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Panic Disorder

When you’re in danger, your body’s natural reaction is to rapidly initiate the fight-or-flight response. This brain response occurs immediately when someone senses danger and it activates many brain areas that are designed to protect you from that danger by preparing you to “fight” the danger or to escape from it (i.e., “flight”). As part of this response, the brain triggers the release of adrenaline and other hormones throughout your body, so you can respond to the threat. This protective mechanism is called the fight-or-flight response and it helps us to survive. Your emotional and physical responses during fight-or-flight can be described as panic.

Sometimes panic can occur “out of the blue”, when you’re not in any danger. These panic episodes are called panic attacks. Because you’re not in any danger, these panic attacks aren’t useful; and in fact, they can cause significant problems. If someone experiences many panic attacks, he or she often begins to worry about having another panic attack and the anticipation causes him or her to feel even more anxiety. Sometimes this worry becomes so strong that he or she will avoid going to places where a panic attack might happen. For some people, this may severely limit where they feel comfortable going (such as: school, the mall, driving on the highway, etc.), resulting in another mental disorder called Agoraphobia.

Panic Disorder occurs when people suffer from sudden, unexpected and uncontrollable panic attacks. These panic attacks aren’t caused by any obvious fear (e.g., having a panic attack because you’re afraid of heights and on top of a ladder or if you’re afraid of flying and about to board a plane). People with Panic Disorder also experience anticipatory anxiety (worrying about having another attack or the consequences of having another attack) and avoid going to places where a panic attack might happen.

Not all people who have panic attacks have Panic Disorder. Panic attacks can occur in many different Anxiety Disorders and also in people who don’t have an Anxiety Disorder at all. In Panic Disorder, the panic attacks occur without any obvious reason. In other Anxiety Disorders (e.g., Social Anxiety Disorder), the panic attacks are triggered only by feared situations or thoughts (e.g., being in certain social situations).

What causes Panic Disorder and who is at risk?

In any one-year period, about 2-3 percent of people will have Panic Disorder. Although anyone can develop Panic Disorder, rates are higher among family members of people with Panic Disorder or other anxiety disorders.Panic attacks may begin in childhood or the early teen years, although Panic Disorder usually begins in late adolescence or early adulthood.

Although we don’t yet completely understand what causes Panic Disorder, we do know that genes play a large role because it’s very common for the immediate family members of someone with Panic Disorder to also have Panic Disorder. Research also suggests that experiencing really stressful events (e.g., major loss or abuse) might play a role in the development of Panic Disorder. And in certain people, marijuana appears to trigger the start of Panic Disorder, suggesting that the family members of someone with Panic Disorder or other anxiety disorders should probably stay away from this (and other) drugs.

How can you tell if someone you know might have Panic Disorder?*

Panic Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the teenager and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.

Someone with Panic Disorder will experience frequent, recurrent, and unexpected panic attacks. A panic attack includes four or more of the following symptoms which come on rapidly and peak within 10 minutes:

  • Sweating
  • Palpitations, pounding or accelerated heart rate
  • Trembling or Shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal pain
  • Feeling dizzy, unsteady, lightheaded or faint
  • Numbness or tingling in the body
  • Chills or hot flashes
  • Feeling of unreality or being detached from oneself
  • Fear of losing control or “going crazy”
  • Fear of dying

Panic attacks are self-limiting and usually last only a short time. They can range in intensity from mild to severe and can even wake you up from sleep.

For a diagnosis of Panic Disorder, at least one of the attacks must be followed by one month or more of persistent worrying about having another attack and/or a change in behaviour because of the attacks. The disturbances from Panic Disorder are not a result of other physiological effects and they cannot be better explained by another mental disorder.

*in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

What can you do if you are concerned that someone you know might have Panic Disorder?

