What's Behind the Panic Attack

Psychiatric research into the causes of panic disorder has been on the rise in recent years. Surveys have shown that more women than men are afflicted with panic disorder by a ratio of approximately two to one--and that panic disorder knows no racial, economic, or geographic boundaries. Because its victims often hide their illness and because healthcare professionals often do not diagnose it, it is difficult to gauge how widespread panic disorder is in the general population. In a recent study by the National Institute of Mental Health, 10 percent of those interviewed reported having had spontaneous panic attacks. The best recent estimate of those with panic disorder places the number of Americans suffering with panic disorder or phobias at 13 million. Apart front the very real suffering the disorder inflicts, the illness costs billions of dollars per year in the U.S., figured in terms of health care expenses, disability benefits, and lost wages. And as the disorder is more widely recognized and researched, those numbers may well climb.

While many studies have examined the emotional components of panic disorder, more recent studies have shown that panic disorder's roots are physical as well as psychological. Researchers have found that panic disorder runs in families, a fact which supports the idea that the condition may pass genetically from generation to generation. To explore this possibility, scientists are pursuing several promising lines of biological study, looking into the brain for clues to the causes of panic disorder. Scientists are studying the brain's chemistry to find out if panic comes from a problem with that organ's complex chemical communications system, the neurotransmitters. Other groups are examining the brain's structure to see if a problem there might cause information from the senses to short-circuit, triggering the panic reflex. Still another group is looking into the effect on the brain of various chemical compounds, such as sodium lactate and carbon dioxide.

Many people who do not have panic disorder may have an occasional panic attack during periods of severe stress. But those with panic disorder have the attacks even after the stressful conditions have gone. The disorder typically begins when its victims are in their twenties. Often a serious event-such as the death of a parent or divorce will kick off the first attack.

"I went to [my family] doctor and he did a number of tests. He thought at first I had multiple sclerosis, but he ruled that out, finally, and said he wasn't sure what I had. So he sent me to a neurologist. The neurologist also did a number of tests and finally gave me a diagnosis of "non-specific idiopathic neuropathy." I asked him what that was and he didn't give me much of an explanation. He just said that maybe I should see a psychiatrist."
(Panic Disorder Sufferer)

Getting Treatment for Panic Disorder

Panic disorder has been called one of the great impostors among illnesses because it is so easily mistaken for other medical or psychiatric problems, such as heart disease, thyroid problems, respiratory problems, or hypochondriasis. Those afflicted with the condition may trudge from doctor to doctor seeking help, and may even give up the hope of a cure, doubting their sanity. That's when a psychiatrist -- who is a specially trained medical doctor -- can help. Psychiatrists' training equips them to interpret correctly the symptoms of panic disorder, make a diagnosis, and treat the illness.

As with any other psychiatric illness, a psychiatrist will first ensure the patient has had a thorough physical exam. The psychiatrist will also try to piece together a complete knowledge of the patient's background, history of drug use (or abuse), and treatment history to gain the complete understanding needed to begin helping the panic disorder sufferer. The fact that other disorders--such as depression and agoraphobia--can exist along with panic disorder makes this process very important for the treatment program. If the treatment program is to help, it must address all the panic disorder sufferer's problems.

Researchers in government, the universities, and industry are working to expose the roots of the illness and are designing more effective means of diagnosing, treating, and controlling panic disorder. Today, psychiatrists treating panic disorder have a number of medicines and therapies they can use to help their patients. The psychiatrist will first seek to ease panic disorder's symptoms with education about the illness, medications if warranted, and behavioral treatment techniques such as relaxation training. Once the psychiatrist has helped the patient to make the symptoms less threatening, he will then help the patient to work against the agoraphobia, anticipatory anxiety, depression, and other ills these panic symptoms have themselves produced. Psychiatrist and patient will then continue to work together on the ongoing consequences of the illness and any other problems that nay exist side-by-side with (and often hidden by) panic disorder.

