Explore causes, symptoms, and effective coping strategies for panic attacks. Get expert advice on managing panic attacks at Meri Sehat.

Panic Attack

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic attacks are discrete periods of intense fear or discomfort that abruptly develop and reach a peak within minutes<a href="#accordion">[1]</a>. 
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According to the World Health Organization (WHO), anxiety disorders, including panic disorder, are among the most prevalent mental health conditions globally<a href="#accordion">[2]</a>. Approximately 40.5% of the world&rsquo;s population suffers from an<a href="https://merisehat.pk/disease/social-anxiety-disorder"> anxiety disorder</a><a href="#accordion">[3]</a>. This number has increased by more than 55% over the last two decades. Moreover, women are 1.7 times more likely than men to develop anxiety disorders<a href="#accordion">[3]</a>.

While there are different types of anxiety disorders, panic disorder accounts for the highest number of medical visits<a href="#accordion">[1]</a>. Panic attacks are a hallmark feature of the mental disorder. However, panic attacks can occur along with other anxiety disorders, mood disorders, and even medical disorders.

Panic attacks are relatively common and affect individuals worldwide, leading to significant distress and impairment in daily functioning. Furthermore, panic attacks are not limited to any specific age group. They can occur in individuals of various ages, from adolescence to late adulthood. The incidence of panic attacks is influenced by factors such as genetic predisposition, environmental stressors, and individual vulnerability. 
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Panic attacks can be classified into different types based on their triggers or the context in which they occur. The main types of panic attacks are<a href="#accordion">[4]</a>: 
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1. Unexpected (Uncued) Panic Attacks: These are panic attacks that occur &quot;out of the blue&quot; without any apparent trigger or specific cause. They can happen at any time, regardless of the person&#39;s current situation, and are characteristic of panic disorder. 
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2. Situational (Cued) Panic Attacks: These panic attacks are triggered by specific situations or stimuli. Common examples include fear of flying, fear of heights, or fear of public speaking. Situational panic attacks are more likely to occur when the individual is exposed to the feared situation or stimulus. 
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3. Expected (Expectedly Cued) Panic Attacks: These attacks are also triggered by specific situations, but unlike situational panic attacks, the individual anticipates their occurrence. The anticipation of panic attacks may lead to significant <a href="https://merisehat.pk/disease/anxiety">anxiety</a>, and individuals may avoid the situations altogether to prevent them. 
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A panic attack refers to a sudden episode of intense fear or discomfort that reaches its peak within minutes. During a panic attack, individuals experience a combination of physical and cognitive symptoms, such as rapid heartbeat, shortness of breath, trembling, sweating, chest pain, dizziness, and a sense of impending doom. Panic attacks can be triggered by specific situations or can occur unexpectedly. It&#39;s important to note that experiencing a panic attack does not necessarily mean someone has a panic disorder.

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On the other hand, panic disorder is a mental health condition characterized by recurrent and unexpected panic attacks. In addition to experiencing panic attacks, individuals with panic disorder also have persistent concerns or worries about future attacks, and they often make significant changes in behavior to avoid situations that they fear might trigger panic. These avoidance behaviors can lead to limitations in daily functioning and can significantly impact a person&#39;s quality of life.

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In summary, while a panic attack refers to an acute episode of intense fear and physical symptoms, panic disorder is a diagnosed mental health condition characterized by recurrent panic attacks, along with persistent fear and behavioral changes. 
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Signs and Symptoms

A Panic attack typically has a sudden onset and occurs without any warning. The level of fear is out of proportion to the actual situation.

During a panic attack, individuals may experience a wide range of physical and psychological symptoms. These include<a href="#accordion">[5]</a>: 
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<ul>
	<li>Rapid heartbeat or palpitations</li>
	<li>Chest pain or discomfort</li>
	<li>Shortness of breath or a sensation of choking</li>
	<li>Sweating</li>
	<li>Trembling or shaking</li>
	<li>Feeling dizzy or lightheaded</li>
	<li>Nausea or abdominal distress</li>
	<li>Feeling hot or cold flashes</li>
	<li>Numbness or tingling sensations</li>
	<li>Feeling a sense of impending doom or loss of control</li>
	<li>Fear of dying or going crazy 
	&nbsp;</li>
</ul>

