Recognising and Treating Panic Disorder
Panic disorder is a prevalent yet often misunderstood condition that affects many individuals across varying demographics. If you or someone you know experiences sudden feelings of intense fear accompanied by frightening physical symptoms, it can be deeply unsettling. Understanding panic disorder and recognising its signs can be the first steps toward seeking help and finding effective treatment.
What is Panic Disorder?
At its core, panic disorder is characterised by recurrent and unexpected panic attacks, which are defined as abrupt surges of intense fear or discomfort. These attacks typically reach their peak within minutes and lead to a range of distressing physical and emotional symptoms. It’s important to note that panic disorder is considered a type of anxiety disorder.
Imagine you're going about your day, feeling relatively calm, when suddenly, your heart starts racing, you’re sweating profusely, and your thoughts spiral into a storm of panic. These experiences are not just fleeting instances of anxiety; for those with panic disorder, they could signify a more persistent issue. People with panic disorder often live in fear of experiencing another attack, which can lead to changes in behaviour that impact daily life.
Some may start avoiding situations where they fear an attack might occur, which can further entrench feelings of isolation and anxiety. Panic disorder is not uncommon, as it affects up to 3% of the population at some point in their lives, with a higher prevalence in females than in males. Significant episodes can occur several times a day or may be separated by weeks or months, making the experience highly unpredictable for those affected.
Signs and Symptoms of Panic Disorder
Identifying the signs and symptoms of panic disorder can help in recognising if you or someone close to you is experiencing it. Panic attacks are the hallmark of this disorder and are marked by both physical and psychological symptoms. Here's what you might experience:
Physical Symptoms:
Racing Heart: A pounding heartbeat that seems to come from nowhere.
Shortness of Breath: A sensation that you’re unable to catch your breath, often likened to the feeling of choking.
Sweating: Excessive perspiration even in relaxed environments.
Trembling or Shaking: An uncontrollable sensation that can make you feel weak or unstable.
Dizziness or Lightheadedness: Feeling faint, unsteady, or like you are about to pass out.
Chills or Hot Flashes: Sudden sensations of intense heat or cold.
Nausea or Abdominal Discomfort: Stomach pains or an unsettled feeling in your gut.
Tingling Sensations: Often in the fingers, toes, or face.
Psychological Symptoms:
Intense Fear: A profound sense of impending doom or fear of losing control.
Fear of Dying: Many individuals express a paralysing fear that they are about to die or have a heart attack.
Derealisation or Depersonalization: Feelings of unreality or disconnection from oneself can make one feel detached from their surroundings.
These symptoms typically peak within 10 minutes and can last 5 to 20 minutes, although some individuals report much longer episodes. It's important to emphasise that while panic attacks can feel incredibly intense, they are generally not considered dangerous. Understanding this can provide some peace of mind; however, the emotional impact can lead to significant anxiety about future episodes, creating a cycle of fear.
If you resonate with these experiences, you are not alone. Many individuals have faced similar struggles, causing them to make substantial changes and isolate themselves. Recognising signs allow for early interventions. If these experiences disrupt your daily life or cause distress, seeking help from a healthcare provider is an important step.
While the road to managing panic disorder may seem daunting, it’s essential to remember that effective treatments, including therapy and medications, exist and can significantly improve quality of life. Understanding panic disorder—what it is and its signs and symptoms—can provide clarity and prompt you to seek the help needed.
Causes and Risk Factors
There is no one cause of panic disorder. However, understanding what contributes to the development of panic disorder can be helpful in managing and addressing it. This disorder is complex and can arise from various biological factors and environmental triggers. By exploring these dimensions, you can gain insights that resonate with your personal experiences or those of your loved ones.
Biological Factors
Biological factors play a significant role in the onset of panic disorder. Research suggests that genetic and chemical components within the brain contribute to how individuals experience fear and anxiety.
