What is panic disorder and what are panic attacks?

Panic attacks are feelings of severe anxiety that start and finish quite suddenly. They are sometimes called anxiety attacks. If you have a panic attack, the feelings may be so scary that you feel you are about to die, collapse or lose control of your mind. You may feel desperate to escape or find help.
 
Such an extreme reaction would be normal in a situation where your life really was in danger, for example, if you were in the sea and a shark was swimming towards you. This is called the 'flight or fight' response and has a life-preserving purpose. But panic attacks happen when there is no real danger. They may start for no obvious reason. Often they happen in an everyday situation you have become anxious about, like being in a supermarket.

Panic attacks are so unpleasant that people are frightened of having another one. They often remember their first attack for the rest of their lives.

Panic disorder

People who have frequent panic attacks, once a month or more, have panic disorder. Other factors which may mean you have panic disorder rather than panic attacks are when your life is seriously affected either by fear of having attacks, or if you avoid certain places in case you have an attack. Although most of the symptoms and treatments are the same, panic disorder is a more serious and life-disrupting form of panic attacks.

Symptoms of panic attacks

The most obvious symptoms are the panic attacks themselves. These start suddenly, often in a few seconds; sometimes over five or 10 minutes. As well as feelings of great anxiety, fear, or terror, people may also have many other symptoms, most of which are physical.

In an attack you may feel several of the following:

• shaking or trembling
• sweating
• choking feelings
• racing or pounding heart
• chest pain or tightness
• nausea or stomach pain
• hot and cold feelings
• shortness of breath or feeling smothered
• dizziness or light-headedness
• tingling, often in the fingers
• feeling cut off from reality
• fear of losing control or going crazy.

These are all symptoms of severe anxiety. Because many of them are physical sensations, people with panic attacks often think there is something wrong with their body. They may think they are having a heart attack or stroke or that they are dying. They may be rushed to an emergency medical service. People do not die of panic attacks, even though they may feel that way during an attack.

Panic attacks normally last for 10 or 20 minutes but people can feel anxious or shaken up for some hours after. Panic attacks are common. Many people will have at least one attack during their lifetime. One person in 10 might have one attack in a year.
 
Panic disorder is also quite common. About three people in 10 will have this disorder at some time in their lives. Women are affected twice as often as men. The problem usually starts between the late teenage years and the age of 35. Usually it causes problems for a few months and then lessens.
 
Unfortunately, panic attacks often come back again after a few months or years and a person's avoidance of places or situations for fear of a panic attack may get worse. One third of people with panic attacks avoid places where they might panic. This is called agoraphobia.

Most people who have not been treated for panic will still have some symptoms 10 years later. By then they may have become depressed or have started to overuse alcohol or other drugs because of repeated panic attacks and the restriction in their lives caused by panic. If depression becomes severe they may feel suicidal.

If you have panic attacks it is important to seek help and information, as panic attacks themselves are fairly easy to treat. Early treatment can help to avoid later complications and the development of panic disorder.

Causes of panic attacks and panic disorder

There are many causes of panic. Most people with panic disorder will have several of the following factors that have led to their attacks.

• Panic runs in families. While you are more likely to have panic attacks if your parents have had them, it is not inevitable that children will have panic attacks just because a parent has.
• Personality may play a part. Some people are more nervous and highly strung than others. This may be good in some circumstances because they are more sensitive and cautious. But the down side is that they will be slightly more likely to have anxiety problems, including panic. Again, this is not always the case. Some anxious people never experience sudden panics and some people who are very calm and confident by nature will develop panic attacks.
• Events and situations in your life can put you under stress and make you more vulnerable to panic. For example, a woman is at home looking after very young children. Her partner is away much of the time and her own mother becomes physically unwell and needs her support. All of this can put stress on her and make her vulnerable to panic. Typically, events that make you feel unsafe or insecure or anxious may be causes. General stresses like poverty or poor housing or relatives dying could make you vulnerable. Panic can also occur as part of another mental illness. It commonly occurs with depression.
• For some people, panic seems to start out of the blue. They may just have a strong inherited tendency to panic. For others there seem to be obvious stresses in their life. There are often some symptoms of general anxiety or depression, or other phobias in the months before panic starts. (If panic attacks follow an experience which really was extremely dangerous or horrific, like being assaulted or being in an accident, then it is usually part of a different condition known as post-traumatic stress disorder or PTSD.)
• Some common substances can cause panic. Caffeine, found in coffee and many soft drinks, is the most common. Tea has a similar, but weaker, effect. People who have panic attacks and panic disorder may be very sensitive to caffeine and even small amounts can be harmful. Alcohol does not directly cause attacks, but as its effects wear off, you are more likely to have a panic attack. Cannabis is another drug which some people are sensitive to, and for them, it can start panic attacks. The effects of cannabis are long-lasting as the body takes weeks to get rid of it.
• Over-breathing, also called hyperventilation, is a problem for the majority of people with panic disorder. Anxiety makes you breathe too much. Over-breathing alters the balance of chemicals and gases in your body so you feel even more anxious. This imbalance can directly cause some of the physical symptoms like dizziness and tingling. Strangely, when you are over-breathing, you may feel as if you are not getting enough air and breathe even harder. This makes you feel worse and you get caught in a vicious cycle.

Triggers for panic attacks

Individual panic attacks may be triggered either by situations or certain thoughts. Attacks can be started by any situation that makes you anxious, but particularly ones in which you have had previous attacks.

Common places that people have attacks are:

• supermarkets
• shopping malls
• church
• meetings
• in cars.

Some people panic when alone, others when they feel they cannot leave a situation easily.

Panic attacks may be started by anxious or catastrophic thoughts. After exercise your heart naturally goes faster. A catastrophic thought would be to think that your heart going fast was a sign of a heart attack. This would make you anxious and anxiety would speed your heart up more and induce panic.

People with panic attacks may believe they developed their problem because of stress or psychological problems arising from the past. Other people with panic attacks cannot so easily find problems in their lives which could lead to panic attacks. They may agree with the view that their problem is genetic or biological in origin. A lot of people with mental illness believe it is a combination of these things.

Sometimes people think their mental illness is a punishment for their moral or spiritual failure. It's important to remember it is not your fault you have a mental illness.

Families and whanau, especially parents, can worry that they caused their relative to develop panic attacks or panic disorder. Sometimes they feel blamed by mental health professionals which can be very distressing for them.

Most families and whanau want the best for their relative. It is important for them to understand what factors have contributed to their relative's problem and to be able to discuss their own feelings about this without feeling guilty or blamed.

See also: Panic attacks/disorder - living with; Panic attacks/disorder - treatment

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health Foundation of New Zealand, 2002. Edited by everybody, May 2005.