What is Panic Attack, and what is Panic Disorder

Panic/anxiety attacks (with or without Agoraphobia) can be an extremely terrifying experience. It causes psychological, social, and occupational impairment. 

A Panic Attack is a sudden surge of intense fear accompanied by robust and frightening body sensations, catastrophic thoughts, and behavioural reactions in anticipation of experiencing such body sensations.

Panic attacks are common and are not dangerous. A panic attack does not necessarily mean the person must seek treatment. Treatment is needed only if one finds him/herself worrying about having more panic attacks to such a degree that it interferes with their daily functioning, well-being or quality of life.

     A Panic Attack is described as a short period of intense fear, discomfort or terror in which four or more of the following symptoms develop rapidly and reach a peak within 10 minutes:

•  Palpitations

• Pounding heart/accelerated heart rate

• Sweating

• Trembling or shaking

• Shortness of breath

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feelings of being dizzy, unsteady, lightheaded, or faint

• Fear of losing control or going crazy

     Symptoms associated with Panic Disorder:

•  Recurrent panic attacks

• Persistent concern about further panic attacks (at least one month after a panic attack)

• A significant change in behaviour because of expectations of panic attacks -safety behaviours, which often entail avoidance

• Worries about the meaning of having a panic attack or the consequences of having it (e.g., having a heart attack, fainting, losing control)

Many people with panic disorder also experience Agoraphobia.

According to (DSM-IV) Agoraphobia is :

• Significant anxiety about being in places or situations from which escape might be difficult or embarrassing because of unexpected or unwanted bodily symptoms.

•  As a result, such situations are either avoided or require the presence of a trusted person.

• Agoraphobic fears are about a specific situation or situations. Some examples are being outside the home alone, being in a crowded place or standing in a line, being on a bridge, or travelling on a bus, train, or car, etc.

• Such situations are endured with marked distress (about having a panic attack or panic-like symptoms) and often require the presence of a companion. The safety behaviour of avoiding these situations may impair a person's ability to travel, work or carry out responsibilities (e.g., grocery shopping, etc).

The symptoms of Agoraphobia without Panic Disorder are similar to those of Panic Disorder, except that fear is centred on incapacitating or extremely embarrassing panic-like symptoms rather than full-blown panic attacks.

For both Panic Disorder and Agoraphobia, the anxiety or the avoidance behaviour should not be better accounted for another mental condition, a direct physiological effect of a substance (e.g., drugs), or a general medical condition. Panic disorder and Agoraphobia can exist in isolation but frequently co-occur. 

What causes Panic Attack, Panic Disorder or Agoraphobia

There is no single cause, but some predispositions include:

• Being under much stress

• Sensitivity to Anxiety

• Strong biological reactions to stress

• A tendency for catastrophising (thinking the worst)

• Other psychological problems - such as posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or depression, often are accompanied by experience of panic attacks due to elevated anxiety.

  Prevalence

•  The median age of onset of PD/PDA is 24 years, although it can occur at any age.

• The lifetime prevalence for PD/PDA is 3.5% to 5.3% (Kessler et al., 1994).

• Women are twice at increased risk for developing PD/PDA compared to men (Katerndahl & Realini, 1993).

• Symptoms are typically chronic, with an overall remission rate of 39% and recurrence rate of 82% in women and 51% in men (Yonkers et al., 1998)

• PD/PDA commonly co-occurs with other psychological conditions. Approximately 59% of sufferers have a comorbid mood or anxiety condition, including major depressive disorder (23%), generalised anxiety disorder (16%), and social or specific phobia (15%). However, outside of PD/PDA, panic attacks are often situationally bound.

Treatment

The UK National Institute of Health and Care Excellence (NICE) Guidelines recommend psychological therapy or a combination of psychological therapy and medications.

One of the most effective psychological treatments for Panic is Cognitive Behavioural Therapy (CBT). If CBT is delivered face-to-face, the optimal range is between 7 and 14 hours of treatment, typically in weekly sessions of 1–2 hours. Guided and non-guided self-help are also appropriate treatments for panic disorder.

About 80% of people with panic disorder who complete a course of CBT are panic-free at the end of treatment.

  References

American Psychiatric Association. (2022). Panik Disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders

International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. Licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).

National Institute for Health and Care Excellence (NICE), Generalised anxiety disorder and panic disorder in adults: management. Retrieved from:https://www.nice.org.uk/guidance/cg113.

National Clinical Coding Standards ICD-10 5th Edition; Terminology and Classifications Delivery Service NHS England in http://systems.digital.nhs.uk/data/clinicalcoding: April 2023 Version: 9.0