Genetic Predisposition
You might be surprised to learn that a family history of panic attacks or panic disorder can significantly increase the likelihood of developing similar issues yourself. No single gene is linked to anxiety or panic disorders. However, research suggests that individuals may inherit a vulnerability to developing anxiety disorders.
In other words, if a first-degree relative, such as a parent or sibling, has a history of panic disorder, you have an increased chance of developing the condition. This hereditary aspect highlights the benefit of understanding your family's mental health history. For instance, if you have a relative who struggles with frequent panic attacks, recognising this pattern might help you understand any feelings of anxiety you might be experiencing.
Neurochemical Imbalances
Neurotransmitters—chemical messengers in the brain—can also play a pivotal role in the development of panic or other anxiety disorders. Imbalances in specific neurotransmitters like serotonin, which regulates mood, and gamma-aminobutyric acid (GABA), which has calming effects, can contribute to heightened anxiety responses.
You might imagine how unsettling it feels when your body reacts as if it’s in danger, even when there’s no apparent threat. This unpredictable response can result from these neural pathways misfiring due to chemical imbalances.
Brain Structure and Function
Studies have shown that some areas of the brain, particularly the amygdala, are involved in fear processing. When the amygdala overreacts, it can trigger panic attacks. The brain's circuitry is often more aroused in individuals prone to panic, making them sensitive to environmental threats—even when such threats do not exist.
If you remember an experience where fear overtook your rational thoughts, it’s often easy to identify how real that panic felt. Understanding it's a biological response can sometimes help to contextualise these feelings without heavy self-judgment.
Environmental Triggers
Alongside biological factors, environmental triggers are also significant in understanding panic disorder. These stressors can be situational and deeply personal.
Major Life Stressors
Challenging life events, such as the death of a loved one or a severe illness, can dramatically impact mental health. For example, imagine dealing with the loss of a family member. The emotional turmoil can often lead to a heightened state of anxiety or might even kick-start panic attacks, particularly if you have a predisposition to anxiety disorders. Some everyday significant life stressors include:
Loss of a loved one
Divorce or relationship breakdown
Job loss or financial insecurity
Experiencing these stressors can understandably lead to a spiral of overwhelming thoughts and fears, further instigating panic attacks.
Traumatic Experiences
Survivors of traumatic events, including accidents or assaults, may also find themselves susceptible to developing panic disorder. Such experiences often lead to a heightened state of vigilance and fear. For instance, someone who has been in a severe car accident may have panic attacks when driving, even if they felt comfortable before.
Lifestyle Factors
Additionally, lifestyle choices can exacerbate feelings of anxiety:
Substance Use: Smoking or excessive caffeine intake can increase anxiety levels.
Poor Sleep Quality: Lack of sleep affects emotional regulation, making individuals more sensitive to stress.
You might relate to the influence of caffeine on your anxiety levels. Perhaps you’ve noticed that after consuming an excessive amount of coffee, your heart races—not just from the caffeine but also due to the underlying anxiety that comes with it.
Agoraphobia and Avoidance
For many suffering from panic disorder, the fear of having another attack can limit their activities. This avoidance can lead to agoraphobia, where individuals avoid public places or situations where they fear they may not be able to escape if another attack occurs.
This fear of having an attack can spiral into a cycle of isolation where individuals avoid crowds altogether because they do not want to risk having an anxiety attack in public. By recognising how these triggers operate in conjunction with feelings, individuals can begin to address their panic disorder comprehensively.
Anxiety Sensitivity
Anxiety sensitivity is a key factor in panic disorder and refers to the tendency to fear anxiety-related sensations, like a racing heart or shortness of breath, due to beliefs that these sensations have harmful consequences. People with high anxiety sensitivity may misinterpret these bodily sensations as signs of an impending heart attack, loss of control, or even mental collapse, which can intensify panic symptoms and lead to a cycle of escalating anxiety.
