Anxiety disorders affect a large number of people, causing great discomfort and affecting their daily lives. In recent years there has been a notable increase in panic disorder and agoraphobia, being one of the most frequent reasons why people come to psychology consultations.
That is why in this Psychology-Online article we explain in detail the symptoms, causes and treatment of panic disorder.
What is panic disorder: definition
It is considered that there is a panic disorder when the subject suffers recurring unexpected panic attacks.
The main characteristic of a panic attack is the isolated and temporary appearance of intense fear or discomfort, which is accompanied by at least 4 of a total of 13 somatic or cognitive symptoms. The crisis begins abruptly and reaches its maximum expression quickly (usually in 10 minutes or less), often accompanied by a feeling of danger or imminent death and an urgent need to escape.
Symptoms of panic disorder
The symptoms of panic disorder are anxiety, panic attacks, and the fear of suffering them. The 13 symptoms of a somatic or cognitive panic attack are as follows:
- Palpitations, pounding heart, or rapid heart rate.
- Sweating.
- Trembling or shaking.
- Feeling of difficulty breathing or suffocation.
- Feeling of suffocation.
- Pain or discomfort in the chest.
- Nausea or abdominal discomfort.
- Feeling dizzy, unsteady, lightheaded, or fainting.
- Chills or feeling of heat.
- Paresthesias (numbness or tingling sensation).
- Derealization (feeling of unreality) or depersonalization (separating from oneself).
- Fear of losing control or “going crazy.”
- Affraid to die.
Seizures that meet the remaining criteria, but present fewer than 4 of these symptoms, are called limited symptomatic seizures. The sudden appearance can occur from a state of calm or from a state of anxiety.
DSM V criteria for panic disorder
The criteria that appear in the DSM V to diagnose panic disorder are:
1. Recurring unforeseen panic attacks
One is the sudden appearance of intense fear or intense discomfort that reaches its maximum expression in minutes and during this time four (or more) of the symptoms in the previous section occur. Sudden onset can occur from a state of calm or from a state of anxiety. Culture-specific symptoms may be observed (for example, tinnitus, neck pain, headache, screaming, or uncontrollable crying). These symptoms do not count as one of the four required symptoms.
2. Concern, worry or poor adjustment
At least one of the attacks has been followed by one month (or more) by one or both of the following events
- Continued concern or worry about other panic attacks or their consequences (for example, losing control, having a heart attack, “going crazy”).
- A significant maladaptive change in attack-related behavior (for example, behaviors aimed at avoiding panic attacks, such as avoidance of exercise or unfamiliar situations).
3. The alteration cannot be attributed to another cause
Such as the physiological effects of a substance (for example, a drug, a medication) or another medical condition (for example, hyperthyroidism, cardiopulmonary disorders).
4. The alteration is not better explained by another mental disorder
For example, panic attacks do not occur solely in response to feared social situations, as in ; in response to specific phobic objects or situations, as in specific phobia; in response to obsessions, as in ; in response to memories of traumatic events, as in ; or in response to the separation of attachment figures, as in the .
Differences between panic disorder with agoraphobia and without agoraphobia
In the previous section we have seen the criteria for the diagnosis of panic disorder without agoraphobia. The fundamental difference between panic disorder without agoraphobia and with agoraphobia is the appearance of anxiety in situations where escape is difficult or embarrassing in the event of a panic attack.
The essential characteristic of agoraphobia is the appearance of anxiety when finding oneself in places or situations where escape may be difficult (or embarrassing) or where, in the event of a panic attack or panic-like symptoms, help may not be available.
This anxiety typically leads to permanent avoidance behaviors multiple situations. The most common situations that are avoided in panic disorder with agoraphobia are:
- Being alone inside or outside the home
- Mix with people
- Travel by car, bus, or plane
- Finding yourself on a bridge or in an elevator
Some people are capable of exposing themselves to feared situations, but this experience produces considerable terror. They often find it easier to face feared situations if they are in the company of someone they know. Avoidance behavior in these situations can lead to a Impaired ability to travel for work or carry out household responsibilities (for example, going to the supermarket, taking the children to the doctor). This anxiety or avoidance behavior cannot be better explained by the presence of another mental disorder.