1. Encourage the person to seek help (or take him or her to a trained health professional yourself, if appropriate).

2.   Ask the person a few questions to get a better sense of what is going on:

  • Do you ever have panic attacks without any clear reason? Panic attacks can include your heart racing, sweating, trembling or shaking, feeling like you can’t breathe, feeling like you’re choking, chest pain, nausea, dizziness, chills or hot flashes, tingling sensations, and fear that you’re losing control, going crazy, or about to die.
  • Are you worried about having another panic attack?
  • Do you avoid doing anything because you’re worried about having another panic attack?
What can you do if someone in your life has been diagnosed with Panic Disorder?
  • If someone in your life has been diagnosed with Panic Disorder, here’s what you can do:
  • Be well-informed. Learn about Panic Disorder and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
  • Encourage him or her to seek help from his or her family doctor. Panic Disorder is treatable.
  • Listen. Listen to his/her thoughts, worries and problems. Be supportive but ultimately be helpful by not enabling or supporting negative thoughts.
  • Give positive feedback. Notice when he or she is doing a good job. Praising him/her in situations that you know make him or her nervous will help boost confidence and reduce avoidance behaviors.
  • Don’t judge. Judging the person could make him or her withdraw from sharing his or her emotions. Not having someone to turn to could make him/her feel alone and make his or her symptoms worse.
  • It is important to accept the perceptions and emotions of the person as genuine and valid. Even if his or her fears don’t make sense to you, the anxiety is very real.
  • Help the person learn time management skills. Planning out your time and understanding what you have to do and how long you have to do it can help keep you from feeling overwhelmed.
  • Help the person find ways to relax. Going to yoga or out for a walk can be helpful.
  • Encourage the person to get lots of rest and eat a well-balanced diet. Having at least eight full hours of sleep each night and steering clear of junk foods makes a big difference in how someone feels. Some people with panic attacks find that caffeine (e.g., coffee, tea, cola, chocolate) can make things worse so avoid or cut down on caffeine. For information on healthy sleep habits, check out: Healthy Sleep
  • Help him or her to be socially active. When you’re afraid of having another panic attack, it can be really tempting to hide out alone at home. Encourage the person you care about to spend time with friends, play sports, and get out of the house. He or she may need you or a friend to join in at first, in order to feel safe.
  • Without lecturing, encourage the person you care about to avoid marijuana (i.e., pot) and drug use. Smoking marijuana can trigger a panic attack in some people. If Panic Disorder or other anxiety disorders run in your family, it’s best to avoid marijuana (and other drugs) altogether.
If the person is currently experiencing a panic attack:

  • Remain calm.
  • Remind the person that he or she is having a panic attack; he or she is not dying.
  • Encourage him or her to breathe deeply.
  • If possible, have the person hold his or her breath for a few seconds at a time.
  • Provide a supportive environment until his or her symptoms pass.
What treatment options exist?

There are several different treatment options for Panic Disorder. The most recommended form of treatment is CBT. In certain cases, CBT may be combined with medication. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional.

  • Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating Panic Disorder in teenagers is Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about his or her fears) and Exposure (e.g., gradually exposing the teenager to his or her fears while keeping him or her safe and teaching him or her effective strategies for coping with fear). Sometimes this therapy is provided in groups. 
  • Medication: Medications may also be used in combination with CBT. There are a number of different medications that might be prescribed, although Serotonin Specific Reuptake Inhibitors (SSRIs) are the most commonly used. For more information on how to properly use medications, check out MedEd.
  • School supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing his or her symptoms. 
  • Community supports: Community supports can include peer support groups for teenagers, support groups for families, and other helpful resources.
  • Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
  • Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with Panic Disorder. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for Panic Disorder, check out Taking Charge of Your Health.

Remember, all treatments have the same goals: decrease symptoms and improve functionality; decrease risk of relapse; and promote recover. Think about it this way: Get well; Stay well; Be well.

Other related disorders

It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders (also called comorbid disorders) include: 

  • Depression
  • Substance Use Disorders
  • Other Anxiety Disorders, including Agoraphobia
  • Bipolar Disorder
Dylan's Panic Disorder
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