Could Anxiety and/or Grief Be
Putting You at Risk of Panic Attacks?

Out of the blue, you feel terror. Your heart is pounding. You're dizzy and you can't catch your breath. You begin to sweat profusely and perhaps even feel pain in your chest. You're certain that you're on the brink of a heart attack or that you're going to die. You may have just had a panic attack. And you're not alone. A nationwide survey documenting the far-reaching psychological impact of the Sept. 11 catastrophe finds the terrorist attacks triggered pronounced signs of emotional stress in 90% of Americans--and that for many, the trauma is now the cause of such problems as recurring panic attacks, a troubling but very treatable condition.

The American Psychiatric Association (APA) describes a panic attack as: "A discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes. The attacks are often accompanied by a sense of imminent danger or impending doom and an urge to escape."

1. Palpitations, pounding heart or accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or smothering

5. Feeling of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, lightheaded or faint

9. De-realization (feeling of unreality) or depersonalization (being detached from oneself)

10. Fear of losing control or going crazy

11. Fear of dying

12. Numbness or tingling sensations

13. Chills or hot flashes

It's estimated that between 3 and 6 million adult Americans suffer from panic disorder. It is extremely important for the person who has panic disorder to learn about the problem and the availability of effective treatments and to seek help fast.

What Is Panic Disorder-and Who Gets It?

In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations and dizziness) that occur repeatedly and unexpectedly in the absence of any current external threat. These "panic attacks," which are the hallmark of panic disorder, are believed to occur when the brain's normal mechanism for reacting to a threat--the so-called "fight or flight" response--becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another unpredictable attack, along with the efforts of avoidance it causes, can lead to disability in panic disorder.

Initial panic attacks often occur when people are under considerable stress, for example, having experienced a particularly traumatic event, or suffering from the loss of a family member or close friend. Panic attacks can also follow surgery, a serious accident, illness, the pressure of an heavy work demands, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.

Panic attacks usually take a person completely by surprise. This unpredictability is one reason they are felt to be so devastating. Sometimes people who have never had a panic attack assume that panic is just a matter of feeling nervous or anxious--the average intensity of feelings that everyone is familiar with. In fact, even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they often are really convinced that they are going to die, lose their minds, or behave in such a way that they will be totally humiliated. While such disastrous consequences don't occur, they can seem quite likely to the person who is suffering a panic attack.

Panic disorder typically begins in young adulthood, but older people and children can become affected. Women are affected twice as frequently as men.

The Course of Panic Disorder

Typically, a first panic attack seems to come "out of the blue," occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control.
This barrage of symptoms usually lasts several seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic attack can attest to the extreme discomfort they felt and to their fear that they had been stricken with some terrible, life-threatening disease--or were "going crazy." Often people who are having a panic attack seek help at a hospital emergency room.

Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, the attacks continue and cause much suffering.

Understanding Panic Disorder

In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear - called anticipatory anxiety or fear of fear--can be present most of the time and seriously interfere with the person's life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has had a panic attack while driving may become afraid to get behind the wheel again, even a short drive to the grocery store.

People who develop these panic-induced phobias will tend to avoid situations that they fear will trigger a panic attack, and their lives may be increasingly limited as a result. Their work may suffer because they can't travel or get to work on time. Relationships may become strained or marred by conflict as panic attacks, or the fear of them, rule the affected person and those close to them.

Also, sleep may be disturbed because of panic attacks that occur at night, causing the person to awaken in a state of terror. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep and suffer from exhaustion. Also, even if there are no nocturnal panic attacks, sleep may be disturbed because of chronic, panic-related anxiety.

Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a physician yields no indication of a life-threatening condition. They may visit a succession of doctors seeking medical treatment for what they believe is heart disease or a respiratory problem. Or their symptoms may make them think they have a neurological disorder or some serious gastrointestinal condition. Some patients see as many as 10 doctors and undergo a succession of expensive and unnecessary tests in the effort to find out what is causing their symptoms.

This search for medical help may continue a long time, because, too often, physicians who see these patients frequently fail to diagnose the symptoms as panic disorder. When doctors do recognize the condition, they sometimes explain it in terms that suggest it is of no importance or not treatable. For example, the doctor may say, "There's nothing to worry about, you're just having a panic attack" or "It's just nerves." Although meant to be reassuring, such words can be dispiriting to the worried patient whose alarming symptoms keep recurring. The patient needs to know that the doctor acknowledges the disabling nature of panic disorder and that it can be treated effectively.

What Is Agoraphobia-and How Is It Related to Panic Disorder?

Panic disorder may progress to a more advanced stage in which the person becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. This condition is called agoraphobia. It affects about a third of all people with panic disorder.

Typically, people with agoraphobia fear being in crowds, standing in line, entering shopping malls, and riding in cars or public transportation. Often, these people restrict themselves to a "zone of safety" that may include only the home or the immediate neighborhood. Any movement beyond the edges of this zone creates mounting anxiety. Sometimes a person with agoraphobia is unable to leave home alone, but can travel if accompanied by a particular family member or friend. Even when they restrict themselves to "safe" situations, most people with agoraphobia continue to have panic attacks at least a few times a month.

People with agoraphobia can be seriously disabled by their condition. Some are unable to work, and they may need to rely heavily on other family members, who must do the shopping and run all the household errands, as well as accompany the affected person on rare excursions outside the "safety zone." Thus the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.


Strategies For Coping With Panic

1. Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.

2. Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.

3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.

4. Do not add to your panic by thinking about what "might"
happen. If you find yourself asking "What if?" tell yourself "So what!"

5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen.

6. Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.

7. When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backward from 100 by 3's or snapping a rubber band on your wrist.

8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.

9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.

10. Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.