AAMFT Consumer Update
Panic
Disorder
Case example: Michael was driving home from work one day and was caught in traffic.
He suddenly noticed that his heart was beginning to race. He then felt
short of breath, and tightness in his chest. When he began to sweat,
he became concerned and drove to the nearest emergency room where they
could find nothing physically wrong with him. Michael had just experienced
his first panic attack. Over the next few weeks, the attacks became
worse, and he started to avoid driving altogether.
Panic
disorder is a type of anxiety disorder in which the key symptom is the
experience of unexpected panic attacks. These panic attacks consist of
physical and/or cognitive symptoms such as racing heart, dizziness, blurred
vision, fear of death, trembling, sweating, and shortness of breath.
As shown in the above example, the experience of panic attacks may lead
to the development of avoidance behavior, known as agoraphobia. In Michael's
case, he started to avoid driving out of concern that he might have another
panic attack, so his agoraphobia was limited to driving. However, it
is common for avoidance behavior to occur in multiple situations. Those
with panic disorder with agoraphobia may stop or reduce activities such
as drinking coffee, sexual encounters, or taking hot showers in an effort
to control the sensations that are associated with panic attacks.
Panic disorder with agoraphobia
is the most common of the panic-related disorders, although individuals
may also report panic disorder without agoraphobia (panic attacks without
avoidance behavior) or agoraphobia without a history of panic (avoidance
behavior related to one or two sensations of panic, but has never had
an actual attack).
The Impact of Panic Disorder on Individuals
and Families
The experience of panic can
range from mild (where the person will have limited interference in their
daily routine) to extremely severe (possibly resulting in being partially
or completely housebound). The experience of panic for most panic sufferers
is frightening and the avoidance can greatly alter one’s lifestyle (e.g.,
inability to drive to work). As a change in their lifestyle becomes apparent,
there is also a change in their personal relationships. Others around
the person must take on more of the day-to-day routine and responsibilities
(e.g., going to grocery stores or taking the kids to school). This may
cause those around the panic sufferer to feel more stress from their
increased duties. The additional stress experienced by the family can
cause resentment and anger towards the person and then worsen the panic
symptoms. At the same time, she or he may begin to show signs of depression
as a result of their changed family role. The negativity that comes with
depression may then lead the person to believe that they don't have the
capability to improve their condition, and consequently increase their
dependency, depression, and panic symptoms. If left untreated, this disorder
can be consuming.
Knowing
When to Seek Help
In
general, a person should consider seeking help when the anxiety occurs
too frequently, intensely, or is becoming disruptive in daily functioning
(e.g., going to fewer parties or social gatherings, going out to stores
or movies less than usual). A good rule to follow is to be conservative
and consider seeking help from a mental health professional when you
notice the following:
- Frequently occurring panic attacks. If you have noticed
that the attacks are increasing in either frequency or intensity, it
may be a sign that they are becoming more difficult to control. At
these times, it is advisable to seek help before the attacks begin
to greatly interfere in your life.
- The appearance of avoidance behavior. If you notice a decrease
in the amount of time you spend in activities you have typically done
in the past, you may want to consider seeking help, especially if the
reason for the decrease is related to experiencing panic attacks. The
same can be said for activities that may bring on some of the sensations
of panic (e.g., coffee). If you are changing your behavior to reduce
the number of activities that are associated with panic symptoms, you
may be letting the fear of the sensations control your behavior at
a subtle level, and should consider seeking help from a qualified mental
health professional.
- Dependency. If you notice that you are becoming more dependent
on others to accomplish tasks that you would normally do because of
the possibility of experiencing a panic attack, you may want to seek
help. While this behavior is functional in the short-run, in the long-run
dependency may intensify your anxious symptoms.
- Use of safety-signals. Safety-signals are objects or people that you
feel comfortable with and signal that you are less likely to experience
a panic attack. As such, it is common for individuals with panic to
seek safe objects or people. If you notice that you want others (e.g.,
spouse or partner) to accompany you more during usual activities, then
you may want to seek help.
What Treatments
are Available?
Treatment
for panic disorder with agoraphobia usually involves psychotherapy, medication,
or a combination of the two. A qualified family therapist can work with
you to determine which treatment will work best for your circumstances.
Psychotherapy usually involves some form of behavior therapy. This basic
approach consists of in-vivo exposure, which involves repeatedly entering
the feared situations, gradually over time. The exposures can be conducted
with or without the direct assistance of the therapist. A variation of
this approach (cognitive behavioral therapy) involves conducting behavior
therapy exposures in combination with helping you manage the troublesome
thoughts that often accompany periods of intense anxiety. Cognitive behavioral
therapy is a comprehensive treatment designed to influence the negative
thinking (e.g., “I might die”) that is common with panic disorder. It
provides accurate information regarding the nature of panic and teaches
specific techniques that allow the patient to correct the catastrophic
thoughts that contribute to panic attacks. In this treatment, the patient
is also taught to utilize breathing techniques to alleviate some of the
physical sensations. This type of therapy has been shown to greatly reduce
the return of panic symptoms in the future. Either of these treatments
can be conducted individually, or in a couples or group format.
Anti-panic
medications may be recommended, including benzodiazepines such as alprazolam,
clonazepam, and lorazepam. These medications work well and are generally
considered safe, quick acting, and have fewer side effects than other
types of medications. While both medications and psychotherapy are effective,
some patients have a preference for one type versus another.
Panic can be very distressing,
but the good news is that it is treatable, and the treatments outlined
here are very successful. The suffering does not have to last for an
extended period of time. A qualified family therapist can help you explore
your treatment options and recommend a treatment plan that is appropriate
for you.
Consumer Resources
Anxiety Disorders
Association of America
8730 Georgia Ave. Suite 600
Silver Spring, MD 20910
(240) 485-1001
www.adaa.org
This mission of ADAA is to
promote the prevention, treatment and cure of anxiety disorders and to
improve the lives of all people who suffer from them.
Anxiety and Its
Disorders. By David H. Barlow, Guilford (2002). This is a comprehensive
and technical textbook that covers all of the recent advances in the
nature and treatment of anxiety disorders.
Life Isn’t Just
a Panic. By Anita Pace, Baby Steps Press (1996). This book
contains the stories of how panic patients recovered from the disorder.
May provide some inspiration and instill a sense hope for recovery.
Triumph Over Fear. By Jerilyn Ross (1995). This book covers many useful
strategies and techniques for managing panic and anxiety—a useful self-help
book.
The text for this brochure
was written by
Michele M. Carter, Ph.D.