It&#39;s important to note that panic attack symptoms can vary from person to person and can also change during different episodes. 
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Causes

The exact causes of panic attacks are not fully understood, but researchers believe they result from a combination of biological, psychological, and environmental factors. 
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<ul>
	<li>Biological Factors: Genetic and neurochemical factors play a role in the development of panic attacks. Studies suggest that there may be a genetic predisposition to panic disorder and that certain neurotransmitters, such as serotonin and norepinephrine, may be involved in regulating anxiety responses. 
	&nbsp;</li>
	<li>Psychological Factors: Psychological factors, including a history of trauma or stressful life events, may contribute to the development of panic attacks. Individuals with certain personality traits, such as a tendency to be highly sensitive or prone to anxiety, may also be more susceptible to experiencing panic attacks. 
	&nbsp;</li>
	<li>Cognitive Factors: Cognitive factors involve the way individuals interpret and perceive situations. Catastrophic thinking, misinterpretation of bodily sensations, and a tendency to interpret physical symptoms as threatening or dangerous can trigger and exacerbate panic attacks. 
	&nbsp;</li>
	<li>Environmental Factors: Environmental stressors, such as significant life changes, chronic stress, or exposure to traumatic events, can contribute to the onset of panic attacks. Substance abuse or withdrawal from certain substances, such as alcohol or benzodiazepines, can also trigger panic attacks. 
	&nbsp;</li>
</ul>

It&#39;s important to note that panic attacks can occur without an identifiable cause, known as unexpected panic attacks. 
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Healthcare professionals use various methods to screen for panic attacks and diagnose panic disorders. Screening tests or self-report measures help assess the presence and severity of panic attacks. Some commonly used screening tests are: 
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<ul>
	<li><a href="https://merisehat.pk/disease/panic-disorder">Panic Disorder</a> Severity Scale (PDSS): The PDSS is a self-report questionnaire designed to assess the severity and frequency of panic attack symptoms, as well as the associated distress and functional impairment. It consists of seven subscales that cover various aspects of panic disorder, including panic attacks, anticipatory anxiety, phobic avoidance, and interference in functioning<a href="#accordion">[6]</a>.</li>
	<li>Anxiety Sensitivity Index (ASI): Although not specific to panic attacks, the ASI is a widely used self-report measure that assesses the fear of anxiety-related sensations. It measures an individual&#39;s beliefs about the potential negative consequences of anxiety symptoms. Higher scores on the ASI may indicate a greater risk for panic attacks<a href="#accordion">[7].</a> 
	&nbsp;</li>
</ul>

Diagnosis

Diagnosing panic attacks involves assessing the presence and characteristics of panic attack symptoms and ruling out other potential causes. Healthcare professionals use established diagnostic criteria, such as those outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to guide the diagnostic process.

The DSM-5 criteria require the presence of sudden and intense episodes of fear or discomfort, along with specific physical and cognitive symptoms, such as rapid heartbeat, shortness of breath, and fear of losing control or dying. These symptoms must reach a peak within minutes and occur unexpectedly or be situationally bound<a href="#accordion">[8]</a>. 
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Medical evaluations may be conducted to rule out any underlying medical conditions that could mimic or contribute to panic attack symptoms. It is important to consider the individual&#39;s medical history and perform appropriate physical examinations and laboratory tests to exclude other potential causes of symptoms.

The diagnosis of panic attacks also involves considering associated features, such as anticipatory anxiety, phobic avoidance of certain situations, or fear of having additional attacks. These features help differentiate panic attacks from other conditions.

Additionally, healthcare professionals assess the impact of panic attacks on an individual&#39;s daily functioning and overall well-being. The presence of significant distress or impairment is an essential criterion for diagnosing panic disorder. 
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Treatment

The treatment of panic attacks typically involves a combination of therapeutic approaches, including psychotherapy and medication<a href="#accordion">[4]</a> <a href="#accordion">[5]</a>.

