Panic Attacks and Panic Disorder: A Primer

Jerry Kennard Health Pro
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    Anyone who has experienced recurrent and unexpected panic attacks -- and who is preoccupied by the thought of further panic attacks and their implications (fainting, incontinence, embarrassment, death) -- might well be suffering from panic disorder.


    A panic attack itself is, of course, an extremely unpleasant and even a terrifying sensation. A person suffering through one might feel weak, dizzy, and nauseous. Chest pains, difficulty breathing, and rapid heart rate are common. In fact, panic attacks are often mistaken for heart attacks.


    During or after a panic episode, some people question their own sanity. But while panic disorder is clearly a psychological problem, it does not share many or most of the symptoms commonly associated with mental illness.

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    Fainting during a panic attack


    Fainting only occurs when the blood pressure in the body gets too low. During anxiety episodes, blood pressure actually increases. Therefore, although you may sense you are going to faint, it's unlikely to happen. But what you are sensing is the wooziness that sometimes comes with the rush of hormones associated with our "fight or flight" response.


    Panic disorder and heredity


    Until fairly recently the genetic basis for panic disorder was uncertain, although it was known that first-degree relatives were more likely to display symptoms. In 2013 the Journal of Neuroscience (1) reported that the gene NTRK3 had, for the first time, been identified as a factor in genetic susceptibility to panic disorder. The study explains that the way memories resulting from a panic attack are stored is influential, but that environmental factors such as stress also increase the risk of panic disorder in those susceptible.


    That said, not very much in the way of evidence exists as to the natural course of untreated panic disorder. We do know that many people with panic disorder also have symptoms of agoraphobia. Left untreated, this can spontaneously improve in around a third of people within two years. Cognitive therapy is highly effective in the treatment of panic disorder and the long-term prognosis is good. However, the trigger for panic is often a buildup of stress, and if exacerbated, symptoms can return in some people who were thought to be "cured."


    And then there is hypnosis, which comes with suggestions that the trance-like state of relaxation may help panic attacks to cease. However, full evaluations of hypnosis are a little difficult to come by, and what exists is a little thin on effectiveness. Available evidence suggests that the efficacy of post-hypnotic suggestions tends to be relatively short-lived. This contrasts strongly with cognitive therapies, which are thoroughly grounded in research and have a record of solid results.


    The strain of panic


    The stresses and strains associated with repeated panics are wearing. Lifestyle and behavior are affected, and this raises questions as to whether the immune system or other physical processes are being negatively affected. There is evidence that long-term stress can and does have an effect on the immune system. But there is little to suggest that panic episodes per se have a negative influence on health -- unless, of course, we include the psychological effects.


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    Caffeine and panic attacks


    Caffeine is found in a number of products including chocolate, tea, cola, and certain medicines (cough syrups, for example). Experiments have shown that certain levels of caffeine can induce panic, and for this reason some people with panic disorder choose to avoid caffeine altogether. This is a matter of personal choice. There is no reason to assume that caffeine, taken in moderation, will be the cause of panic symptoms.


    Herbal and alternative treatments


    Alternative methods of treatment for all sorts of conditions and disorders are, of course, very popular, and many people would far rather use these than conventional forms of medicine. Bear in mind, however, that no consistent standards exist as to correct dosages, for example. Evidence for the effectiveness of most alternative medications is rather sparse or anecdotal. If mixed with conventional treatments, there is also a danger of adverse reactions.


    A number of conventional options do exist that may help to reduce the symptoms associated with panic. Some are specifically targeted toward the reduction of anxiety while others, often used in the treatment of depression, may also be effective. Finding the best medication or combination of medicines at a dosage that is therapeutic may take some time. In most people the side effects associated with such medications become less troublesome over time.


    Patients treating themselves


    If your symptoms are uncomplicated -- that is, with no other psychological issues -- there are certainly steps individuals can take to treat themselves. For instance, remove drugs, alcohol, and excessive caffeine from your life. If your panic is associated with agoraphobia, set simple goals for dealing with it and, crucially, keep practicing.


    Finally, engaging in relaxation techniques and, of course, getting regular physical exercise are two time-honored ways of maintaining one's physical and psychological equilibrium.




    Centre for Genomic Regulation. "Gene found responsible for susceptibility to panic disorder." ScienceDaily. ScienceDaily, 28 November 2013. <>.

    Rachman, S. & De Silva, P (2003) Panic Disorder: the facts (2nd Ed) Oxford University Press


    Dr. Jerry Kennard is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry's clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of


    Updated on: May 17, 2016


Published On: May 20, 2016