Understanding panic disorder

Dr Meesha Haorongbam *

Introduction

Have you ever had an overwhelming sense of fear lasting for minutes ? Perhaps you felt your heartbeat racing with a pounding sensation, your limbs feeling jiggly, with butterflies in your tummy-like sensation, gasping for breath, your hands feeling clammy, unable to think and worried that the end is near ? This is called a panic attack.

With a lifetime prevalence of 22.7%, it is not as uncommon as one might presume. When panic attacks increases in intensity, duration, and frequency then one might be diagnosed with panic disorder.

What is panic disorder ?

Panic disorder is a type of anxiety disorder where there are repeated and frequent discrete episodes called panic attacks. Panic attacks are overwhelming sudden surge of fear lasting for minutes that occurs without warning and without any obvious reasons. It is more intense than the usual stress that most people experience.

During the episode there is a feeling of being out of control, or a fear of death or impending doom. Physical symptoms vary from person to person but some common ones are: pounding heart, sweating, trembling or shaking, dryness of mouth, breathlessness, choking sensation, chest pain, nausea, dizziness, hot flushes or chills, and numbness or tingling sensation.

The hallmark of panic disorder is the fear of having another panic attack and the intense worry about when the next episode will happen. This leads to a person avoiding presumed objects and scenarios causing panic attacks thereby hampering their quality of life.

Whom does it affect ?

Panic disorder affects more women more than men (almost 2X). It usually starts during late childhood or early adulthood. However no demographic variable is immune to it. It can affect anyone at any point of time.

What causes panic disorder ?

You might have noticed that the symptoms of a panic attack (as described earlier) closely resemble a “flight or fight” reaction which occurs in normal conditions when humans are faced with a threat or a dangerous object/situation. In panic attacks/disorder, our brain misinterprets harmless signals as “dangerous” and prepares the body for a flight-or-fight-reaction.

The increased blood pressure, increased pulse rate, and palpitation, that occur as a result, are further misinterpreted by the brain as a “threat” and so on the cycle continues until the body is exhausted. So why does the misinterpretation or the misfiring of signals happen in the first place ? There is no single satisfactory answer for it.

However twin studies have confirmed the possibility of genetic inheritance of panic disorder though we have yet to identify a specific biological marker. Genetic vulnerability acted upon by a stressful life event such as a recent loss or separation or failure seems to be the best explanation for panic disorder so far.

To put it simply- stressors lower one’s resistance which causes underlying physical predisposition to kick in and thereby trigger an attack.

What are the effects of panic disorder ?

Panic attacks are not lethal per se but they are absolutely uncomfortable and terrifying to the point that people start thinking they are going crazy or having a heart attack or even dying. It can also lead to other mental health conditions such as depression, substance dependence, phobia and even suicide. Severity can range from mild to severe leading to social impairment and a total inability to carry out any day-to-day tasks.

Some commonly reported effects of panic disorder are:

o Inability to attend classes, coaching, or work leading to poor academic and work performance
o Spending less time on satisfying recreational activities
o Spending more time in hospital emergency rooms
o Drain on financial resources
o Feeling physically and emotionally less healthy than their peers
o Inability to involve in activities in places and space outside their comfort zone
o Strain on their relationships with their family, friends, and colleagues.

Can a person with panic disorder live a normal life ?

YES!!!!! But only if you receive treatment. With proper treatment you do not have to experience any of the above mentioned effects and can go on to lead satisfying lives. If left untreated, there can be serious consequences as mentioned earlier.

Adequate treatment should be sought in a timely manner and there should also be strict adherence to the treatment protocol advised by your health care provider. Poor treatment compliance is the major challenge faced while managing panic disorder.

What are the treatments available ?

Treatment for panic disorder can be broadly divided into: pharmacotherapy, psychotherapy, and dual therapy. The mode and duration of treatment depends on various factors-the most crucial being the severity of illness.

The internet is loaded with information about various treatments for panic disorder. But remember, any treatment should be outlined and prescribed by a mental health professional such as a psychiatrist or a clinical psychologist.

Why should more people be aware of panic disorder ?

It is worthwhile to reiterate the fact that the prevalence of mental illnesses have been steadily increasing for decades. The ongoing pandemic has also contributed to a sudden spike in the prevalence of mental health conditions. Anxiety is reported to be the most common mental disorder currently experienced around the world especially due to the current situation.

It won’t be wrong to say that more than 80% of the cases handled by the psychosocial support staff of various districts in Manipur in the past 10 months are anxiety disorders and around 50% of those are panic attacks/disorders. Panic disorder requires prompt diagnosis and treatment because if left untreated it can have harmful consequences.

A survey by the American Psychiatric Association found that a person with panic disorder usually visits 10 doctors before being properly diagnosed and only one out of four receive the treatment they need.

Leaving the stigma of mental illness aside, the very disturbing physical complaints (which often mimics cardiac or respiratory diseases) makes it very hard for a person to accept that it is more of a mind and body illness than a purely physical illness. As will any illnesses, earlier the diagnosis and treatment better will be the outcome.

Hence it's absolutely essential to spread awareness about this very common yet often misdiagnosed disorder.