This heightened focus on bodily sensations often triggers a fear response, which can increase the likelihood of experiencing recurrent panic attacks. Reducing anxiety sensitivity through cognitive-behavioural strategies, such as cognitive restructuring and exposure exercises, is a central goal in treating panic disorder. We discuss these treatment strategies further down in this article.
Understanding the causes and risk factors of panic disorder emphasises that it’s not simply a character flaw or personal weakness. Biological dispositions combined with environmental factors contribute to the development of this disorder. If you or someone you know is struggling, seeking support from mental health professionals can help navigate these challenges and cultivate coping strategies tailored to individual experiences.
Diagnosis of Panic Disorder
Getting the correct diagnosis for panic disorder is an important step as it helps to determine the appropriate treatment approach to address your concerns Learning more about how panic disorder is diagnosed may enable you to feel more empowered and prepared in your journey toward managing panic disorder.
Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) details the diagnostic criteria for panic disorder. According to the DSM-5, an individual must meet specific criteria to be diagnosed with panic disorder. Understanding these can clarify whether what you or a loved one is experiencing aligns with this condition.
Key Criteria for Diagnosis
Recurrent Unexpected Panic Attacks: At least four physical symptoms from the list below must occur during a panic attack. These symptoms include:
Racing or pounding heart
Sweating
Trembling or shaking
Shortness of breath
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Dizziness, unsteadiness, or faintness
Chills or sensations of heat
Numbness or tingling sensations
Feelings of unreality or detachment
Fear of losing control
Fear of dying
Persistent Concern or behavioural change: At least one of the panic attacks must be followed by one month or more of persistent worry about having another attack, concern about the consequences of the panic attacks, or a significant change in behaviour to avoid panic attacks.
Exclusion of Other Conditions: The attacks must not be attributable to the effects of a substance (like drug use) or medical conditions, such as a heart problem or anxiety that might arise from other mental health conditions, including social phobia or obsessive-compulsive disorder.
You might remember a time when a sudden panic attack struck you unexpectedly. Perhaps you were in the middle of a meeting, and your heart began racing out of nowhere, making you feel like you were losing control. Experiencing several of these attacks over time could lead you to seek a professional diagnosis. It’s vital to understand that the feelings are valid and that help is available.
Impact of Diagnosis
Receiving a diagnosis can be a significant turning point. It validates your experiences and opens the door to effective treatment options. Many people feel a sense of relief upon receiving a diagnosis, knowing that they are not alone in their struggles and that there are professionals who understand what they are going through.
Assessment
Once you've recognised the symptoms of panic disorder, seeking an assessment by a medical or mental health professional is a helpful next step. A good place to start is speaking with your GP, who can assess your concerns and provide a referral to a psychologist.
You don’t need a referral from your GP to see a psychologist; however, if you wish to claim a medicare rebate, a referral under a mental health care plan from your GP is required. Your GP may want to conduct a medical examination to rule out other potential physical causes of your symptoms and ensure an accurate diagnosis.
Initial Consultation with a psychologist: At your first visit with a psychologist, they will likely conduct a detailed assessment. This assessment could include obtaining a history of your symptoms, including their start, frequency, and potential triggers. For instance, you may be asked about:
The first instance you noticed panic symptoms.
How often you experience these symptoms.
Situations or activities that may provoke your attacks
They might also ask about your feelings, thoughts, and anxiety-related behaviours. You might be asked to fill out psychological self-assessment questionnaires to pinpoint the specifics of your disorder.
Getting a proper diagnosis is an important first step for anyone suspecting they may have panic disorder. The diagnostic criteria provides a framework to identify the disorder, while thorough medical evaluation reassures individuals that their symptoms are not due to another health issue.
If your experiences align with those discussed, seeking help from a healthcare provider can lead you toward getting appropriate treatment. Remember, you are not alone in this journey, and help is available to guide you through understanding and managing your panic disorder.
