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The Basics About Panic Attacks - Introduction

Don't Panic, Chapter 3. Panic within Psychological Disorders

Although the first panic attack may seem to appear "out of the blue," it typically comes during an extended period of stress. This stress is not caused by a few days of tension, but extends over several months. Life transitions, such as moving, job change, marriage, or the birth of a child, often account for much of the psychological pressure.

For some individuals, learning to manage this stressful period or to reduce the pressures will eliminate the panic episodes. For others, it is as though the stress of the life transition or problem situation uncovered a psychological vulnerability. If the panic-prone individual accepts increased responsibilities -- for instance, through a job promotion or through the birth of a first child -- he may begin to doubt his ability to meet the new demands, the expectation of others, and the increased energy required for these responsibilities. Instead of focusing on mastering the task, he becomes more concerned with the possibility of failure. This attention to the threat of failure continually undermines his confidence. Either gradually or quickly, he translates these fears into panic.

Certain people experience symptoms in the middle of sleep. These are either caused by panic disorder or are identified as "night terrors". Most nighttime (or nocturnal) panics take place during non-REM sleep, which means they do not tend to come in response to dreams or nightmares. They occur between a half-hour to three and a half hours after falling asleep and are usually not as severe as daytime panics. These are distinct from night terrors, known as pavor-nocturnus in children and incubus in adults. The similarities are that they produce sudden awakening and autonomic arousal and tend to not be associated with nightmares. However, a person who experiences a night terror tends to have amnesia for it and returns to sleep without trouble. He also can become physically active during the terror -- tossing, turning, kicking, sometimes screaming loudly or running out of the bedroom in the midst of an episode. Nocturnal panic attacks, however, tend to cause insomnia. The person has a vivid memory of the panic. He does not become physically aggressive during the panic attack, but remains physically aroused after the occurrence.

WHAT IS AGORAPHOBIA?

Each person diagnosed with agoraphobia (meaning "fear of the marketplace") has a unique combination of symptoms. But common to all agoraphobics is a marked fear or avoidance either of being alone or of being in certain public places. It is a response strong enough to significantly limit the individual's normal activities.

For the person who experiences panic attacks, the distinction between agoraphobia and panic disorder is based on how many activities he avoids. In panic disorder, the person remains relatively active, although he may avoid a few uncomfortable situations. If the panic-prone person begins to significantly restrict his normal activities because of his fearful thoughts, agoraphobia is the more appropriate diagnosis.

For some, agoraphobia develops from panic disorder. Repeated panic attacks produce "anticipatory anxiety," a state of physical and emotional tension in anticipation of the next attack. The person then begins to avoid any circumstances that seem associated with past panic attacks, becoming more and more limited in his range of activities.

The fearful thoughts that plague the agoraphobic often revolve around loss of control. The person may fear the development of uncomfortable physical symptoms familiar from past experiences (such as dizziness or rapid heartbeat). He may then worry that these symptoms could become even worse than they were in the past (fainting or heart attack), and/or that he will become trapped or confined in some physical location or social situation (such as a restaurant or party). In the first two situations, the person senses that his body is out of control. In the third, he feels unable to readily control his surroundings.