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Individuals with panic disorder regularly suffer intense episodes of anxiety, known as panic attacks (see below). They worry a lot about having more attacks, or about what the attacks imply or might cause, or have made changes to their behaviors because of the attacks.
These intense anxiety attacks include 4 or more of the following symptoms:
- shortness of breath
- increased heart beats
- trembling, shaking
- chest pain
- chills or hot flashes
- feelings of unreality or being detached from oneself
- numbing or tingling sensations
- choking sensations
- fear of dying
- fear of insanity or of losing control
Panic attacks begin suddenly and usually peak quickly, within 10 minutes or less of starting. Multiple attacks of different intensities may occur over several hours, which might feel as if one panic attack is rolling into the next, like waves. At first, panic attacks usually seem to come ‘out of the blue,’ but over time a person may come to expect them in certain situations. If a person begins to avoid these situations due to fear of a panic attack, they may also have agoraphobia (see below).
Some people suffer panic attacks on a daily or weekly basis. The outward symptoms of a panic attack frequently result in social difficulties, such as embarrassment, stigma, or social isolation. However, people who have had these attacks for a long time are often able to restrain outward signs of even very intense panic attacks. Sometimes people will suffer milder attacks with only 3 or less of the above symptoms, which are known as Limited Symptom Attacks (see below).
Panic disorder is a serious mental health problem, but it can be successfully treated. An estimated 2-3% of Americans have panic disorder at some point in their lives. It is observable before 14 years of age, but the prevalence is low in this age category. The rates gradually increase throughout puberty and peak during adulthood. This timeframe is particularly common if someone has been subjected to a traumatic experience. Women are twice as likely as men to develop panic disorder.
The frequency and severity of panic attacks vary widely between individuals. Panic disorder can continue for months or years, depending on how and when treatment is pursued. If left untreated, symptoms may become so severe that a person has significant problems with their friends, family, or job. Some people may experience several months or years of frequent symptoms, then many symptom-free years. In others, symptoms persist at the same level indefinitely. There is some evidence that many people, particularly those whose symptoms begin at an early age, may naturally experience a partial or even complete reduction in symptoms after middle age.
Risk factors can be temperamental (i.e. neuroticism and anxiety sensitivity), environmental (i.e. childhood abuse and smoking), or genetic and physiological. The exact causes of panic disorder are not known, but like many other anxiety disorders, panic disorder runs in families, meaning that inheritance may play a strong role in determining who becomes affected by it. In fact, panic disorder is often found in combination with other hereditary disorders such as bipolar disorder and alcoholism. However, many people without a family history of panic disorder develop it. Malfunctioning in brain areas such as the amygdala and adrenaline glands may cause an overproduction of certain chemicals which produce the physical symptoms.
Other biological factors, stressful life events, and exaggerated thinking about common bodily reactions are also believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, major stressors, or certain medications. People who take on too many responsibilities may develop a tendency to suffer panic attacks. Individuals with post-traumatic stress disorder (PTSD) also show a much higher rate of panic disorder than other people. Some evidence suggests that hypoglycemia, hyperthyroidism, mitral valve prolapse, labyrinthitis, and pheochromocytoma may trigger or worsen panic disorder.
Agoraphobia is a disorder in which a person becomes anxious in and therefore begins to avoid situations from which escape might be difficult or help might be unavailable in the event of a panic attack. In the recent shift from the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) to the Fifth Edition of the DSM (DSM-5), agoraphobia was transitioned from only being diagnosed in individuals with panic disorder to being a standalone diagnosis. To be diagnosed with agoraphobia, the individual must exhibit explicitly observable fear or anxiety about two or more of the following situations:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or behind a crowd
- Being outside of the home alone
This anxiety is often increased by a fear of embarrassment, as the person fears suffering a panic attack and showing distress in public. About one of every three people with panic disorder develops agoraphobia.
Agoraphobics may experience panic attacks in the situations where they feel trapped, insecure, out of control, or too far from their comfort zone. In very severe cases, an agoraphobic may confine themselves to their home. These people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones.
Many people with panic disorder have a mixture of panic attacks and limited symptom attacks. A limited symptom attack (LSA) is a lower-scale, less comprehensive onset of panic symptoms, when a person feels 3 or less of the panic symptoms listed above. For example, a sudden episode of trembling or nausea accompanied by a fear of dying would be considered an LSA. Not everyone who experiences an LSA has a mental illness. People often experience limited symptom attacks while recovering from or being treated for panic disorder. Like a panic attack, an LSA usually peaks in 10 minutes; however, an attack might last only 1 to 5 minutes, or could be part of a panic episode of varying intensity that lasts several hours.
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