Panic disorder is a condition characterised by recurring and regular panic attacks. People who suffer from panic disorder will experience frequent intense surges of terror and anxiety, which can strike suddenly without warning. In between attacks sufferers may also constantly worry about further attacks and may fret over the symptoms that they trigger, including dizziness, chest pains and heart palpitations.
It can be very stressful living with panic disorder, and many sufferers go on to develop further problems such as depression, and drug or alcohol abuse. A number of people with panic disorder will also avoid situations where they fear an attack may occur, and in severe cases may become housebound. However, early treatment can help to prevent this.
This page will explore panic disorder in more detail, highlighting symptoms and causes, and how the condition can impact on a sufferer's life. It will also look into panic disorder treatment and how counselling in particular is considered highly effective for alleviating symptoms and helping people to overcome their fear of panic.
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How does panic disorder develop?
Anxiety and feelings of panic are completely natural human responses, designed to enhance our chances of survival and help us to deal effectively with stressful or dangerous situations. Unfortunately, some people will experience feelings of anxiety, stress and panic on a regular basis.
Around one in 10 people in the UK have the occasional panic attack, which are usually triggered by a stressful event. They strike, often without warning, when the body experiences a rush of intense emotional and physical symptoms. Panic disorder is a result of these one-off attacks escalating to the extent that they become more frequent and less predictable. The NHS estimates that one in 100 people are currently affected - young people as well as adults - and the condition is twice as common in women as it is in men.
Panic disorder symptoms
The symptoms of panic disorder can be very distressing and frightening, especially as they are often completely unexpected and develop abruptly. Panic attacks can strike anywhere and at any time. They tend to peak after 10 minutes and last between five and 20 minutes, however in rare cases some last longer. People with panic disorder may have one while they are out shopping, walking down the street, driving their car or even when they are relaxing at home. The frequency in which panic attacks occur will vary from person to person. While some people with panic disorder will have one or two attacks a month, others may have them several times a week.
As well as overwhelming feelings of anxiety, panic attack symptoms also include a combination of the following:
- feeling dizzy, faint or light-headed
- hot or cold flushes
- trembling or shaking
- chest pain or discomfort
- heart palpitations
- shortness of breath
- a choking feeling
- fear of dying, losing control or going crazy
- numbness or tingling sensations
- dry mouth
- a need to go to the toilet
- ringing in your ears
- a feeling of dread
A fear of future attacks
It is due to the intensity of these panic attack symptoms - particularly the feelings of fear and terror - that many people with panic disorder are unable to relax between attacks. Constantly worrying about when another attack will occur creates a cycle of living in 'fear of fear', which reinforces panic and anxiety. The emotional toll of this anticipatory anxiety can negatively impact self-confidence and may greatly disrupt a person's ability to function normally on a day-to-day basis.
In some cases, people with panic disorder will develop phobic avoidance, where they attempt to avoid certain situations and environments out of fear that these may put them at risk of having an attack. If this behaviour progresses, it can lead to agoraphobia, which is a common complication of panic disorder.
People with agoraphobia will be fearful of leaving their home, and will aim to avoid:
- Going anywhere without the company of a 'safe' person.
- Physical exertion.
- Going to places where escape may be difficult (e.g. public transport).
- Going to places where it would be embarrassing to have a panic attack (e.g. a social gathering)
- Eating or drinking anything that may provoke a panic attack (e.g. alcohol, caffeine, sugary foods, etc.)
According to Patient.co.uk around one in three people with panic disorder will develop agoraphobia, although the severity can vary. Some people with agoraphobia can cope well outside of their home as long as they only visit areas that they are familiar with, while others may become housebound due to such intense fear of going out in public. It is also possible for sufferers to experience good spells where they cope better than at other times.
Heart attack sensation
Sometimes the symptoms of panic attacks can be so intense that people may feel like they are having a heart attack. Those who have had panic disorder for some time are usually able to recognise this 'heart attack sensation', and will be aware that although the tightening of the chest may be scary, it cannot cause any physical harm.
Many people with panic disorder will experience a sense of unreality and loss of control during a panic attack. The unexpectedness and sheer intensity of symptoms can make you feel detached from your body, your surroundings and the situation. This depersonalisation does not provide any relief, or make an attack seem less frightening. Instead it can make it more disorientating and confusing.
Problems with development
Panic disorder is less common in young people and children, but it can have similarly debilitating effects. A severe case of panic disorder has the potential to affect a child's development and learning, especially if their ongoing fear of having a panic attack prevents them attending school and engaging in social life. Panic attacks in children can be quite dramatic - often featuring lots of screaming and weeping - and this can be distressing for all those involved. Panic disorder treatment can be provided for both adults and young people living with panic disorder, so if you recognise panic disorder symptoms in your child, you should contact your GP as soon as possible.
