Case example: Michael was driving home from work one day and was caught in traffic. He suddenly noticed that his heart was beginning to race. He then felt short of breath, and tightness in his chest. When he began to sweat, he became concerned and drove to the nearest emergency room where they could find nothing physically wrong with him. Michael had just experienced his first panic attack. Over the next few weeks, the attacks became worse, and he started to avoid driving altogether.
Panic disorder is a type of anxiety disorder in which the key symptom is the experience of unexpected panic attacks. These panic attacks consist of physical and/or cognitive symptoms such as racing heart, dizziness, blurred vision, fear of death, trembling, sweating, and shortness of breath. As shown in the above example, the experience of panic attacks may lead to the development of avoidance behavior, known as agoraphobia. In Michael's case, he started to avoid driving out of concern that he might have another panic attack, so his agoraphobia was limited to driving. However, it is common for avoidance behavior to occur in multiple situations. Those with panic disorder with agoraphobia may stop or reduce activities such as drinking coffee, sexual encounters, or taking hot showers in an effort to control the sensations that are associated with panic attacks.
Panic disorder with agoraphobia is the most common of the panic-related disorders, although individuals may also report panic disorder without agoraphobia (panic attacks without avoidance behavior) or agoraphobia without a history of panic (avoidance behavior related to one or two sensations of panic, but has never had an actual attack).
The Impact of Panic Disorder on Individuals and Families
The experience of panic can range from mild (where the person will have limited interference in their daily routine) to extremely severe (possibly resulting in being partially or completely housebound). The experience of panic for most panic sufferers is frightening and the avoidance can greatly alter one's lifestyle (e.g., inability to drive to work). As a change in their lifestyle becomes apparent, there is also a change in their personal relationships. Others around the person must take on more of the day-to-day routine and responsibilities (e.g., going to grocery stores or taking the kids to school). This may cause those around the panic sufferer to feel more stress from their increased duties. The additional stress experienced by the family can cause resentment and anger towards the person and then worsen the panic symptoms. At the same time, she or he may begin to show signs of depression as a result of their changed family role. The negativity that comes with depression may then lead the person to believe that they don't have the capability to improve their condition, and consequently increase their dependency, depression, and panic symptoms. If left untreated, this disorder can be consuming.
Knowing When to Seek Help
In general, a person should consider seeking help when the anxiety occurs too frequently, intensely, or is becoming disruptive in daily functioning (e.g., going to fewer parties or social gatherings, going out to stores or movies less than usual). A good rule to follow is to be conservative and consider seeking help from a mental health professional when you notice the following:
- Frequently occurring panic attacks. If you have noticed that the attacks are increasing in either frequency or intensity, it may be a sign that they are becoming more difficult to control. At these times, it is advisable to seek help before the attacks begin to greatly interfere in your life.
- The appearance of avoidance behavior. If you notice a decrease in the amount of time you spend in activities you have typically done in the past, you may want to consider seeking help, especially if the reason for the decrease is related to experiencing panic attacks. The same can be said for activities that may bring on some of the sensations of panic (e.g., coffee). If you are changing your behavior to reduce the number of activities that are associated with panic symptoms, you may be letting the fear of the sensations control your behavior at a subtle level, and should consider seeking help from a qualified mental health professional.
- Dependency. If you notice that you are becoming more dependent on others to accomplish tasks that you would normally do because of the possibility of experiencing a panic attack, you may want to seek help. While this behavior is functional in the short-run, in the long-run dependency may intensify your anxious symptoms.
- Use of safety-signals. Safety-signals are objects or people that you feel comfortable with and signal that you are less likely to experience a panic attack. As such, it is common for individuals with panic to seek safe objects or people. If you notice that you want others (e.g., spouse or partner) to accompany you more during usual activities, then you may want to seek help.
What Treatments are Available?
Treatment for panic disorder with agoraphobia usually involves psychotherapy, medication, or a combination of the two. A qualified family therapist can work with you to determine which treatment will work best for your circumstances. Psychotherapy usually involves some form of behavior therapy. This basic approach consists of in-vivo exposure, which involves repeatedly entering the feared situations, gradually over time. The exposures can be conducted with or without the direct assistance of the therapist. A variation of this approach (cognitive behavioral therapy) involves conducting behavior therapy exposures in combination with helping you manage the troublesome thoughts that often accompany periods of intense anxiety. Cognitive behavioral therapy is a comprehensive treatment designed to influence the negative thinking (e.g., "I might die") that is common with panic disorder. It provides accurate information regarding the nature of panic and teaches specific techniques that allow the patient to correct the catastrophic thoughts that contribute to panic attacks. In this treatment, the patient is also taught to utilize breathing techniques to alleviate some of the physical sensations. This type of therapy has been shown to greatly reduce the return of panic symptoms in the future. Either of these treatments can be conducted individually, or in a couples or group format.
Anti-panic medications may be recommended, including benzodiazepines such as alprazolam, clonazepam, and lorazepam. These medications work well and are generally considered safe, quick acting, and have fewer side effects than other types of medications. While both medications and psychotherapy are effective, some patients have a preference for one type versus another.
Panic can be very distressing, but the good news is that it is treatable, and the treatments outlined here are very successful. The suffering does not have to last for an extended period of time. A qualified family therapist can help you explore your treatment options and recommend a treatment plan that is appropriate for you.