Panic disorder is characterized by recurrent and unexpected panic attacks, which are sudden surges of severe fear or discomfort that heighten significantly within minutes. One type of unexpected panic attack, and a common one at that, is a nocturnal panic attack. This is when the individual wakes up from sleep in a state of panic. In the United States, nocturnal panic attacks affect around 1/4 to 1/3 of all individuals with panic disorder; these people also typically experience daytime panic attacks.
Panic disorder typically incites serious and constant feelings of anxiety in an individual, which often concern his or her health and mental health. For example, individuals with the disorder anticipate that a mild symptom will result in a disastrous outcome. Additionally, individuals may worry about their ability to go about their daily lives normally and withstand daily stressors.
Panic Disorder Criteria DSM-5 300.01 (F41.0)
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the following criteria must be met in order for a panic disorder diagnosis to be successfully made:
- The individual experiences recurrent unexpected panic attacks, which are abrupt feelings of intense fear or discomfort that reach great heights within minutes, during a time in which at least four of the following symptoms occur:
- Palpitations or quickened heartbeat
- Abnormal sweating
- Trembling or shaking
- Instances of shortness of breath or feeling smothered
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal pain
- Dizziness or faintness
- Chills or hot flashes
- Numbness or tingling sensations
- Derealization (feelings of unreality) or depersonalization (feeling detached from his or herself)
- Fear of losing control or “going crazy”
- Fear of death
- One or more of the attacks were followed by a month (or longer) of one or both of the following:
- Persistent worry about having more panic attacks and/or their consequences (e.g., having a heart attack)
- A significant abnormal change in behavior in response to the attacks, such as ones intended to avoid unfamiliar situations.
- The disturbance cannot be attributed to the physiological effects of a substance, such as a drug or medication, or another medical condition.
- The disturbance cannot be better explained by another mental disorder, such as social anxiety disorder or specific phobia, which may involve panic attacks.
Who is at Risk of Developing Panic Disorder DSM-5 300.01 (F41.0)?
Panic disorder typically begins to affect individuals when they’re in their 20s or 30s. Cases do begin in childhood, as well as in individuals over 45 years, but these cases are rare. If the disorder is left untreated, the course is chronic, which can wax and wane over time. Some may experience sudden episodic outbreaks after years of remission and others may experience consistent symptoms.
There are no gender or culture-related risks, but there are environmental and genetic risks. Most individuals report identifiable stressors in the months leading up to their first panic attack. Reports of childhood abuse are more common in panic disorder than other anxiety-related disorders, and there are numerous genes that may make an individual more vulnerable to panic disorder.
Is There Treatment for Panic Disorder?
Panic attacks and panic disorder can be effectively treated. Some of these treatment options include:
1. Cognitive behavioral therapy (CBT): This form of therapy focuses on determining the thought and behavior patterns responsible for sustaining or causing the panic attacks. The therapist will help the individual look at his or her fears more realistically. For example, someone may have a panic attack when they get behind the wheel of their car. But what’s the worst thing that will happen? He or she is not likely to crash or have a heart attack while driving. The severity of the fears is irrational.
2. Exposure therapy: This therapy involves the individual being exposed to physical sensations that come with his or her panic attacks in a safe environment and allows them to learn better coping techniques. For example, the individual may be asked to mimic or cause symptoms of panic, like holding his or her breath. This repeated exposure will help the individual shake their fears associated with these symptoms and gain control over his or her panic.
3. Medication: Medication can be used to control or lessen symptoms related to panic disorder, but only temporarily—it does not resolve the issue. It is most effective when combined with other treatments, such as the aforementioned cognitive behavioral therapy and exposure therapy. The medications used to treat panic attacks and panic disorder include antidepressants, which work after being taken for several weeks, and benzodiazepines, which take effect much more quickly.
4. Mindfulness training: Many people with panic disorder have benefited from mindfulness techniques that help them focus attention on the present by engaging their senses. These methods can be especially helpful in the midst of a panic attack, as when a person tries to slow their breathing and count 5 things in their environment they can smell, five things they can see, etc.
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