Panic Attacks & Panic Disorder: Cause, Symptoms & How to Treat & Support

Introduction to Panic Attacks and Panic Disorder

Have you ever experienced an intense surge of stress, worry, and anxiety out of nowhere? In the middle of a stressful situation, your hands start trembling, your heart starts beating faster, and it feels like the end of the world. Or you are just going about your day and these overwhelming feelings hit you all of the sudden.

You may feel crazy. People around you may not understand what is happening or how to help you. 

While daunting, these are not random occurrences. It is quite possible that you are going through a panic attack.

SO,

What Are Panic Attacks?

Panic attacks are unexpected surges of anxiety that reach a peak within a few minutes and then settle down. These attacks are accompanied by at least four symptoms of anxiety.

There are no obvious causes of what triggers a panic attack. It is as if the individual is thrown off-guard without a warning, for example, when they are sleeping or relaxing. You can imagine how scary it is to deal with a panic attack. While panic attacks can be tough to handle, recovery is possible with the right kind of support and treatment.

Are panic attacks and anxiety attacks the same? 

No, panic attacks and anxiety attacks are not the same. While both show up as symptoms of anxiety, the root cause is different. Panic attacks are unexplainable surges in anxiety for a brief amount of time whereas anxiety attacks can last from minutes to days and are about a specific trigger (for e.g., fear of a specific place, fear of public speaking, etc.).  

For example, If Hema out of nowhere starts to feel that she is going out of breath and discomfort in the body without any medical cause, it is like she is experiencing a panic attack. However, if there is a history of feeling anxious in social situations, it is most likely some form of anxiety attack or a disorder. 

Here we’ve covered Panic attack and Anxiety attack

Symptoms and Identification of Panic Attacks

How to Recognize the Signs of a Panic Attack

Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult with a healthcare provider for personalized treatment options. 

So how will you know if someone is likely experiencing a panic attack? 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), in a panic attack at least four of the following symptoms must be present: 

1. Changes in heart rate 
2. Sweating  
3. Body trembles  
4. Difficulty in breathing 
5. Choking sensations
6. Pain or discomfort in the chest 
7. Feeling queasy  
8. Lightheadedness 
9. Feeling too cold or hot in the body 
10. Going numb 
11. A sense of detachment from the body
12. Feeling as if the world is unreal 
13. Worried that one may be “going crazy.”
14. Feeling as if one would die.

It is important to note that in a panic attack, these symptoms will resolve within a few minutes.

However, since there is a great overlap between signs of anxiety with distress caused by other medical reasons it can be impossible to make a clinical judgement on your own. If you are experiencing any of these symptoms out of the blue, it is best to reach out to a healthcare provider for professional support. 

Duration and Intensity of Panic Attacks

The panic attacks are often triggered without a cause. The panic builds suddenly and lasts for a few minutes after which the intensity of the symptoms starts to lessen. 

It can be quite overwhelming to experience a panic attack due to its unexpected nature. The intensity of the panic attack depends upon the type of anxiety-related symptoms that accompany it. For example, someone may find panic-induced bodily discomfort easier to manage than heart palpitations that feel like the end of the world. 

Irrespective of the duration and intensity of panic attacks, you will most likely benefit from consulting a therapist. Reach out to a Mave Health Therapist today to get the mental health support you deserve.   

Causes and Risk Factors for Panic Attacks

What Causes Panic Attacks?

While there are no exact causes for the development of Panic Disorder, certain genetic, physiological, psychological, and environmental risk factors increase the chances for the development of panic attack disorder (APA, 2013).  

1. Genetic: A family history of anxiety, depression, and bipolar disorder increases the risk for Panic Disorder.
2. Physiological: Lung-related conditions, like Asthma, are linked with Panic Disorder. Individuals with a smoking history also pose a risk for the development of Panic Disorder. 
3. Psychological: Individuals who are at risk for developing Panic Disorders are more sensitive to anxiety and negative emotions. For example, such individuals may view anxiety as harmful and actively try to avoid it. This may in turn fuel the panic symptoms. 
4. Environmental: The presence of stressful and traumatic life events makes an individual prone to panic attacks and Panic Disorder.  

