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Biology 103
2001 Third Web Report
On Serendip

Panic Attacks Why? How can we stop them?

Jackie Chew

It rises, seemingly, out of nowhere. It is sudden, yet discrete... an intense feeling of terror. You cannot breathe, and are nearly unable to stand as you tremble with chills. Most frighteningly, your heart races, it seems that it will explode from your chest. Before you know it, though... this attack has vanished... leaving you only with the fear that you will soon be struck with another. This, contrary to what you may believe is not a heart attack, nor are you losing your mind. You have been hit by a panic attack. Frightening as this is, it is not uncommon. Ten percent of the American population will, at one time in their lives, experience a panic attack. (1). One in every 75 Americans will be afflicted with Panic Disorder in their lifetimes. (3).

When you are faced with more stress than you know how to deal with, your body becomes aroused because it is being bombarded with anxiety producing stimuli. Your body is, in essence, preparing to protect itself against sudden danger, making you physically ready to react by either fighting the stressor, or fleeing from it. The brain releases powerful hormones that constrict the blood vessels in the peripheral parts of the body in order to force blood into the brain and deeper into the large muscles for added strength. In turn, your heart pounds, digestive system shuts down, breathing increases, and muscles tighten. (5). This rush of changes in your body is the cause of the intense physical discomfort experienced during a panic attack.

The criteria for a panic attack is specific, to discern an attack from general affects of fear or stress. When under attack, you experience some of the following symptoms all within a very short period of time, and without warning or apparent reason. Generally, the level of fear is drastically out of proportion to the situation, or even unrelated. Panic attacks can even occur in your sleep. (3). You may experience heart palpitations, sweating/chills, shaking, the feeling of shortness of breath, nausea, dizziness, and tingling. You may also experience a feeling of detachment from reality, fear of dying, or fear of losing control. (2).

In order to constitute Panic Disorder, as opposed to isolated panic attacks, you would experience at least one month, following a panic attack, of persistent concern that another attack will follow. You also worry about the implications of the attacks, and have significant change in daily life and behavior due to the attacks. (2). Many people experience isolated panic attacks, but the key symptom of the panic disorder is the unrelenting fear of future attacks. Panic disorder is frightening not only because of the panic attacks, but also because it, many times, leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Panic disorder can have a wide range of effects, from minor social impairment to total inability to function in the outside world. (3).

Over four million people in America are afflicted with panic disorder. It usually emerges during the teens or early adulthood and is rare in people over 65. Panic disorder is twice as common in women, as compared to men. (1). These statistics are asserted with confidence, yet as of now, we can only theorize about the actual causes of panic attacks. Extensive research has been done to determine whether panic disorder is caused by physical/genetic makeup, or purely by the mind. There is evidence that there may be a genetic predisposition to panic disorder, as some sufferers report that a family member has or had panic disorder or other emotional disorders such as depression. Studies with twins have been conducted to confirm the possibility of genetic inheritance of this disorder. (3). The risk of family members passing panic disorder on is between ten and twenty percent. (1).

It is also possible that panic disorder is due to a biological malfunction or imbalance. Researchers from Ohio State University have found that a specific gene, the 5-HTT, which is responsible for regulating the chemical, serotonin, may be partly responsible for causing psychological disorders such as panic disorder. The researchers contend that, while no single gene can be solely responsible for complex emotional states, certain genetic traits can make a person more susceptible to psychological disorders. In the experiment, the people who had a variation in the gene that caused the brain to take up serotonin more quickly, leaving less available, were more likely to have panic attacks. (4).

Panic disorders can be triggered by stressful life events. From this, we theorize that panic disorder has psychological causes. Specifically, panic attacks are associated with recent loss or separation, or major life transitions of any sort. (3). Childhood issues seem also to be a main cause of panic disorder. Many panic disorder sufferers report a history of child abuse, and more than half of all sufferers recall experiencing panic symptoms in their childhood. (8). Twenty percent of panic disorder sufferers recall experiencing separation anxiety as a child. (1).

However, it is most probable that both physical and psychological causes of panic disorder work in combination. It is theorized that stress in life lowers your resistance, and thus allows the underlying physical disposition to trigger an attack. Although initially attacks seem to appear from nowhere, the sufferer may be helping to bring them on by responding to the physical symptoms of the attack. If a person with panic disorder experiences an increased heart rate caused by something unrelated, such as exercise, they might interpret it to be a symptom of a panic attack. They may actually bring on an attack because of their anxiety. The problem is that something such as exercise may actually be a cause for panic attacks. The panic disorder sufferer is not able to tell how to isolate different triggers of an attack. Because of this, the most effective treatment for panic disorder should focus on all aspects of the disorder: physical, psychological, and physiological. (3).

Therapy for panic disorder often involves medication, specific forms of psychotherapy, or a combination of both. Medications can be very effective in relieving symptoms of anxiety. More and more medications are becoming available to treat anxiety disorders. Anti-anxiety medications or antidepressants may be prescribed, as well as heart medications, such as beta blockers, that are used to control irregular heart rate. (7). There are two classes of antidepressants as well as certain high potency benzodiazepines that have been found to be effective in reducing, or even eliminating panic attacks associated with panic disorder. Further research is being conducted in order to produce other medications that might be more effective, specifically the serotonin uptake blockers. The problem with the use of medication as the sole treatment is that there are undesirable side effects, the risk of dependence, and a significant possibility for relapse once the medication is discontinued. (2).

It is believed that the most effective treatment for panic disorder is a combination of cognitive and behavioral therapies. Cognitive therapy can help the patient identify possible triggers for attacks. Once the patient understands that his or her thinking patterns contribute to the symptoms, and that the attack is independent of the trigger, the trigger loses some of its power to spark an attack. Cognitive therapy teaches patients to react differently to the situations that trigger attacks. Patients identify the triggers, and confront them, trying to alter their anxious thinking. (6).

Behavioral therapy is effective in that it focuses on changing specific actions, using techniques to decrease or stop unwanted behavior. For example, patients are taught breathing techniques in order to avoid hyperventilation, which can trigger further anxiety symptoms such as rapid heart rate and dizziness. (6). Behavior therapy can also involve "interoceptive exposure." This, in essence, is a system of desensitization, focusing on exposing the patients to the actual physical sensations that are experienced during a panic attack. The patients are exposed to the symptoms of an attack, but in a controlled setting, in order to show that the symptoms do not need to develop into a full-blown attack. (7). The combination of behavioral and cognitive treatment has been shown to be effective, as reports have shown that significant numbers of patients are panic-free at the end of cognitive/behavioral treatment, and remain so at a two-year follow up. (2). In general, with either medication treatment or behavioral/cognitive treatment, up to thirty percent of patients were completely free of panic attacks after a few years of treatment. (8).

While there has been extensive research conducted on the causes and treatments of panic disorder, there is yet much to be learned. Much of the information currently available is derived from cross-sectional studies, and from only short-term follow up. Longer-term studies which track panic attacks and their context are necessary. There has not been sufficient research comparing the effectiveness of cognitive/behavioral treatment versus pharmacological. However, there have been great lengths made in identifying the disorder, and consequently providing treatment for it. It is a disorder that affects many in the world, more prominently women, but there exist many effective treatments, and there is hope for many more.

WWW Sources

1) Panic and Anxiety Disorders

2) Internet Mental Health

3) Answers to Your Questions About Panic Disorder

4) BBC News | HEALTH | 'Gene for panic attacks'

5) Anxiety and panic attacks

6) Treatments for Panic Disorder

7) Answers to Your Questions About Panic Disorder

8) Panic and Anxiety Hub

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