Treatment Options
Once you've received a diagnosis of panic disorder, the next step is exploring the various treatment options available. Research suggests there are effective treatments that can help manage and even reduce the frequency of panic attacks. The most common approaches include Cognitive Behavioral Therapy (CBT) and medication management. Understanding these options empowers you or your loved ones to make informed decisions about your mental health journey.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy, often abbreviated as CBT, is one of the most widely recommended therapeutic options for panic disorder. This form of psychotherapy emphasises the connection between thoughts, feelings, and behaviours. The goal is to help individuals change negative thought patterns and behavioural responses contributing to their panic attacks.
How Does CBT Work?
Thought Identification: You may learn to identify distorted or irrational thoughts that precede panic attacks. For instance, if you often think, "I can't breathe; I must be having a heart attack," CBT helps you challenge and reframe this belief.
Behavioural Techniques: Practicing different coping strategies can significantly reduce the intensity and frequency of panic attacks. You may work with a qualified therapist to develop a personalised toolkit. Some strategies include:
Deep Breathing Exercises: Learning controlled, deep breathing techniques can soothe your body's panic response.
Progressive Muscle Relaxation involves tensing and relaxing different muscle groups to reduce anxiety-related physical tension.
Exposure Therapy: A key component of CBT involves gradual exposure to feared situations related to your panic attacks. For example, suppose you avoid public transportation due to a panic attack while riding the bus. In that case, the therapist may help you slowly reintroduce this experience in a controlled manner. Over time, this process helps desensitise you to fear these situations.
Interoceptive exposure: Interoceptive exposure is a therapeutic technique used primarily in the treatment of panic disorder and anxiety disorders aimed at reducing sensitivity to physical sensations associated with anxiety. In this approach, individuals are gradually exposed to bodily sensations, such as a racing heart or dizziness, by intentionally inducing these sensations in a controlled setting—through exercises like spinning, breathing through a straw, or running in place. By repeatedly experiencing these sensations without catastrophic outcomes, individuals learn to tolerate and reframe their reactions to these bodily cues, reducing their fear of panic symptoms and interrupting the cycle that fuels panic attacks.
The Effectiveness of CBT
Many individuals see an improvement in their condition after weeks or months of CBT. By facing their fears directly and learning strategic coping mechanisms, they can be comfortable again in situations that generally make them anxious. Overall, CBT can result in:
Reduced frequency and intensity of panic attacks.
Improved ability to manage anxiety in daily activities.
Increased knowledge and understanding of your thoughts and feelings.
Medication Management
While psychotherapy plays a vital role in treating panic disorder, medication management may also be necessary or recommended, mainly if symptoms are severe. Not everyone who experiences panic attacks or panic disorder needs medication. A medical practitioner such as your GP or a psychiatrist can assess your symptoms and determine if medication is an appropriate treatment option for you.
They can also organise follow-up appointments to monitor how you respond to medication treatment, and recommend other treatments (such as CBT or other forms of psychotherapy) that can work in conjunction with medication. Psychologists cannot prescribe medication.
Both Cognitive Behavioral Therapy and medication management can be vital in treating panic disorder. Every journey is unique, and finding what works best for you may take time, but understanding these options and being proactive in seeking help will significantly enhance your path to recovery. Don't hesitate to contact healthcare providers to discuss your symptoms, concerns, and the best combination of therapies.
Lifestyle Changes and Coping Strategies
Living with panic disorder can be challenging, but incorporating lifestyle changes and coping strategies into your daily routine may significantly improve the overall quality of your life. Alongside professional treatment options like Cognitive Behavioral Therapy (CBT) or medication, implementing stress management techniques and relaxation exercises can serve as powerful tools to help manage panic symptoms.
Stress Management Techniques
For some people. Stress can act as a trigger for panic attacks, making it essential to develop healthy strategies for handling life’s challenges.
Recognise Stress Triggers: Understanding what causes your stress is the first step toward managing it. Keeping a journal can help you identify specific incidents or circumstances that escalate your feelings of stress or anxiety.
