Panic Disorder refers to recurrent panic attacks that typically reach a peak within 15-30 minutes and require the presence of four or more of the following physical and cognitive symptoms.
- Palpitations, pounding heart, or accelerated heart rate
- Sweating, chills, hot flashes
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Numbness or tingling sensations
- Feeling detached from oneself and from reality
- Fear of losing control or “going crazy,” and/ or dying.
It is not uncommon for those experiencing their first panic attack to go to the hospital emergency room as they feel their life is in danger. When a medical condition is ruled out, it can often heighten the person’s anxiety in their search to explain the horrific sensations and emotions they experienced during the panic attack.
Cognition and behavior each play a central role in the experience and maintenance of panic disorder. The cognitive concerns related to panic usually center around the presence of a life-threatening illness (e.g., cardiac disease, seizure disorder); the social impact (e.g. being judged negatively by others); and on cognitive functioning (e.g. ”going crazy” or “losing control”). Chronic worry is characterized by focusing on and searching for any bodily sensations that may forewarn of another panic attack, and by increased levels of physical tension in general. For example, an individual with panic disorder may notice a change in their breathing and interpret this as cue that they could choke, as opposed to a normal physical symptom of anxiety or exertion. Another example is believing that their increased heart rate is a sign they are about to have a heart attack.
The most common behavioral response is to avoid places or activities that have or could trigger panic. Additionally, and in line with the fight or flight response, escaping from the places or situations where panic strikes. This in turn creates a hypervigilance to a multitude of variables in the environment that might be responsible for triggering the panic attack. This can lead to further avoidance of situations and scenarios that include these variables that one believes might have led to the panic.
Without intensive CBT and exposure therapy, other safety behaviors beyond escape and avoidance can be used to decrease, distract, and reassure. For example, carrying items such as medication, water or a cell phone, having a family member or friend accompany you, and sitting near exits or bathrooms. Other common safety behaviors include avoiding any physical activities, certain foods (e.g. spicy dishes) or beverages (e.g. caffeine, alcohol), and always keeping busy to avoid thinking about anxiety or feeling anxious. While these behaviors may seem rational diversion strategies, the benefits are short lived as they counteract the goal of decreasing the intensity and frequency of panic symptoms in the long run.
At the Anxiety Institute, we believe that “symptoms of panic are not indicators of threat, but signals of opportunity to face anxiety, transcend fear, and nurture courage.”