Panic Disorder Overview and Analysis

Introduction

Panic disorder (PD) is one of the most common mental illnesses around the world, and it can negatively influence the life of a patient. Panic disorders disrupt every aspect of human life, making it hard to do even small daily activities like learning, working, or taking care of oneself. It causes sudden and continuous attacks of intense fear for no apparent reason, in other words, panic attacks (Brown et al., 2016, p. 1). Such attacks are almost unpreventable and can last for a few minutes or even hours.

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Patients who suffer from this disorder are usually afraid of having another attack, and this fear interferes with their life. Such patients are afraid to be alone, for the fear of not getting medical help or even dying (Locke et al., 2015). These intense emotions can trigger severe physical reactions, which will be described further in this paper. The goal of this research is to provide a report on the disorder, including its syndromes, causes, and the best possible treatment.

Description of the Disorder

Several researchers conducted studies on the issue of panic disorder. Some researchers note that “panic disorder is marked by recurrent panic attacks that include symptoms such as sweating, trembling, shortness of breath or a feeling of choking, a pounding heart or rapid heart rate, and feelings of dread” (Sauer-Zavala, et al., 2016). Other doctors agree with this statement by adding that “during a panic attack, people experience heart palpitations, shaking, smothering, feelings of impending doom and feelings of being out of control” (The National Institute of Mental Health, 2018, para. 5).

Moreover, PD is defined by irregular and unexpected panic attacks that are not caused by an evident trigger, unlike attacks because of PTSD. Such attacks are characterized by the sudden rise of extreme fear “with at least four of the physical and psychological symptoms in the DSM-5 diagnostic criteria” (Locke et al., 2015, p. 618).

Another feature that is vital for the diagnosis of such a disease is that the patient is anxious about the fact that the attack might happen again. For this reason, the patient tries to change the behavior in counterproductive ways to limit the risk of further attacks. Even though sudden panic attacks are the primary reason for the diagnosis, several patients with panic disorder also sometimes can have panic attacks caused by a known trigger. In this way, a panic attack cannot be called unexpected, but a triggered to attack.

DSM-5 criteria for panic disorder include “the experiencing of recurrent panic attacks, with one or more attacks followed by at least one month of fear of another panic attack or significant maladaptive behavior related to the attacks” (American Psychiatric Association, para. 10). Regarding the age onset, several researchers indicate that panic attacks usually occur at the age of 24 (Bandelow & Michaelis, 2015). Moreover, Bandelow and Michaelis point out that “differences in prevalence rates found in different countries and cultures may be due to differences in methodology rather than to culture-specific factors” (Bandelow & Michaelis, 2015, p. 327).

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That fact can be confirmed by several cross-cultural studies. For example, Shimada-Sugimoto et al. (2015) conducted a study, which demonstrated that this disorder is among the most common mental disorders with a 12-month prevalence estimated as 19.3% in the USA (p. 388)

Causes of the Disorder

It is not yet clear what exactly causes panic disorder, and if the reasons for it are mostly environmental or genetic. However, PD is usually found and diagnosed during puberty or early adulthood. Despite the unclear nature of causes, it is apparent that there is a link between panic attacks and major life events that overall cause great stress. It may be exams for school or college graduation, suffering abuse at school or home, or even the death of loved ones and the following spiral into depression.

Nevid agrees with this point of view by saying that panic attacks initially seem to come “out of the blue” (Nevid, 2011). Yet they can later be connected with the situations in which they occur, such as shopping in a crowded department store or riding on a train. Agoraphobia, too, sometimes develops in people with panic disorder when they begin avoiding public places out of fear of having panic attacks while away from the security of their homes.

According to some researchers, it is possible that recognition of risk factors that occurred during the child’s development stage may help to avoid adult panic disorder. For example, Newman, et al. (2016) note that “both maternal avoidant attachment and balancing/forgiving appeared to be a stronger risk factor for the development of GAD than PD” (p. 94). Some studies evaluating anxiety treatments assess non-specific anxiety-related symptoms rather than the set of symptoms that characterize GAD or PD.

As was mentioned earlier, stressful life circumstances can be a reason for the occurrence of panic disorders. Some researchers liken “the life stressor to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack” (American Psychological Association, 2020, para. 4). Nevertheless, not only environmental causes may lead to such a disorder.

Some doctors also note that panic disorder can be caused by a genetic predisposition. For instance, if parents or grandparents have suffered from panic disorder or any mental disorder, a child is at higher risk of getting the same illnesses, especially in cases of stressful life events (Detzel et al., 2015). It is possible that Panic Disorder can also be caused by a biological or genetic malfunction during pregnancy (Meuret et al., 2017). However, a study on this subject, as well as specific biological reasons for this is yet to be determined. Nonetheless, panic disorders generally occur because of a mixture of physical and psychological reasons. Even though at first panic attacks may begin suddenly, eventually the pain may actually manage them by recognizing the early signs and responding to symptoms in a productive and harmless way.