Practice Mindfulness: Mindfulness can help you ground yourself in the present moment, possibly reducing feelings of anxiety. It involves focusing on your thoughts, feelings, and bodily sensations without judgment. Consider trying techniques such as:
Mindful Breathing: Set aside a few minutes daily to focus solely on your breath. Inhale deeply, hold for a moment, and exhale slowly, allowing your thoughts to drift away.
Body Scan: Progressively focus on different parts of your body, inviting relaxation as you mentally scan from head to toe.
Set Boundaries: Healthy boundaries with work, relationships, and commitments are essential to reducing stress. Don’t hesitate to say no to extra tasks that could overwhelm you. Establishing limits can protect your mental space and enable you to recharge when needed.
Time Management: Being organised can significantly reduce stress levels. By prioritising tasks and managing your time effectively, you can alleviate the pressure that often leads to panic. Create a to-do list to keep track of your responsibilities. This method not only helps to minimise your workload but also allows you to celebrate small achievements daily.
Seek Support: When overwhelmed, lean on loved ones or friends. A trusted confidant can provide comfort and perspective during trying times, allowing you to voice your fears without judgment.
Benefits of Stress Management
It’s possible that by engaging in stress manage strategies, you might experience:
Improved emotional regulation
Reduced frequency and intensity of panic attacks
Enhanced self-awareness and coping skills
Relaxation Exercises
Incorporating relaxation exercises into your routine can help counterbalance the anxiety that accompanies panic disorder. Focusing on relaxation techniques can reduce muscle tension, calm your mind, and possibly develop a greater sense of control during panic episodes.
Deep Breathing Exercises: Deep may help to reduce panic symptoms in the heat of the moment. Try this simple exercise:
Breathe In: Inhale slowly through your nose for five counts.
Hold: Pause for five counts.
Breathe Out: Exhale gently through your mouth for five counts.
Progressive Muscle Relaxation (PMR): PMR is a technique that systematically tenses and relaxes different muscle groups. This practice not only reduces tension but also increases awareness of physical sensations:
Tense a Muscle Group: Begin with your feet; tense those muscles for five seconds.
Release: Say "relax" as you let the muscles go loose.
Wait: Remain relaxed for ten seconds before moving to the next muscle group.
Visualisation Techniques: Engaging in guided imagery or visualisation can calm your mind during stress. Picture yourself in a serene setting like a beach or quiet forest. Close your eyes, breathe deeply, and let your mind explore this peaceful environment. Focus on the details, such as sounds, smells, and sensations, to immerse yourself in this mental escape.
Habitual Exercise: Regular physical activity can also be an effective way to reduce anxiety. Aim for moderate exercise like brisk walking, swimming, or dancing for at least 30 minutes most days of the week. This engagement releases endorphins, which naturally improve mood and project feelings of calm.
Engage in Hobbies: Pursuing hobbies that you enjoy can be a great stress reliever. Whether painting, gardening, or crafting, finding activities that allow you to unwind can offset anxiety and provide fulfilment in daily life.
Integrating lifestyle changes and coping strategies into your routine may significantly enhance your ability to manage panic disorder. Stress management techniques coupled with relaxation exercises provide powerful tools to navigate the unpredictability of panic attacks.
Remember that every individual’s journey in managing panic disorder is unique. Don’t hesitate to combine these self-help strategies with professional treatment to maximise their effectiveness. Change takes time, so be patient with yourself as you embark on this journey toward healing and resilience.
Meet Your Clinical Psychologists In Newcastle
Dr Emma Doolan is a Clinical Psychologist based in Newcastle. With a collaborative and evidence-based approach, she helps clients overcome various challenges such as anxiety, depression, stress, and trauma.
Emma is experienced in cognitive behavioural therapy (CBT) and other modalities like schema therapy, acceptance and commitment therapy (ACT), and compassion-focused therapy. She holds a PhD in clinical psychology and has completed her registration as a clinical psychologist from AHPRA. Emma is a member of several professional associations, including ACPA, APS, AACBT, and APN.
