Panic Attacks : types, symptoms and treatment

Panic attacks can be very frightening and is usually described as a sudden episode or wave of intense fear and anxiety that triggers other severe physical reactions when there is no real danger or apparent cause. Panic attacks usually strike out of the blue with little to no warning and can even occur when you’re relaxed or asleep. The intensity may feel so debilitating and immobilizing that it may feel like you are having a heart attack or even dying.

Most people may only experience one or two panic attacks during their lifetime and they usually go away after the situation that triggered it ends. Recurrent panic attacks are usually triggered by a specific situation such as speaking in public or walking across a bridge.

These are often situations where you feel endangered and unable to escape, hence triggering the body’s fight or flight response. Conversely, if you’ve had recurrent, unexpected panic attacks or spent long periods in constant fear of another attack, then it may be part of a larger condition called panic disorder.

Not only can panic attacks vary in intensity and duration, they can also differ according to what triggered the attack. There are generally two distinct types of panic attacks:

  • Expected – These, as the name suggest, are anticipated or expected when an individual is subjected to a known panic trigger. For example, an individual with claustrophobia may expect to have a panic attack when put in an enclosed space such as an elevator, or a person with a fear of flying entering an airplane.
  • Unexpected – These occur suddenly and without any obvious reason or indication. This type of panic attack does not accompany any conscious internal or external triggers such as any phobias or being exposed to a specific event. In addition, the individual must be completely relaxed prior to the symptoms developing. 

Panic attacks themselves are not life threatening but can however be very scary and can affect the quality of your life. In spite of this, treatment can be very effective.

The risk factors

Symptoms of panic disorder often start in the late teens or early adulthood and usually affect women more than men. The exact cause is unknown but the following factors appear to play a role:

  • Major life stress such as the death of a loved one. 
  • Traumatic event such as sexual assault or serious accident. 
  • Family history of panic attacks/disorder. 
  • Smoking or excessive caffeine intake. 
  • History of childhood physical or sexual abuseabuse.
  • Major stress. 
  • Temperament that is more prone to negative emotions. 

Signs and symptoms

The signs and symptoms of panic attacks usually develop abruptly, without warning and will reach their peak within about 10 minutes. They often end within 20 or 30 minutes and rarely last longer than an hour. They can happen anywhere and anytime such as when you’re driving, sleeping, walking down the street or in the middle of a business meeting. There are many symptoms of a panic attack, some are listed below:

  • Heart palpitations or accelerated heart rate
  • Shortness of breath or hyperventilation. 
  • Excessive sweating
  • Feeling of choking. 
  • Nausea or abdominal pain
  • Chest pain or discomfort
  • Trembling or shaking
  • Derealization or depersonalization
  • Chills or hot flashes
  • Feeling dizzy, lightheaded or unsteady
  • Numbness or tingling sensations
  • Sense of impending doom or danger. 

Diagnosis

Your primary care or mental health provider will determine whether you have panic attacks/disorder or whether it is due to another condition such as heart or thyroid problems, with symptoms that resemble panic attacks. Some tests your doctor may run to help with the diagnosis are:

  • A physical exam. 
  • Blood tests to check your thyroid and tests such as an ECG or EKG for your heart. 
  • A psychological evaluation where you talk about your symptoms and fears, concerns and possible alcohol or substance use in order to find the root of the issue. 
  • A psychological self assessment or questionnaire may also be filled out. 

In order to be diagnosed with panic disorder (i.e. not just panic attacks) your panic attacks must be following the following points listed by the American Psychiatric Association:

  • You have frequent, unexpected panic attacks. 
  • Your panic attacks are not caused by drugs or any other substance abuse, medical condition or mental health condition such as a phobia.
  • At least one of your attacks has been followed by at least one month of worrying about another attack.

Treatment

Treatment can help reduce both the intensity and frequency of your attacks. The main form of treatment is through psychotherapy and medications such as Selective serotonin reuptake inhibitors(SSRI’s), Serotonin and norepinephrine reuptake inhibitors(SNRI’s), and Benzodiazepines. The option of treatment depends on your preference, history and severity of panic disorder in addition to whether you have access to mental health professionals who have training in dealing with panic disorders.

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