Panic disorder is an anxiety disorder characterised by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, dizziness, shortness of breath, or abdominal distress.
THE PANIC ATTACK FAMILY TREE
Like most full-blooded psychological disorders the panic attack belongs to a family tree – in this case the family of anxiety disorders and specific phobias such as fear of strangers, pain, heights, germs, social phobia (fear of social and performance situations), acute stress disorder and anxiety disorder.
SIGNS AND SYMPTOMS
Panic attacks masquerade as a variety of medical disorders. They mimic some medical conditions almost completely, leading to misdiagnosis. These include hypoglycaemia, complex partial seizures, drug effects, arrhythmia and hyperventilation syndrome. They partly mimic others, including asthma, angina, colitis, irritable bowel, post concussion syndrome, vertigo, mitral valve prolapse, hiatal hernia, heart attack and hypertension. Many patients with panic attacks believe they have a serious physical illness, and might go from doctor to doctor as symptoms persist.
WHAT DOES IT FEEL LIKE?
It is essential to know the experience of the panic itself. Once it happens, a person’s life changes dramatically. Panic attacks bring on the fastest and most drastic changes known in the human body. They are experienced as overwhelming, uncontrollable dread, as if one is terribly ill, almost dying or losing one’s mind. They drastically change the functioning of the major glands, heart, lungs, stomach, intestines, pancreas, kidney, bladder and the largest muscle groups. A cascade of stimulant hormones – cortical hormones, adrenaline, epinephrine, glycogen and norepinephrine, among others, flood all the cells of the body and bloodstream.
During a panic attack you feel suddenly terrified for no reason, your heart will most likely pound and you will feel sweaty, weak, dizzy or faint. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control.
The reaction is the typical ‘fight-or-flight reaction’ and the impulse is to run, hide or get out. Many patients develop intense anxiety between episodes. It is not unusual for a person suffering from panic disorders to develop phobias about places, persons or situations where panic attacks have occurred. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur, or where help may not be immediately available. This avoidance may eventually develop into agoraphobia.
THREE TYPES OF PANIC ATTACK
- Unexpected – it ‘comes out of the blue’ without warning and for no discernible reason.
- Situational – situations in which an individual always has an attack, for example, upon entering a tunnel, or flying in an airplane.
- Situational predisposed scenarios – situations in which an individual is likely to have a panic attack, but does not always have one, for example, while driving or attending a work meeting.
WHY DO I PANIC?
Panic disorder usually starts when we are young adults, around 18 to 24 years old. Sometimes it starts when a person is under a lot of stress, for example, work pressure, high personal or unrealistic expectations, or after having a baby. Anyone can have a panic disorder, but more women than men have the disorder. It sometimes runs in families. When you have a problem with panic disorder, you are part of 7.2% (or 1 in 15) people. However, the reasons and contributing circumstances leading to this disorder are highly personal and varied. There is seldom only a single cause for this disorder, but rather a couple of contributing and explanatory causes or circumstances.
These are some of the most regular causes of panic attacks: prolonged stress, traumatic events, anxiety neurosis, previous traumatic experiences, blood sugar blues, inadequate supplementation, histamine-copper connection (many patients with very low histamine levels experience phobias, anxiety and paranoia and excessive copper levels may depress histamine levels), low magnesium levels, too much lactic acid, food allergies, poor liver function, unhealthy lifestyle choices and lack of life skills, adrenal fatigue, and personality (socially avoidant, schizotypal and obsessive-compulsive patients tend to be more prone to panic attacks due to their being inhibited, feeling inadequate, hypersensitive, with cognitive and perceptual distortions as well as the need for perfectionism and control).
Panic disorders seem to occur more often in people who are socially avoidant, perfectionist or who have been abused in childhood. Many experts believe panic anxiety disorder afflicts emotionally healthy people. However people experiencing panic attacks are more likely than the average person to have suffered from emotional problems or extenuating circumstances at the time the disorder began. Many therapists view panic and anxiety as indications of a lack of balance or harmony between body, mind and spirit, rather than a personality disorder.
TREATMENT OPTIONS
There are many treatment options for panic disorder and treatment is individualised. If ever the adage ‘treating the patient, not the illness’ is applicable, it is proved by the treatment procedures for panic attacks. Therapists will use one or a combination of these therapies, according to their training or theoretical preference.
Medical/psychiatric
Allopathic medication can be useful for the treatment of anxiety disorders and is often used in conjunction with one or more of the therapies mentioned. Anti-depressants (usually the selective serotonin re-uptake inhibitors) and/or anti-anxiety medication such as anxiolytics (usually from the benzodiazepine family) are commonly prescribed. However be aware of allopathic medications’ side-effects, such as excessive sedation, poor memory and concentration, dependence on and tolerance to medication. Withdrawal symptoms might include anxiety, insomnia, apprehension, irritability, tremors, sweating, etc.
Psychological
Psychologists generally use behaviour or cognitive therapy, or a combination of both, as well as relaxation techniques, visualisation, medication and hypnotherapy. Many psychologists will assist a patient with lifestyle management, lifeskills training and hypnotherapy as well. Some anxiety and panic attack conditions are very effectively dealt with by means of NLP (neuro-linguistic programming) and EMDR (eye movement desensitisation and restoration).
