From Wikipedia, the free encyclopedia
A panic attack is a period of intense, often temporarily disabling, sense of extreme fear or psychological distress, typically of abrupt onset. Though it is often a purely terrifying feeling to the sufferer, panic attacks are actually an evolutionary body response often known as the fight-or-flight response occuring out of context. Symptoms may include trembling, shortness of breath, heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), hyperventilation, paresthesias (tingling sensations), vomiting, and sensations of choking or smothering. During a panic attack, the body typically releases large amounts of adrenaline into the bloodstream. Many first time sufferers of a panic attack believe they are dying or going insane. It is a feeling that cannot be described until one has had an attack. Many say panic attacks are among the most frightening experiences of their lives. Repeated and apparently unprovoked panic attacks may be a sign of panic disorder, but panic attacks are associated with other anxiety disorders as well. For example, people who suffer from phobias may experience panic attacks upon exposure to certain triggers. People with panic disorder often can be treated with therapy and/or anti-anxiety/depression medication.
Recreational drugs have also been known to provoke panic attacks in certain people.
[edit] Description
Most sufferers of panic attacks report a fear of dying, "going crazy", having a heart attack, fainting or losing control of emotions or behavior. These feelings generally provoke a strong urge to escape or flee the place where the attack began ("fight or flight" reaction) and, when associated with chest pain or shortness of breath, a feeling of impending doom and/or tunnel vision, frequently result in the sufferer seeking medical attention, often in an emergency room. Panic attacks have been linked to high quantities of acetylcholinesterase in the blood. Also the release of adreno-cortisols aid in catalyzing the panic attacks.
The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks are often experienced by sufferers of anxiety disorders and other psychological conditions involving anxiety, though panic attacks are not always indicative of a mental disorder, nor are they uncommon. In fact some sufferers are not under any "fear" or any psychological illness but are under extreme amounts of stress and anxiety resulting in a panic attack or an anxiety attack. Up to 10 percent of otherwise healthy people experience an isolated panic attack per year, and 1 in 60 people in the U.S. will suffer from a panic disorder at some point in their lifetime.
When the sufferer experiences more than four bodily symptoms it is said that they have had a full blown panic attack while experiencing four or less symptoms constitutes a limited symptom attack.
[edit] Duration
A panic attack typically lasts ten minutes according to the American Psychological Association. More severe panic attacks may form a series of episodes waxing and waning every few minutes, only to be ended by physical exhaustion and sleep.
In conditions of chronic anxiety, one panic attack can roll into another, leading to nervous exhaustion over a period of days.
[edit] Trigger
People with phobias will often experience panic attacks as a direct result of exposure to their trigger. These panic attacks are usually short-lived and self-limiting, as they will subside once the trigger is no longer present.
Hyperventilation alone can bring about some of the symptoms of a panic attack. However, the person experiencing the panic attack often does not realize this and sees these symptoms as further evidence of how serious their condition is. An ensuing positive feedback loop of adrenaline release fuels worsening physical symptoms and psychological distress.
In some rare cases, using marijuana can trigger moderate to severe panic attacks in its users. Panic attacks induced by marijuana usually influence the user to seek medical treatment.
[edit] Biological explanation
The various symptoms of a panic attack can be understood as follows. First, there is the sudden onset of fear with little or no provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response where the person's body prepares for major physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, and lightheadedness. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood.
[edit] Symptoms
[edit] Physical
[edit] Mental
- The loss of the ability to react logically to oncoming stimuli
- Loss of cognitive ability in general
- Loud internal dialogue
- Impending doom
[edit] Emotional
- Terror, or a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
- Fear of losing control
- Fear of death
- Fear of going crazy
- Flashbacks to earlier panic triggers
[edit] Perceptual
[edit] Mnemonic
The symptoms of a panic attack can be remembered with the mnemonic: STUDENTS FEAR the 3 Cs: Sweating, Trembling, Unsteadiness/dizziness, Derealization/depersonalization, Elevated heart rate (tachycardia), Nausea, Tingling, Shortness of breath,FEAR of dying, FEAR of losing control, FEAR of going crazy, 3 Cs - Choking, Chest pain, Chills.
[edit] Agoraphobia
People who have had a panic attack in certain situations, for example, while driving, shopping in a crowded store, or riding in an elevator — may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place.
[edit] Panic disorder
People who have repeated attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked. An episode is often categorized as a positive feedback loop where the mental symptoms increase the physical symptoms, which increase the mental symptoms, and so on.
[edit] Treatment
Benzodiazepines like diazepam, lorazepam, alprazolam or clonazepam can be prescribed to be taken at the onset of the panic attack. Sometimes, the psychological knowledge of knowing that such medication is close at hand may be enough to prevent the panic attack. However, this form of treatment may be considered unfavourable by some doctors, because of the potential for abuse. Additionally, benzodiazepines will not treat the cause of the panic attacks. As such, some doctors may prefer to prescribe an antidepressant, particularly an SSRI (such as paroxetine or sertraline), which after an initial titration period may be effective at reducing anxiety. NaSSAs such as mirtazapine have also been found effective, particularly with individuals whose anxiety and panic causes insomnia. Individuals can also treat themselves during panic attacks by breathing into a paper bag (to decrease effects of hyperventilation) and/or using ice on the face (rubbing with an ice cube, washing face with icy water on washcloth, dipping face into bowl of ice water) to stop the physiological reactions. Panic attacks are completely treatable and can be overcome with the correct combination of medication and therapy.
