A sudden episode of intense fear that triggers an intense reaction when there is no real danger or apparent cause. The intense fear or discomfort can reach a peak within a minute, within 10 minutes. Panic attacks can be very frightening – you might feel like you’re losing control, having a heart attack, or even dying.

Many people who’ve experienced these types of attacks may go to the Emergency Room. When all cardiac or other medical causes are ruled out, the emergency room doctor will tell you “you’ve had a panic attack.”

Many people may have 1-2 panic attacks in their life and the problem goes away – perhaps when a stressful situation comes to an end. These attacks are more common than you think – did you know that ¼ of us will experience a panic attack in our lifetime? That is a lot of people. If you have recurrent, unexpected panic attacks and have spent long periods fearful of experiencing another panic attack, you may be suffering from a condition called a Panic Disorder.

While panic attacks themselves are not life threatening they can be very frightening and alarming – significantly affecting your quality of life. But treatments are very effective which we will discuss in a bit.

Panic attacks typically begin SUDDENLY – without warning. They can strike at any time. For example, you’re driving, or you’re sound asleep, or you’re in the middle of a business meeting and you didn’t even expect it.

You may have occasional panic attacks: maybe once a month, or maybe they occur frequently, 1 every other day.

Panic attacks have many variations but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack. It is very tiresome to have these.

Symptoms of a Panic Attack
There are many symptoms through which a panic attack manifests itself and can be divided into these categories:

Feelings & Thoughts
– Sense of impending doom or danger
– Fear of loss of control
– Fear of death
– Feeling of detachment from reality, as if you are not real or where you are is not real

Symptoms in Chest Area
– Shortness of breath
– Rapid pounding heart rate
– Tightness in your throat
– Chest pain / discomfort in the chest

Symptoms in Bodily Area
– Sweating
– Trembling
– Shaking
– Hot flashes
– Tingling sensations
– Nausea
– Abdominal cramping
– Headaches
– Dizziness / feeling lightheaded
– Feeling faint

It is a horrible feeling to have so many of these symptoms all at once. One of the worst things about panic attacks is the intense fear that you may have another one. You fear having panic attacks so much that you avoid certain situations in which you think they may occur.

What are some CAUSES of Panic Disorder?
Medically, it is not really known what exactly causes panic attacks or panic disorder. Some factors may play a role such as genetics, major stress, a temperament more sensitive to stress, or prone to negative emotions, and certain changes in the way parts of your brain functions.

Panic attacks may come on suddenly without warning at first but overtime, they are usually triggered by certain situations. Some research suggests that your body’s natural flight or fight responses are involved in panic attacks.

For example, if a grizzly bear were to come after you, your body would react instinctively – your heart rate would speed up as your body prepares for a life- threatening situation. Many of the same reactions occur in a panic attack, but there is no known or obviously dangerous situation that triggers this apparently- random panic attack.

What are some risk factors for Panic Disorder?

Symptoms of a Panic Disorder often start in the late teens or early adulthood and affect more women than men, however children can have Panic Disorder as well. They are less common in children, and many times they will not be able to express what their fears are. Symptoms of children may be excessive screaming, excessive agitation, or excessive disobedience and defiant behaviors.

The factors that may increase a risk of panic attack or panic disorders include:
– Family history of panic attacks or a panic disorder
– Major life-related stressors such as divorce or addition of a baby, or any big changes
– A traumatic event such as physical or sexual assault or a serious accident
– Death of a loved one
– Smoking
– Excessive caffeine intake
– History of childhood physical or sexual abuse, or severe neglect – perhaps memory of those traumas have faded but the body can remember and will induce a panic attack if it feels as though it is in danger

What are the potential complications of Panic Disorder?
Left untreated, panic attacks and panic disorder can affect almost every area of your life. You may be so afraid of having more panic attacks, you live in constant fear and thus ruin your quality of life.