Lifestyle management
Therapists may evaluate a person’s lifestyle and recommend changes, as excessive use of alcohol, medication, caffeine, smoking, poor sleeping habits and financial, marital, environmental, social, career, family and interpersonal stressors might contribute to or stimulate the panic attack.
Lifeskills training
Lifeskills training may assist a person to reduce general anxiety, cope better with life’s demands and impede the onset of a panic attack. Some topics that should be addressed in lifeskills training are time management, self-assertiveness, stress management, communication, social skills, problem solving and wellness awareness.
Hypnosis
In the hands of a well-trained and professional hypnotherapist (usually psychologists) hypnosis can be a valuable tool in resolving behaviour, thoughts, emotions or other issues contributing to the panic attack. Treatment topics might range from lifeskills, lifestyle, desensitisation, behaviour modification and irrational thoughts to past traumatic incidents, pre-natal and past-life experiences.
NATURAL TREATMENTS OPTIONS
Phytotherapy
A combination of relaxing nutriceuticals, herbs and amino acids might be effective in reducing the general anxiety and stress that induce panic attacks. The most popular and effective relaxants are the herbs valerian, kava, hops and passionflower, and the amino acids taurine and GABA. Chamomile, vervain, lavender, St John’s wort and liquorice also assist the body and mind to relax, recuperate and resist anxiety and stress more efficiently.
Supplementation/nutrition
Eat magnesium-rich foods such as seeds, nuts, fruit and vegetables, and supplement daily with between 300 and 500 mg magnesium, especially if you are anxious or can’t sleep. Other supportive supplementation includes inositol, vitamin B complex, niacinamide (B3), magnesium, calcium, vitamin C and chromium.
Bach flower remedies
For anxiety there are many potential remedies, e.g. agrimony, aspen, cerato, chicory, rescue remedy, etc. For fear, aspen, cherry plum, mimulus, red chestnut and rock rose can be considered. The Bach flower essences also include remedies that address aggression, anger, depression, hysteria, nervous breakdown, overwork, phobias, shock, stress, tension and worry.
Herbal teas
The following herbal teas assist the nervous system and induce relaxation and calmness: chamomile, lemon balm, betony, skullcap and vervain.
Aromatherapy/essential oils
Some essential oils that may induce calmness and relaxation are lavender, marjoram, bergamot, basil, neroli, juniper and ylang ylang.
Homeopathy
There are many treatment options available for panic attacks and anxiety in homeopathy. It is best to consult a well-qualified practitioner, but some examples of likely treatment are:
- Aconite: for great fear, anxiety, anguish and forebodings.
- Ignatia: if panic is caused by grief, with tearfulness, sighing and sobbing.
- Lycopodium: if there is anxiety about an impending public ordeal.
- Arg nit: for cases of tearfulness, trembling and anxiety.
- Nux vomica: when there is irritability, overwork and reproachfulness.
Tissue/cell salts
The following tissue salts might assist a person in coping with general anxiety and panic:
- Kali phos is an important remedy for people feeling depressed, irritable, bad tempered, timid, or those who start at a sudden noise, are exhausted from overwork and have phobias.
- Nat mur is for people who feel sad, apprehensive and negative, as well as for those who avoid other people, are easily annoyed and who have palpitations.
Other helpful therapies
Other helpful therapies include relaxation techniques, breathing techniques, yoga and visualisation.
WHAT CAN I DO TO HELP MYSELF?
In any given year about a third of American adults have at least one panic attack, and after a few months of panic about 105 of these people become housebound and unable to leave home alone. After a few years about 30% of panic sufferers lose their jobs, income or job responsibilities. Some 17% are at risk for alcoholism and addiction to self-medication, and about 40% risk chronic depression as life opportunities are cut off. A majority have marital problems and a much-reduced travel and social life. For many sufferers, panic closes life off like a prison. This means that anxiety attacks and panic disorder are more common than bipolar disorder, depression, schizophrenia, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD) and alcoholism.
GENERAL GUIDELINES
- Consult an experienced and appropriately qualified health practitioner.
- Keep your blood sugar balanced by eating slow-releasing carbohydrates, as well as eating little and often.
- Avoid stimulants such as caffeine, nicotine and sugar.
- Avoid sugar, sorbitol, honey, refined grains and cereals, milk, caffeine and alcohol as they stimulate lactate levels.
- Exercise is still one of the most time and cost-efficient ways of controlling anxiety and managing stress hormones.
- Positive affirmations during or before a panic attack might assist the patient, for example: ‘I have survived feelings and circumstances like these before’ and ‘this will last only a short while’.
- Deal with the underlying causes of your stress and anxiety by working with a psychologist or suitable health professional.
Editor's note: I am happy to share that we have four excellent articles on anxiety that you may find helpful: The A to Z of Nutrition can Calm our Anxiety, Treating Anxiety and Mild Depression – the natural way and Dissolve anxiety – transform poison into poise.
Further reading
- Anxiety Disorders Association of America www.adaa.org
- National Institute of Mental Health www.nimh.nih.gov
- Holford P, Cass H. Natural Highs. London: Piatkus, 2001.
- Needes R. You Don’t Have to Feel Unwell. Gateway Books.
- Trattler R, Jones A. Better Health Through Natural Healing. Victoria, Australia: Hinkler Books, 2001.
- American Psychiatry Association (APA). Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Washington DC: APA, 2000.
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