Panic Disorder

This is the 4^th in my series of the most common psychological disorders in Australia. I’ve jumped the queue a bit with this one (actually should be the 7^th article). Frankly, I’m surprised this one wasn’t more common as its one of the most common conditions I treat. This disorder is closely associated with Agoraphobia which I’ll probably do next.

Panic Attacks

Scotty feels his body jolt. “Somethings wrong” he thinks in alarm. He’s sitting on the window seat of a crowded train. Scotty feels his pulse in his ears and tries to breathe deeply “only three more stops to go” he reassures himself weakly. The deeper he tries to breathe the harder it is to get air, “I’m going to lose control” thinks Scotty. He quickly stands up and feels lightheaded, he is aware of the other passengers’ eyes on him. He bustles past the commuters and out onto the open platform where he can finally breathe. He finds a seat and closes his eyes.

A panic attack is an intense, escalating fear/anxiety experience. Panic attacks consist of physiological changes such as shallow breathing, heart racing/palpitations, sweating, trembling and blurred vision. These physiological changes are associated with the body’s fight or flight, or adrenaline response.

Panic attacks also commonly occur with certain fear-beliefs such as the fear of a heart attack, or dying, or going crazy or losing control. These beliefs represent our mind trying to make sense of the fear and the body’s frightening response. The mind catastrophises which causes more fear and further escalation of panic.

In Panic disorder, this experience seemingly comes out of the blue. Its unlike a specific phobia like of fear of flying, or social phobia in this way. This unexpected quality makes the panic attacks all the more scary and adds to the experience of helplessness.

Fear of Future Attacks

Scotty tentatively resumed his normal commute the following day, willing to put his experience down to a one-off. He felt gradually less nervous for the next week. Then, exactly one week later, he was hit by the second, much more intense attack. The woman sitting next to Scotty asked if he was okay, Scotty was unable to speak, but managed to make his way off the train at the next stop. The following evening Scotty had another attack. From that day on, Scotty lived in fear of future attacks.  

Panic disorder involves the fear of future attacks. Once one or more attack has occurred our attention becomes attuned to any sign that another attack might occur. Any feelings of anxiety or physical symptoms (like shallow breathing) might be a signal that another attack is about to occur.

Being hypervigilant to signs of panic is obviously stressful. Ironically the more frightened of panic attacks we become, the more likely they are to occur. This is because the stress of waiting for the next attack is more likely to create a panic trigger (such as shallow breathing). Once the panic trigger is perceived, the panic attack quickly escalates. In this way, fear of panic becomes a self-fulfilling prophecy.

Treatment

Scotty attended an appointment with his GP who told him that he was probably experiencing panic attacks and taught him breathing techniques which moderately helped. She ran some scans and wrote a referral to a Cardiologist (who reaffirmed the panic attack diagnosis). Scotty’s GP then referred him to a Clinical Psychologist. Scotty engaged in exposure to his bodily sensations (deliberately hyperventilating and making himself lightheaded). Scotty also learnt to challenge his panic beliefs. Scotty had previously worried that he might have a heart attack or go crazy.

Cognitive Behavioural Therapy (CBT) is an effective, evidence-based treatment for panic disorder. This treatment involves identifying and challenging panic beliefs. It also involves exposure to the physical signs of panic. The goal of the treatment is to decatastrophise panic attacks and prevent avoidance or escape from panic situations.