The differential diagnosis between agoraphobia and social or specific phobia and severe separation anxiety disorder can be difficult, since all of these entities are characterized by avoidance behaviors of specific situations.
Causes of panic disorder
Throughout history there have arisen various explanatory models of panic and agoraphobia. The first models insisted on its biological nature, considering the existence of a genetically predisposed physical alteration. However, each of the arguments of the biological models is debatable in some aspect, which is why alternative explanatory models such as cognitive models began to emerge.
One of the most accepted models is that of Clark and Salkovskis (1987). According to this model, various internal or external stimuli can be perceived as threatening, causing fear or apprehension. This fear manifests itself in a series of bodily sensations (physiological response to anxiety) such as an acceleration of the heart rate. By interpreting them in a catastrophic way, anxiety increases, which confirms the catastrophic thoughts that provoke more fear, and we enter the fear-anxiety loop. The crisis continues until a few minutes later the mechanism responsible for restoring the body’s balance acts or until the subject uses some coping strategy.
When a person has developed the tendency to interpret sensations catastrophically, there are two processes that contribute to the maintenance of the disorder:
- Hypervigilance and control of bodily sensations. He becomes hypervigilant and is able to recognize the slightest variations in his body. These changes that go unnoticed for other people, for them with confirmations that they suffer from a serious mental or physical illness. This would explain the apparently spontaneous seizures, which are actually triggered by the perception of bodily sensations.
- Avoidance of situations. Avoidance behaviors eliminate discomfort in the short term, but contribute to the maintenance of the disorder because reinforce the belief in danger when in reality there is no opportunity to check if the situation is really dangerous by not exposing yourself to it.
The model we have just seen explains panic attacks and the maintenance of anxiety, but why does the first attack appear? Research indicates that The first attack may appear after a life situation of intense stressfor example:
- family problems
- work difficulties
- couple affairs
- consumption of drugs
- concern about a medical problem
What happens to the body in a panic attack
During a panic attack our body mobilizes to give a emergency response: fight or flight. Initially, through the activation of the sympathetic nervous system (SNS), which is responsible for mobilizing our body’s resources for immediate and intense action. Here you can see more information about it.
And if the situation drags on, the neuroendocrine system that increases the production of adrenaline and norepinephrine. This activation mainly produces:
- Increased blood pressure
- increased heart rate
- tension in skeletal muscles
- increased breathing rate
- glucose release
Panic disorder treatment
For panic disorder with or without agoraphobia, an effective treatment has been developed and has become the treatment of first choice in healthcare systems around the world.
It is a cognitive-behavioral intervention that is made up of:
- Psychoeducation. Treatment begins by explaining to the patient what a panic attack is, what its symptoms are and what the disorder consists of.
- Muscle relaxation training. Muscle tension is a very common physiological reaction in anxiety and panic attacks. Hence the importance of having resources to deal with this annoying symptom. There are various relaxation techniques and one of the most used in the treatment of anxiety is.
- Anti-panic breathing training. During panic attacks, breathing is normally altered by hyperventilation, which usually causes dizziness and lightheadedness. Breathing training is a self-control strategy to regulate breathing in states of anxiety. Here you will find .
- Cognitive intervention. Through the ABC model, the patient learns to identify the maladaptive automatic thoughts that cause undesirable emotions to replace them with more realistic and adaptive ones. This is known as cognitive restructuring.
- Interoceptive exposure. It consists of exposing yourself to stimuli that generate anxiety until its symptoms are reduced or disappear. It can be done in imagination or live and intensively or gradually. The live exposure being the one that offers the best results.
- Exposure to agoraphobic situations. If the panic disorder is with agoraphobia, the feared stimuli are environmental situations, so the exposure would be in these. Like interoceptive exposure, exposure to agoraphobic situations can be done intensively (directly to the feared situation) or gradually. For the second we will use a hierarchy of situations that cause fear to the patient and we will do the exposure from less to more.
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist so that…