The most successful treatment programs combine three main forms of therapy: medication, cognitive and behavioral treatment. A number of medications that have worked well against depression also work against panic disorder, helping front 75 to 90 percent of its sufferers. These medications include tricyclic antidepressants, MAO inhibitors, and other drugs from the benzodiazepine group of minor tranquilizers. Preliminary evidence indicates there are more medications that will prove useful in treating the illness.

The cognitive and behavioral elements of treatment usually begin with education about the illness and encouragement to reenter situations to which the patient has become phobic along the history of the illness. Psychiatrists will then proceed with several forms of psychotherapy that help patients to change how they think (cognitive therapy) and how they act (behavioral therapy). Behavioral therapists are using desensitization techniques in which they teach panic disorder sufferers relaxation exercises and then gradually expose them to situations they have phobically avoided, teaching them to modify their breathing and to "reshape" their fearful thoughts to avoid panic attacks. They have found that, since panic disorder exists both alone and in tandem with depression and agoraphobia, they must modify treatment to fit individual cases. Follow-up treatment can also include in-depth psychodynamic psychotherapy that helps the patient to deal with the long-term consequences of the illness, which may have gone for years untreated.

Effective treatments and ongoing research are bringing new hope for recovery to sufferers of panic disorder. And continuing medical education is helping more and more physicians to recognize the disorder and get patients the help they need. Earlier diagnoses are significantly reducing the complications of untreated panic disorder and, with appropriate psychiatric treatment, nine out of ten sufferers will recover and return to normal life activities.

(c) Copyright 1989 American Psychiatric Association

Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This document contains text of a pamphlet developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.

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Additional Resources

Agras, M.W. Panic: Facing Fears, Phobias, and Anxiety. New York: W.H. Freeman, 1985.

Beck, Aaron, M.D. Anxieties and Phobias. New York: Basic Books, 1985.

DuPont, Robert L., M.D. Phobia: A Comprehensive Summary of Modern Treatments. New York: Brunner Mazel, 1982.

Goodwin D.W., M.D. Anxiety. New York: Oxford University Press, 1986.

Gorman, J.M., M.D., M.R. Leibowitz, M.D., and D.F. Klein, M.D. Panic Disorders and Agoraphobia. Kalamazoo, MI: Current Concepts in Medicine, 1984.

Greist, John H., M.D., James W. Jefferson, M.D., and Isaac M. Marks, M.D. Anxiety and Its Treatment: Help Is Available. Washington, DC: American Psychiatric Press, Inc., 1984.

Pasnau, Robert 0., M.D. Diagnosis and Treatment of Anxiety Disorders. Washington, DC: American Psychiatric Press, Inc., 1984.

Sheehan, David, M.D. The Anxiety Disease and How to Overcome It. New York: Charles Scribner & Sons, 1984.

Taylor, C. Barr, M.D. and Bruce Arnow, Ph.D. The Nature and Treatment of Anxiety Disorders. New York: Free Press, 1988.

Zane. Manuel D., M.D. and Harry Milt. Your Phobia. Washington, DC: American Psychiatric Press, Inc., 1984.

National Phobia Treatment Directory (Second Edition). Rockville, MD: Phobia Society of America, 1986.

Other Resources

American Academy of Child and Adolescent Psychiatry
(202) 966-7300

American Mental Health Fund 2735 Hartland Road, Suite 335 Merrifield, VA 22081
Freedom From Fear
(718) 351-1717

National Alliance for the Mentally Ill
(703) 524-7600

National Association of Private Psychiatric Health Systems
(202) 393-6700

National Community Mental Health Care Council
(301) 984-6200

National Institute of Mental Health Division of Communications
(301) 443-3673

National Mental Health Association
(703) 684-7722

Anxiety Disorders Association of America
(301) 231-9350

next: Panic Disorder A Highly Treatable Anxiety Disorder