Panic Disorder
Description of Symptoms and criteria
A panic attack is a sudden surge of intense fear that is diagnosed by a group of 13 physical and cognitive symptoms, including palpitations, shortness of breath, parasthesias, trembling, derealization and a sense of losing control. If four or more of the thirteen symptoms co-occur, the panic attack is said to be full blown; on the other hand, limited symptom attacks are defined as fewer than four symptoms. In contrast to the gradually building anxious arousal, panic attacks are discrete, having a sudden abrupt onset and relatively brief duration. Panic attacks are common in anxiety disorders in general, still in Panic Disorder they are distinguished by the following features:
- They occur without an obvious trigger.
- Fear of the recurrence of the panic attack that lasts at least one month.
- Behavioral changes as result of the fear of recurrence of panic attacks, e.g.: fear of being in public places, agoraphobia.
Surveys of clinical groups suffering Panic Disorder show that 44% to 71 % of the individuals with Panic disorder report nocturnal panic attack at least once. Nocturnal panic refers to waking from sleep in a state of panic with symptoms that are very similar to panic attacks that occur during wakeful states. Frequent nocturnal panics may result in sleep avoidance and insomnia which in turn might cause more panic attacks.
Epidemiology
From the National Comorbidity Survey Replication prevalence estimates are 2.7%(12 month) and 4.7%(lifetime). The 12 month prevalence refers to the number of individuals that have experienced at least one panic in the last 12 months while lifetime prevalence refers to the percentage of individuals that have experienced at least one panic in their lifetime. Panic disorder occurs rarely in isolation and it is often accompanied by Social Phobia, Dysthymia, Generalized Anxiety Disorder and Major depressive disorder.
The typical age of outset of Panic Disorder is early adulthood, between 21 and 23. The over all ratio of females to males is approximately 2:1 although the ratio may be higher for conditions of Panic disorder with high levels of agoraphobia.
All behavioral patterns of Panic disorder must be seen as an effort to prevent panic attacks. These behaviors can be divided in the following four categories:
- Agoraphobic Avoidance-Concerns certain behaviors that involve avoiding places and situations from which escape might be challenging or embarrassing or in which help may not be available in case of panic attacks. Typical agoraphobic avoidance behaviors include avoidance of public means of transport (bus, subway, train), large crowds, shopping malls, sporting events, concerts and so on. Agoraphobic avoidance doesn`t accompany always Panic Disorder, in fact there have been many cases of individuals with Panic Disorder who manifested few or no agoraphobic symptoms. Many studies have shown that females are much more prone to acquire agoraphobia than males.
- Introceptive Avoidance-This refers to the tendency among individuals with Panic Disorder to avoid any situation, substance or activity which might reproduce bodily sensations associated with panic attacks. For example, working out, sex, caffeine, alcohol or scary movies.
- Safety behaviors-Panic Disorder individuals consider panic attacks as causes of disaster. They become increasingly worried about their daily occupations- like looking after someone-which results in a very low confidence in one’s abilities. Safety behaviors are behaviors meant to avoid disaster in case of a panic attack; checking to make sure that a hospital is close by, carrying cell phones everywhere and taking one’s pulse rate are all examples of safety behaviors.
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