Complications of panic disorder, or linked to the development of panic disorder include:
– Development of specific phobias, such as fear of driving or leaving your home.
– Frequent medical care for health problems and medical conditions – this is very common because there are so many bodily symptoms that occur during a panic attack and may cause someone to go to the ER – only to find out nothing is wrong on a medical level.
– Avoidance of agoraphobia or social situations and social isolation due to a fear of having a panic attack in public or amongst your loved ones. You may avoid important occasions because of this fear and become increasingly isolated.
– Development of secondary depression or other anxiety disorders
– Increased risk of suicide and suicidal thoughts. Many people think suicide risk increases only with major depression. This is not so. Untreated anxiety and panic disorder can increase suicide risk.
– Alcohol and substance abuse as patients try to ‘self-medicate’ or find coping mechanisms.

When should someone seek help?
If you have panic attack symptoms, please seek help as soon as possible. Remember, panic attacks are intensely uncomfortable, they are not dangerous. But panic attacks are hard to manage on your own and may get worse without treatment.

1 out of 4 of us may get 1 panic attack in our lifetime but if a second one happens, then a third one happens, and they’re coming more frequently – please seek help!

Panic attack symptoms can also resemble other serious health problems such as a heart attack, so it is important to get evaluated by a primary care physician if you are not sure what is causing these symptoms. However since there are no underlying physical / medical causes to these panic attacks, it is important to see a mental health professional to get the help that you need.

Treatment recommendations provided for a Panic Disorder diagnosis:
– Psychotherapy such as Cognitive Behavioral Therapy
– Medication management can be recommended

But I want to emphasize that psychotherapy is the initial treatment of choice! If you go to a psychiatrist first and if you were to receive a medication prescription, I would say this will definitely need to include psychotherapy as well. Medication may help decrease frequency and intensity of panic attacks, but psychotherapy will help you discover and understand where those underlying triggers come from. Medications cannot help you alone. They may help correct chemical imbalances in the brain for intense feelings of anxiety, but your brain has implicit
memories that need to be worked through during psychotherapy.

What are your thought patterns, what are your core beliefs that may not be correct and thus triggering these panic attacks? Thus, if medication is recommended, I always recommend a combination of both medication and psychotherapy. I want to emphasize that psychotherapy is the KEY FIRST STEP for panic disorder!

Trusting in God while combating Panic Disorder
This is much easier said than done, especially since during panic attacks, you feel like your brain is running a mile a minute and you do not have control of your body or you feel like you are going to die.

You absolutely need to see a therapist to find the root cause of what triggers these panic attacks, however we also must remember that panic disorder is one of the many manifestations of how Satan wants us to be separate, and remain separate from God.

From the moment Adam & Eve took a bite of the forbidden fruit in the Garden of Eden, spiritual, physical, mental, and generational curses began to plague humanity to deceive us and to keep us separate from God.

Panic attacks and panic disorder are tools of Satan to keep us miserable, fearful, and mistrustful towards God – or even worse, forget the presence of God. When we forget the presence of God, we forget that He loves us who are his children. We have to remember that even though we are suffering now, He has a plan for us and He will give us refuge:

Psalm 91: 1-6
Whoever dwells in the shelter of the Most High will rest in the shadow of the Almighty. I will say of the Lord, “He is my refuge and my fortress, my God, in whom I trust.” Surely he will save you from the fowler’s snare and from the deadly pestilence. He will cover you with his feathers, and under his wings you will find refuge; his faithfulness will be your shield and rampart. You will not fear the terror of the night, nor the arrow that flies by day, nor the pestilence that stalks in the darkness, nor the plague that destroys at midday.”

We hope that you can walk away from this with some hope that you are loved and there is a plan for you.

We are licensed psychiatrists, nurse practitioners and psychotherapists that believe in integrating the Gospel message into mental health treatment and counseling, as well as reducing the stigma and prevalence of mental health disorders. Contact us now to learn more about treatments, or just to receive a brief consultation about the need for treatment.

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