What causes panic disorder?
The exact causes of panic attacks, and subsequently panic disorder, are unknown, though it does tend to run in families. Certain medical conditions and other physical complications are also linked, while many people with panic disorder will develop the condition following major life transitions and experiences. A common theme that surrounds panic disorder is severe stress, and panic attacks can be viewed as a physical outpouring of this built-up anxiety, which escapes through a sudden burst of intense symptoms.
Below are some of the physical and emotional factors that are thought to contribute to the development of panic disorder.
- Traumatic life experiences - Trauma such as bereavement or abuse can trigger feelings of anxiety. These may surface soon after the trauma or unexpectedly years later.
- Stressful life transitions - Having a baby, losing a job, getting married or divorced are major life changes that can cause a lot of stress and trigger panic attacks.
- Brain chemical imbalance - An imbalance of neurotransmitters in the brain is thought to increase a person's risk of developing conditions such as panic disorder.
- Enhanced sensitivity to carbon dioxide - Some experts believe that panic disorder is associated with heightened sensitivity to carbon dioxide. Breathing air with high levels of carbon dioxide can trigger panic attacks, while breathing techniques are often used to help relieve or stop them.
Diagnosis of panic disorder
A professional diagnosis for panic disorder can ensure that treatment is provided to individuals whose health and well-being is beginning to suffer as a result of their regular panic attacks. Essentially, while all those who have panic disorder will experience panic attacks, not everyone who experiences panic attacks will be diagnosed with panic disorder. This means many people could be missing out on valuable treatment and support.
Some people's panic attacks will be a response to certain situations - triggered by a particular fear. For example someone with an intense phobia of small, enclosed spaces is likely to have a panic attack when faced with such a situation. People with panic disorder, however, will have panic attacks for no obvious reason, and far more frequently. This, as previously mentioned, is often coupled with an ongoing fear of future panic attacks and the symptoms that arise.
If you are worried that you may have, or may be in the early stages of panic disorder, you should seek help from your GP straight away. Sharing your concerns with a medical professional will not only provide a sense of relief from your ordeal, but will help to ensure you get an accurate diagnosis of your ailments. Typically, your GP will ask you to describe your symptoms in detail and explain how often these are occurring. He/she may also carry out some tests to determine whether your panic attacks are linked to particular health conditions such as heart or thyroid problems. Although it may be hard talking about your condition, your GP needs a thorough understanding of what you are experiencing in order to ensure you receive the most appropriate treatment for your individual situation.
Panic disorder treatment
Panic disorder and panic attacks are treatable, and there are various treatment options available which can help to ease the severity of symptoms and reduce the number of panic attacks that occur. Treatment will be tailored to your individual circumstances and your GP will discuss the options available - outlining the advantages of each method and also making you aware of any risks or side effects.
Counselling for panic disorder
Generally the most effective means of panic disorder treatment is counselling, and the application of cognitive behavioural therapy (CBT). This approach has long-term benefits and will also help to tackle complications that develop from panic disorder such as agoraphobia. In CBT sessions, therapists will work with clients to focus on the negative thinking patterns and behaviours that are triggering or sustaining panic attacks. By helping you to see your fears in a more realistic light, CBT can teach you new coping skills, which will make it easier to deal with future panic attacks. For example, your therapist may teach you breathing techniques that can be used to help keep you calm during the stress of a panic attack. The National Institute for Health and Care Excellence (NICE) recommends 14 hours of CBT over a few months to ensure effective treatment for panic disorder.
As there is no single treatment that suits everyone, some people with panic disorder will require medication to support their recovery process. Medication involves the prescription of antidepressants and other tablets which help to temporarily control or reduce panic disorder symptoms. This treatment is usually only effective when combined with other methods, including counselling and lifestyle changes. This is because an important part of panic disorder treatment is addressing the underlying causes of the condition.
As panic disorder can be frightening and isolating, many sufferers benefit from attending face-to-face meetings where they can talk about their problems with people who are experiencing the same feelings and emotions. Your GP can direct you to support groups for panic disorder in your local area.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat panic disorder. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments.
In the first instance those suffering with panic disorder should be offered access to a support group and self-help information recommendations by their doctor. If this doesn't help, or the panic disorder is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.
Read the full NICE guidelines:
There are several accredited courses, qualifications and workshops available that can improve a counsellors knowledge of a particular area, so for peace of mind you may wish to check to see if they have had further training in treating panic disorder.
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- Anxiety disorders - have I got one and how can counselling help?
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