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Fear...heart palpitations...terror, a sense of impending doom...dizziness...fear of fear. The words used to describe panic disorder are often

frightening. But there is great hope: Treatment can benefit virtually everyone who has this condition. It is extremely important for the person who has panic disorder to learn about the problem and the availability of effective treatments and to seek help.

The encouraging progress in the treatment of panic disorder reflects recent, rapid advances in scientific understanding of the brain. In fact, the President and the U.S. Congress have declared the 1990s the Decade of the Brain. In addition to supporting intensified research on brain disorders, the Federal Government is working to bring information about these conditions to the people who need it.

The National Institute of Mental Health (NIMH), the Federal agency responsible for conducting and supporting research related to mental disorders, mental health, and the brain, is conducting a nationwide education program on anxiety disorder, a group of illnesses. The program's purpose is to educate the public and health care professionals about the disorder and encourage people with it to obtain effective treatments.

WHAT IS PANIC DISORDER?

In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations and dizziness) that occur repeatedly and unexpectedly in the absence of any external threat. These "panic attacks," which are the hallmark of panic disorder, are believed to occur when the brain's normal mechanism for reacting to a threat—the so-called "fight or flight" response—becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.

WHO HAS PANIC DISORDER?

In the United States, between 3 and 6 million will have panic disorder at some time in their lives. The disorder typically begins in young adulthood, but older people and children can be affected. Women are affected twice as frequently as men. While people of all races and social classes can have panic disorder, there appear to be cultural differences in how individual symptoms are expressed.

SYMPTOMS AND COURSE OF PANIC DISORDER

Panic Attack Symptoms
During a panic attack, some or all of the following symptoms occur:

• Terror—a sense that something unimaginably horrible is about to happen and one is powerless to prevent it
• Racing or pounding heartbeat
• Chest pain
• Dizziness, lightheadedness, nausea
• Difficulty breathing
• Tingling or numbness in the hands
• Flushes or chills
• Sense of unreality
• Fear of losing control, going "crazy," or doing something embarrassing
• Fear of dying

Initial Panic Attack

Typically, a first panic attack seems to come "out of the blue," occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control.

This barrage of symptoms usually lasts several seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic attack can attest to the extreme discomfort they felt and to their fear that they had been stricken with some terrible, life- threatening disease or were "going crazy." Often people who are having a panic attack seek help at a hospital emergency room.

Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.

Nevertheless panic attacks usually take a person completely by surprise. This unpredictability is one reason they are so devastating.

Sometimes people who have never had a panic attack assume that panic is just a matter of feeling nervous or anxious—the sort of feelings that everyone is familiar with. In fact, even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, lose their minds, or be totally humiliated. These disastrous consequences don't occur, but they seem quite likely to the person who is suffering a panic attack.

Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, the attacks continue and cause much suffering.

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