Panic disorder: symptoms, causes and treatment

The term “anxiety attack” is something we are all probably familiar with. In fact, most people have experienced it or seen someone do it in their lifetime. But in some cases, these seizures occur relatively frequently and generate a great fear of having them again, which in turn avoids the situations. We are talking about those people who suffer from panic disorder.

    Panic disorder

    So-called panic disorder is one of the most common types of mental disorder, which is characterized by the recurrent onset of sudden and unplanned panic attacks (the subject may be calm or in a state of anxiety before his or her appearance).

    Panic attacks, also called anxiety attacks, are the appearance of sudden and temporary episodes of feelings of anxiety, discomfort and the fear of a high intensity which can have a variable duration and which generally generate a maximum peak of activation in a few minutes and to be resolved in about fifteen minutes (although sometimes they can last for hours).

    During these seizures, a wide variety of symptoms appear, between which they emphasize tachycardia, profuse sweating, tremors, hyperventilation and feeling of suffocation, hyperthermiaNumbness, chest pain, intestinal discomfort, and psychological symptoms such as fear of dying or having a heart attack, the thought of losing control of one’s body or even going mad and possibly dissociative symptoms such as real) or depersonalization (strangeness with the very existence of the subject).

    After the anxiety attack (s), worry arises for a month or more so that they can let go again or that they experience the same sensations again at some point. The subject anticipates the occurrence of these attacks and this generates great fear and anguish, a fear that causes a state of great tension in the subject and can lead to the establishment of mechanisms and behaviors to prevent either these sensations or the possible emergence of new attacks. So, for example, if the panic attack hits us in the subway, we will probably avoid using public transport again.

    This will engender consequences of varying magnitude which will modify your daily life to a greater or lesser extent, both personally and socially and professionally. The functionality and daily life of the person with this problem will be limited by the panic and avoidance of the circumstances that can generate it. In fact, it is common for the subject to also end up suffering from depressive problems or even substance use and abuse.

    Anxiety attacks as something non-pathological

    Experiencing a panic attack is certainly an extremely unpleasant and aversive experience. As we said, it is common for the fear of dying or going crazy to appear. Also, many of the symptoms are somewhat reminiscent of a heart attack, which reinforces the idea that something very serious is happening and increases panic and anxiety and reinforces the symptoms described above.

    However, it should be borne in mind that panic attacks are not in themselves an indication of a disorder unless they occur very recurrently and generate avoidance in anticipation of their occurrence. In fact, a relatively high percentage of the world’s population will experience anxiety attacks or panic attacks at some point in their lives. This is especially common in demanding companies with a high level of demand., A common thing today.

    But despite what has been said, they should be taken into account when assessing psychopathology, as it is not uncommon for them to appear in both panic disorder and other mental problems.

      Relationship with agoraphobia

      Panic disorder has traditionally been closely linked to another psychological problem called agoraphobia, in which there is fear and anxiety about exposing yourself to places where escaping would be difficult or might not. receive help. in case of panic attack or other awkward situations (While the majority of the population considers this to be the fear of open spaces, in reality the underlying fear and what would result in avoiding these and other types of spaces would be as follows).

      Indeed, it is very common for agoraphobic subjects to anticipate anxiety and panic attacks and avoid these situations. In fact, although they were currently diagnosed separately until a few years ago, a distinction was made between panic disorder with or without agoraphobia.

        Confusion with heart problems

        One of the most common fears that arise during a panic attack is that you are about to die from a heart attack. This is a logical confusion, given that many symptoms are similar to angina or myocardial infarction: Tachycardia, chest pain, sweating …

        However, it should be noted that there are differences between panic attack and heart attack. Among them, there is no hyperventilation or a feeling of losing control of the body during the heart attack, unless other problems arise or anxiety arises. The pain is different and is usually more generalized too while in heart attack there is a link with exertion, in anxiety this does not happen. The duration of symptoms is also different. In all cases, it is advisable to go to a medical center.

        What is the cause?

        As with other disorders, the exact cause why some people develop panic disorder and others do not is not fully known.

        The onset of the first seizure may be due to situational factorsWhile some authors propose that the recurrence, anticipation and worry for panic attacks occur when faced with the generation of negative and aversive interpretations of bodily sensations unrelated to anxiety.

        The fact that certain sensations are interpreted as anxious it causes fear and anxiety, which ultimately leads to the onset of a seizure.

        There is also speculation about the possible influence of genes, with anxiety disorders generally being more common in families with previous cases. Patterns of learning behavior or past experiences may also have some influence.

        Treatment and therapy

        Panic disorder is a very disabling problem for those who suffer from it and generally tends to be chronic if left untreated. Fortunately, studies conducted on this anxiety disorder indicate that the most common and recommended treatments available are generally very effective, More precisely more than 80% of recoveries.

        One of the most common and effective treatments is, like with phobias, exposure. This technique is based on putting the subject in situations in which he gradually experiences situations that he avoids and generates anxiety in order to reduce the level of fear and anxiety in front of him and the avoidance that they entail. habitually.

        It is important to note that the exposure should be gradualA hierarchy of feared situations must be agreed with the patient in order to gradually reduce the anxiety generated. In the case of panic disorder, we are talking about both situations that avoid for fear of suffering a panic attack and work at the interoceptive level, including exposure to feelings of panic (eg: hyperventilation).

        Another of the most effective treatments, which can be given at the same time as the above, is cognitive restructuring. In this case, we aim to combat the dysfunctional thoughts and beliefs that generated and / or supported the problem. He seeks to de-catastrophize the situation and manages to change the negative interpretations of bodily sensations so that they are not attributed to the event of a seizure. of anguish. Behavioral experiments are also used in which the patient is asked to perform tests to check whether or not their thoughts and assumptions about what is going on (being sort of a small exhibition) correspond to reality.

        Teaching relaxation techniques can be used to lower the level of anxiety and distress or learn to control it, which results in great benefit to the patient.

        Drug use

        Sometimes psychotropic drugs are also used, it is common to prescribe benzodiazepines and tranquilizers or even some antidepressants such as SSRIs. The use of these drugs can be helpful in reducing the level of anxietyBut it must be combined with psychotherapy so that the subject learns to change his beliefs and stops avoiding situations and sensations, so that there are no relapses after withdrawing the drug.

        Bibliographical references:

        • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
        • National Institute of Mental Health (sf). Panic disorder: when the fear subsides. [publicación online]. Available at: https://www.nimh.nih.gov/health/publications/espanol/trastorno-de-panico-cuando-el-miedo-agobia/index.shtml#pub8

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