Diagnosis and Evaluation of Panic Disorder

Diagnostic Criteria for Panic Disorder

To be diagnosed with Panic Disorder, the individual must fulfill the following criteria: 

1. Frequency: There must be one or more instances of panic attack in the last 30 days which has at least 4 out of 13 symptoms of anxiety. 
2. Worry and or avoidance about panic attacks: A constant state of worry about additional panic attacks (for example, fear of losing control or going crazy). Going to great lengths to avoid an instance that can trigger a panic attack (for example, refusal to go to work). 
3. The symptoms of anxiety are not because of other reasons (for example, heart conditions, obsessive-compulsive disorder, etc.) 

It is not possible to differentiate between the multiple causes that may be causing panic-like symptoms. Please avoid self–diagnosis and reach out to a professional healthcare provider like a clinical psychologist or psychiatrist for consultation. 

Assessment Tools for Panic Disorder

You must consult an RCI-registered clinical psychologist or a psychiatrist for assessment of Panic Disorder in India. Your healthcare provider will ask you questions about the difficulties you are experiencing. Based on the conversation, they may ask you to take some assessment tools to support a formal diagnosis like:

1. Beck Anxiety Inventory
2. Hamilton Anxiety Rating Scale
3. Panic Disorder Severity Scale
4. NIMH Panic Questionnaire

A formal diagnosis will be given based on the clinical interview, information from the patient and their environments, and data from psychological assessments. If you meet the criteria for Panic Disorders, you will be directed towards treatment options that are best fit for you. 

Treatment and Management of Panic Attacks

Effective Therapies for Managing Panic Attacks

Going through panic attacks can put a lot of burden on our body and mind. A therapist can offer invaluable support in your mental health journey. Mental health Therapy offers a safe space in which we can talk about our concerns freely and receive invaluable insights about what is causing our panic attacks and how to manage them. 

While there are multiple therapies available for treating panic attacks, for example, interpersonal therapy, Eye movement desensitization and reprocessing, psychodynamic therapy, cognitive behavioral therapy, and exposure therapy are found to be most effective for the treatment of Panic Disorder. 

Cognitive Behavioral Therapy (CBT) for Panic Disorder

Cognitive Behavior Therapy is based on the premise that our mental health is influenced by the interaction of our thoughts and behaviors. In CBT, the client and therapist collaborate to identify unhelpful thought patterns and behaviors and replace them with more helpful ones. 

The Cognitive Behavioral Therapy (CBT) for Panic Disorder may involve: 

1. Building a therapeutic alliance: A good therapeutic alliance is essential for the treatment of Panic Disorder. It involves creating a safe space where the client and the therapist can freely talk with each other about the client’s problems and look for possibilities for treatment. 
2. Monitoring of symptoms: The therapist may conduct some assessment using standardized tools to gauge the severity of symptoms. The client may also be encouraged to keep track of their anxiety using a thought log or a diary. 
3. Cognitive restructuring: The client and the therapist work together to identify thoughts and beliefs that are not helpful (e.g., I am a failure at work) to something that helps the client to move towards their therapy goals (for e.g., I need support to achieve my work goals).
4. Exposure Therapy:  In exposure therapy, the client is asked to make a list of things they are fearful would cause a panic attack. Then, they are asked to grade how fearful each stimulus is (for e.g., on a scale of 1 – 10). With the help of psychological tools and resources, the therapist encourages the client to face their fears. When a client starts to gain more confidence in their ability to deal with fearful stimuli, their sense of panic goes down. In a steady and systematic manner, the client targets all the fearful stimuli in the presence of a supportive therapist, till they feel confident to manage situations on their own. 
5. Response Evaluation: After each instance of cognitive restructuring and exposure therapy, the client and the therapist may look at how effective it was. Any progress made by the client is celebrated to keep the momentum going and any setbacks or challenges are reviewed so that alternative solutions can be generated.

Medication Options for Panic Disorder

There are many types of medication options available for Panic Disorder. It varies due to factors like the patient’s history, cost, potential side effects, etc. The most commonly used medications are: 

1. Selective serotonin reuptake inhibitors (SSRIs): It is the first line of treatment for stabilizing mood symptoms related to Panic Disorder. SSRIs are found to be relatively safe to use with minimum side effects. 
2. Benzodiazepines can be used along with SSRIs for severe panic symptoms. It helps to bring rapid relief and treat residual symptoms of anxiety. However, it can create a risk of dependence and must only be used under a doctor’s supervision.

