Panic disorder is one of the ways that normal fear and anxiety can become a problem.
A panic attack is a sudden rush of fear. It can include a variety of physical symptoms: pounding or racing heart, chest pains, shortness of breath, trembling or shaking, a feeling of choking, sweating, dizziness, nausea, numbness or tingling in face, hands, or legs, hot flashes or chills. Along with physical symptoms there can be thoughts like fear of dying, fear of going crazy, fear of doing something uncontrolled, or feeling that you or your surroundings are strange or unreal.
One of the frightening features of panic attacks is that often, they seem to come out of nowhere; there doesn’t seem to be any triggering event or an obvious source of threat or danger. Normal fear and anxiety can help you be aware of situations that are threatening or need your attention, so it is easy to see how the intense symptoms of a panic attack that make no sense or serve no purpose can be a real struggle.
Panic attacks are not unusual; various studies show that anywhere from 10 to 30 percent of people will experience a panic attack in a given year. So how do panic attacks turn into a panic disorder? There are several criteria for diagnosing a panic disorder. One is that the panic attack seems to show up without an obvious trigger or cause. But there is more to it than that. Another panic disorder diagnosis is worry about when the next attack will come and what will happen to you when it does. You picture yourself having a panic attack in public and being humiliated. You worry that you will have one at work and lose your job. You may worry that the presence of a panic attack means you have serious mental problems.
Worry Leads to Change in Behavior
This constant worry about the next attack leads to a final panic disorder criterion. You start to change your behavior so you will be ready to cope with the attacks or prevent them from happening. In their book, The Mindfulness and Acceptance Workbook for Anxiety, John P. Forsyth and Georg H. Eifert list some of the behaviors you may do to manage your panic:
· Sitting near exits at the movies or in a restaurant.
· Checking for the closest exit when visiting a mall or store.
· Carrying medication, money, cell phone, water, or other safety items.
· Drinking alcohol to combat the panic.
· Avoiding caffeine, alcohol, other substances (spicy foods, etc.).
· Frequently checking your pulse or blood pressure.
· Distracting yourself to avoid panic (reading a book, watching TV).
· Needing to be accompanied when leaving the house.
· Needing to know the location of your spouse, your partner, or a “safe” person.
Forsyth and Eifert also identify places and events that you avoid because they are where a panic attack might happen. These include:
· Crowded public places (malls, stores, theaters, sporting events).
· Enclosed or confined places (tunnels, bridges, small rooms, elevators, airplanes, subways, buses, long lines.
· Driving, especially on highways and bridges, in bad traffic, or long distances.
· Being away from home. Some people have a safe distance beyond which they find it difficult to travel; in some cases, leaving home may be difficult or impossible.
· Being alone, at home or in any if the situations listed above.
Avoidance is often the problem.
If you have experienced a panic disorder or know someone who has this disorder, you can see how debilitating it might be. And it makes sense that people with panic disorder would do all they could to avoid any hint of fear and anxiety. But it is that avoidance which leads to all the restrictive behaviors listed above that keep you from living a life of meaning and value.
Acceptance and Commitment Therapy (ACT) is an evidence-based approach to treating panic disorder that is effective in developing a different relationship with the panic. You can learn more about this counseling approach by going to my anxiety treatment specialty page.