Paige Cornell is a clinical psychologist in Newcastle who has experience in therapeutic modalities such as Motivational Interviewing, CBT, Schema Therapy, DBT, and ACT. She focuses on building a solid therapeutic relationship and tailoring treatment to each individual. Paige has experience in private practice, NGOs, and forensic settings.
She works with a diverse range of mental health issues, including anxiety, mood disorders, PTSD, relationship problems, substance abuse, and offending behaviours. Paige is particularly interested in helping LGBTQI+ individuals and those dealing with trauma and substance abuse. She is fully registered and endorsed as a clinical psychologist and a board-approved supervisor for psychologists. Paige is a member of ACPA and APS, holding a Master's in Clinical Psychology and a Bachelor's in Psychological Science (Honours).
Taylah Armstrong is a Clinical Psychologist in Newcastle. She focuses on developing solid therapeutic relationships to assist individuals in enhancing their well-being and achieving their goals. Taylah is skilled in treating various concerns such as anxiety, stress, mood disorders, trauma, and eating disorders.
She utilises evidence-based therapies like CBT, DBT, and ACT. Taylah has worked in public healthcare, primary care, and education sectors. She is fully registered and endorsed as a clinical psychologist by AHPRA and holds a Master's and Bachelor's degree in Psychology from the University of Newcastle.
Paige Whitfield is a clinical psychologist in Newcastle with experience in private and public health settings. She collaborates with health professionals, families, and schools to provide evidence-based treatments like CBT, Narrative Therapy, and ACT for various issues. Paige has a Bachelor's degree in Psychology (Honours) and a Master's in Clinical Psychology. She is fully registered and endorsed as a clinical psychologist and is a member of APS and ACPA.
Dr Kaitlin Fitzgerald is a clinical psychologist in Newcastle who takes a collaborative and client-centred approach to therapy. She creates a warm and relaxed environment for clients, aiming to make therapy sessions comfortable and even enjoyable. Kaitlin holds a Doctor of Philosophy in Clinical Psychology and a Bachelor of Psychology (Honours) from the University of Newcastle. In addition to her private practice at ELD Psychology, she also works in public mental health treating adults with various mental health issues.
Kaitlin has experience working with a wide range of concerns, such as anxiety, depression, and relationship difficulties. She is skilled in evidence-based therapies like CBT, Schema Therapy, DBT, and ACT. Kaitlin is fully registered as a clinical psychologist with AHPRA and is approved to supervise provisional and registered psychologists.
Eliza Newton is a person-centred Clinical Psychologist dedicated to helping clients explore their deeper selves. She tailors her approach to each client, using psychodynamic therapy for self-exploration or structured techniques like Acceptance and Commitment Therapy, Cognitive Behaviour Therapy, and Schema Therapy. Eliza focuses on individuals overcoming childhood trauma, including Complex PTSD, and helps those with ADHD develop organisational and emotional well-being strategies. With experience in private practice, inpatient settings, and psychiatric rehabilitation, she addresses challenges from anxiety and mood disorders to severe mental illness.
Eliza holds a Bachelor of Psychology (Honours) from the University of Newcastle and a Master of Clinical Psychology from Western Sydney University. She is registered as a Clinical Psychologist with AHPRA and is a member of AAPi and ACPA.
Disclaimer
The content provided on this blog is intended for Australian audiences and is for informational purposes only. It should not be considered as professional psychological advice, diagnosis, or treatment. The information shared here is based on general knowledge and experience in the field of psychology, but it may not be applicable to your specific situation.
Always seek the advice of your psychologist or other qualified mental health provider with any questions you may have regarding a psychological condition or treatment. Never disregard professional psychological advice or delay in seeking it because of something you have read on this blog.
If you are in crisis or you think you may have an emergency, call your doctor, or dial 000 immediately. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment.
The opinions expressed in this blog are solely those of the author and do not necessarily reflect the views of any affiliated organisations or institutions.