How to Stop Panic Attack & Manage Panic Disorder

4 Lifestyle Changes to Manage Panic Disorder

It is no secret that panic symptoms affect both our body and mind. Working on our physical health can be beneficial to reduce the intensity of our Panic Disorder symptoms. Apart from therapy and medication, making some lifestyle changes can be very beneficial. This can look like: 

1. Practicing sleep hygiene: Panic attacks can cause a lot of depletion of energy and a night of quality sleep is essential for our body’s rest and repair. Sleep hygiene is a set of behavioral strategies to improve our sleeping experience. For example, making sure the environment is comfortable, limiting distractions, etc. 
2. Incorporating movement: Moving our body in accessible and joyful ways (for e.g., walking, gym, dancing, etc.) can help us to discharge excess energy and build resilience.  
3. Managing stress: Our body can become hypersensitive to any danger due to panic attacks. Try practicing problem-solving strategies and relaxation techniques to move through difficult situations and bring down the stress levels. 
4. Staying connected with loved ones: The journey to deal with panic attacks can be quite lonely. Our loved ones can offer practical and emotional support as we move towards recovery from Panic Disorders.  

Living with Panic Disorder

It can be quite challenging to live with Panic Disorder. Multiple panic attacks can wear our mind and body down which can lead to difficulties in our relationships, sense of self, and work. 

We may also become fearful of situations that may cause panic and go to extreme lengths to avoid them. This can lead to our absenteeism at social events putting economic and social burdens. 

With the right kind of support and treatment, recovery from Panic Disorder is possible. Reach out to a doctor or a psychologist near you to get your treatment started.

How to Support Someone Experiencing Panic Attacks

It can be very hard to see a loved one struggling with panic attacks and Panic Disorder. Here are some practical ways to help: 

1. Help them practice mindfulness techniques to know they are not in danger.
2. Offer words of encouragement and reassurance to let them know they are safe.
3. Listen to them patiently about what is troubling them.
4. You can ask what will be supportive for them and offer what you can.
5. Help them to book an appointment with a therapist.

Your compassionate and supportive presence can offer invaluable support to a loved one struggling with panic attacks to improve their mental wellbeing. 

In Detail we’ve covered  How to Help Someone with a Panic Attack and A Guide for Supportive Friends and Family

When to Seek Professional Help for Panic Disorder

When the symptoms of panic are difficult to manage and start interfering in your daily life, it is a sign that you need to seek professional help for Panic Disorder. 

No matter the level of difficulty, you deserve support in your mental health journey. Connect with a Mave Health Therapist to understand your treatment options for Panic Disorder. 

Conclusion

Panic attacks are unexpected surges of anxiety that reach a peak within a few minutes and then settle down. It must include four or more physical and emotional symptoms of anxiety. A person is diagnosed with Panic Disorder when they experience one or more episodes of panic attacks in a month. The treatment of Panic Disorder includes a combination of psychotherapy, medications, and lifestyle changes. If you are experiencing symptoms of anxiety that build and dissipate within a few minutes, it’s a sign that you may be struggling with panic attacks.

Dealing with panic attacks can take an extreme toll on our body and mind. The good news is that help is available. You do not need to go through this journey alone. Connect with a Mave Health Therapist to get the mental health support you deserve.

References 

1. American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American Psychiatric Association.
2. American Psychiatric Association. (2004). Treating Panic Disorder. A Quick Reference Guide. Washington, DC: Author.
3. Raju, N. N., Naga Pavan Kumar, K. S. V. R., & Nihal, G. (2023). Clinical Practice Guidelines for Assessment and Management of Anxiety and Panic Disorders in Emergency Setting. Indian journal of psychiatry, 65(2), 181–185. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_489_22
4. Reddy, Y. C. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020). Clinical Practice Guidelines for Cognitive-Behavioral Therapies in Anxiety Disorders and Obsessive-Compulsive and Related Disorders. Indian journal of psychiatry, 62(Suppl 2), S230–S250. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_773_19