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Treatment

As there are several types of reasons that cause panic disorder, there are several ways to treat it. They are divided into psychological and medicinal, although usually a combination of both methods is implemented during treatment. Special medication and psychotherapy are appropriate initial options for treating panic disorder (Locke et al., 2015). When the patient comes to a doctor, they are often offered medication to lessen the symptoms.

After this, psychotherapy is recommended in order to discover and work with the primary cause of the disease, which can be hidden in certain life events. That is why the mixture of different types of treatment can be more effective for patients with moderate and severe symptoms of panic disorder. Moreover, other treatment methods include self-help and group therapies; however, nowadays it is difficult to implement them in the United States because of a lack of information about this treatment (Locke et al., 2015).

Pharmacological Treatment

In order to treat panic disorder, a number of different medications are available for patients. According to the study of Locke et al. (2015), “selective serotonin reuptake inhibitors (SSRIs) are generally considered first-line therapy for panic disorder” (p. 620). Moreover, they include tricyclic antidepressants (TCAs) and consider them to be efficient in treatment as well as SSRIs. However, in some cases, several side effects may occur, which restricts the use of tricyclic antidepressants.

In other cases of panic disorder, Venlafaxine with extended-release is efficient in treatment. Azapirones, such as buspirone (Buspar), while being effective in treatment for anxiety disorder, do not seem to be effective for panic disorder. Some researchers advise using bupropion (Wellbutrin), because it “may have anxiogenic effects for some patients, thus warranting close monitoring if used for the treatment of comorbid depression, seasonal affective disorder, or smoking cessation” (Locke et al., p. 620). Other medications like Bupropion, while are appropriate for treating addiction, are not approved for the treatment of the panic disorder.

Psychological Treatment

Some medical professors also suggest adding psychotherapy to the process of treatment. For example, Kim et al. (2016) conducted a study that “demonstrated with statistical significance that symptoms in panic disorder patients can be substantially reduced by mindfulness-based cognitive therapy (MBCT)” (p. 196). While going through this kind of therapy patients with panic disorder learn to observe their thoughts and analyze them.

Moreover, sessions with a therapist teach patients to change their usual way of thinking, thus, getting rid of irrational and catastrophic misconceptions. Another advantage of MBCT is that by practicing being aware of physical sensations in detail, such as breathing or heartbeat patients learn to “ground themselves” (Kim et al., 2016). It prevents them from escalating the panic even further, which causes the attacks. Researchers note that in the long run, if patients learn to recognize and work with uncertain bodily reactions or triggers of panic attacks, they can handle it better (Kim et al., 2016). By using mindfulness techniques catastrophic misconceptions can be greatly reduced.

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Conclusion

In conclusion, it would appear that using such medication as tricyclic antidepressants or selective serotonin reuptake inhibitors would be effective in the treatment of the panic disorder. However, besides medication, psychotherapy and mindfulness-based cognitive therapy also help patients to manage panic attacks successfully. Moreover, recognizing the initial causes of the disorder is also important when it comes to choosing an appropriate treatment method. All things considered, in order to ensure a patient’s recovery, two types of treatment should be implemented together as they address both symptoms and causes of panic disorder.

References

American Psychological Association. (2020). Answers to your Questions about Panic Disorder. Web.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Web.

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327.

Brown, L. A., LeBeau, R., Liao, B., Niles, A. N., Glenn, D., & Craske, M. G. (2016). A comparison of the nature and correlates of panic attacks in the context of Panic Disorder and Social Anxiety Disorder. Psychiatry research, 235, 69-76.

Detzel, T., Wesner, A. C., Fritz, A., da Silva, C. T. B., Guimarães, L., & Heldt, E. (2015). Family burden and family environment: Comparison between patients with panic disorder and with clinical diseases. Psychiatry and Clinical Neurosciences, 69(2), 100-108.

Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S. H. (2016). Impact of mindfulness-based cognitive therapy on intolerance of uncertainty in patients with panic disorder. Psychiatry Investigation, 13(2), 196.

Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617-624.

Meuret, A. E., Kroll, J., & Ritz, T. (2017). Panic disorder comorbidity with medical conditions and treatment implications. Annual Review of Clinical Psychology, 13, 209-240.

Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016). Developmental risk factors in generalized anxiety disorder and panic disorder. Journal of affective disorders, 206, 94-102.

Nevid, J. S. (2011). Essentials of Psychology: Concepts and applications. Cengage Learning.

Sauer-Zavala, S, Bufka, L., Wright C.V., (2016). Beyond Worry. How psychologists help with anxiety disorder. Web.

Shimada-Sugimoto, M., Otowa, T., & Hettema, J. M. (2015). Genetics of anxiety disorders: Genetic epidemiological and molecular studies in humans. Psychiatry and Clinical Neurosciences, 69(7), 388-401.

The National Institute of Mental Health. (2018). Anxiety Disorders. Web.

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