Panic Disorders

Dr. Kleiner Health Guide
  • The word "anxiety" is frequently tossed around. "Anxiety", after all is not a diagnosis, but a subjective feeling. It may even be something that is temporarily helpful, as in the case of having situational anxiety. Not all situational anxiety, of course is helpful, but at times it can be. For example anxiety before an exam in school helps us study harder and anxiety one week before April 15th ("Tax Day"), may help us get our taxes in order. Sometimes anxiety is helpful if it is contained, limited and resolves after the stressor (the exam or "tax day" in our examples) disappears. 


    Anxiety becomes more chronic, however, when it becomes a symptom of an underlying condition. These can include Panic Disorder, General Anxiety Disorder, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and specific phobiad. You may have heard of some of these conditions from friends, or even in the press. You may even suspect that you have "an anxiety problem" which brought you to this website. As requested by our blogging community, in the next several blogs, we will review some of the more common anxiety disorders, their signs and symptoms, and the potential treatments available. Let us first start with Panic Disorder.

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    ­Panic Attacks: Panic Disorder consists of panic attacks. We have all heard this term before. Sometimes it is used too casually, as in referring to mild situational anxiety. So, what is a panic attack?  The technical definition of a panic attack is "A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: 1. Palpitations (pounding or rapid heart rate), 2. Sweating, 3. Trembling or shaking, 4. Sensation of shortness of breath, 5. Feeling of choking, 6. Chest pain or discomfort, 7. Nausea and abdominal distress, 8. Feeling dizzy, unsteady, lightheaded or faint, 9. Derealization (feeling detatched from reality) or depersonalization (feeling detatched from oneself), 10. Fear of losing control or going crazy, 11. Fear of dying, 12. Paresthesia (numbness or tingling sensation), 13. Chills or hot flashes."


    The symptoms of panic attacks are not identical amongst all people. Nevertheless, there are some common symptoms that tend to occur more often such as trembling and shaking, shortness of breath, dizziness, and palpitations (rapid, pounding heart). Some people can experience a feeling of an "impending sense of doom" i.e. like they are going to "die."



    Panic Disorder. Although rare, it is possible to have a discreet panic attack, without having panic disorder. This can occur when, for example, a person witnesses a devastating event, such as a kidnapping or earthquake - in such cases, having a panic attack might be considered understandable.  Panic Disorder, however, consists largely of recurrent, unexpected panic attacks or "spikes" in anxiety. This is accompanied by at least one month or more of persistent concern about having another attack, and is often accompanied by worry about the implication of having an attack or of significant behavioral change related to the attack. It is important to realize that in panic disorder attacks are "unexpected" - meaning that the attack is not a logical conclusion to a stressful event


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    Agoraphobia is a disabling complication of panic disorder characterized by fearful avoidance of situations that might cause a panic attack. Although in the public imagination it is thought of as a condition that prevents people from entering public places-and this is true for many agoraphobics, at its core, agoraphobia is really about being away from one's source of security. For example , if an agoraphobic patient had a panic attack in an elevator, he might avoid buildings or places with an elevator. Furthermore, he may even have anxiety about thinking about his taxes, since he knows that his accountant's office is on the 15th floor.


    Many panic attacks ae due to crowds, feeling pinned down or trapped or before an appointment. I once treated a patient who experienced panic attacks if he couldn't fall asleep. Unable to fall asleep, he would ruminate about the effects it would have on his ability to function the next day. Often this led to a full blown panic attack, complete with palpitations, shortness of breath, chest pain, diziness and more. On several occasions, he felt compelled to go to the emergency room to ensure that he was not having a heart attack. (this, of course, all but ended the possibility of getting a restful night of sleep. Interestingly, his panic disorder was eventually accompanied by agoraphobia. He would not travel for fear that being in another bed might delay his ability to fall asleep. This prevented him from attending conferences and even visiting his girlfriend who was a student in another state!


    It is important to remember that Panic Disorder, especially when accompanied by Agoraphobia can be debilitating and impact the quality of your life. There are several methods for treating panic disorder that are very effective. These will be discussed in my next blog. In the meantime, if you feel you experience some of these symptoms you should seek consultation with your health-care professional. If you feel you are having a panic attack, you may even want to report to the nearest emergency room.

Published On: May 05, 2008