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1. Psychotherapy: Cognitive-behavioral therapy (CBT) is the most widely recommended psychotherapy for panic attacks. CBT helps individuals identify and challenge negative thought patterns and beliefs that contribute to panic attacks. It also involves teaching coping strategies, relaxation techniques, and gradual exposure to feared situations. Another effective form of therapy is panic-focused psychodynamic psychotherapy, which explores underlying emotional conflicts and their relation to panic symptoms. 
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2. Medications: Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed for panic attacks. These medications help regulate neurotransmitter levels and can reduce the frequency and intensity of panic attacks. Benzodiazepines may be used on a short-term basis for acute symptom relief, but their long-term use is generally avoided due to the risk of dependence. 
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3. Relaxation Techniques: Learning and practicing relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation, can help manage anxiety and reduce the intensity of panic attacks. These techniques promote a sense of calm and provide individuals with effective coping strategies. 
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4. Lifestyle Changes: Making certain lifestyle changes can also contribute to the management of panic attacks. Regular exercise, adequate sleep, and healthy eating habits can improve overall well-being and help reduce anxiety symptoms. Avoiding stimulants like caffeine and alcohol may also be beneficial. 
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Panic attacks can have several complications that impact an individual&#39;s well-being and daily functioning. Here are some brief descriptions of potential complications: 
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1. Panic Disorder: Recurrent panic attacks can lead to the development of panic disorder, a mental health condition characterized by repeated panic attacks and persistent worry about future attacks. Panic disorder may cause significant distress and impairment in various areas of life. 
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2. Agoraphobia: Agoraphobia is a condition often associated with panic disorder. It involves intense fear and avoidance of situations or places where escape or help might be difficult in the event of a panic attack. Agoraphobia can limit a person&#39;s ability to engage in routine activities and lead to social isolation. 
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3.&nbsp; Anxiety And Depression: Frequent panic attacks can contribute to the development or exacerbation of other anxiety disorders, such as generalized anxiety disorder (GAD), social anxiety disorder, or specific phobias. Panic attacks can also increase the risk of developing depressive symptoms or major depressive disorder. 
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4. Impaired Quality Of Life: Panic attacks and related disorders can significantly impact an individual&#39;s quality of life. They may interfere with work or school performance, relationships, social activities, and overall well-being. The fear of having another panic attack can lead to avoidance behaviors and a sense of constant worry and anticipation. 
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5. Substance Abuse: Some individuals with panic attacks may turn to substance use as a way to cope with their symptoms. Substance abuse, including alcohol or drug misuse, can worsen the overall mental health condition and complicate treatment. 
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The following factors can increase the risk of a panic attack<a href="#accordion">[5]</a>: 
&nbsp;

<ul>
	<li>Family History: Having a family history of panic attacks or panic disorder increases the risk of experiencing panic attacks.</li>
	<li>Gender: Women are more likely than men to experience panic attacks.</li>
	<li>Age: Panic attacks can occur at any age, but they often first appear in late adolescence or early adulthood.</li>
	<li>Genetics: Genetic factors play a role in the development of panic attacks. Certain gene variations or abnormalities may contribute to an individual&#39;s vulnerability.</li>
	<li>Psychological Factors: Certain personality traits, such as high levels of anxiety or neuroticism, may increase the risk of panic attacks. Additionally, individuals with a history of trauma or a previous history of anxiety or mood disorders may be more prone to experiencing panic attacks.</li>
	<li>Major Life Stressors: Significant life stressors, such as the loss of a loved one, divorce, job loss, or financial difficulties, can contribute to the onset of panic attacks.</li>
	<li>Chronic Medical Conditions: Certain chronic medical conditions, such as cardiovascular disease, respiratory disorders, or chronic pain conditions, may increase the risk of developing panic attacks.</li>
	<li>Substance Abuse: Substance abuse, including alcohol or drug misuse, can increase the risk of experiencing panic attacks.</li>
	<li>Smoking: Cigarette smoking has been associated with an increased risk of panic attacks.</li>
	<li>Sensitivity To Physical Sensations: Some individuals who are more sensitive or highly reactive to physical sensations may be at a higher risk of experiencing panic attacks. 
	&nbsp;</li>
</ul>

It&#39;s important to note that having one or more of these risk factors does not necessarily mean an individual will develop panic attacks. 
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Preventing panic attacks involves adopting certain strategies and lifestyle changes to manage anxiety and minimize triggers. These include: 
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<ul>
	<li>Identifying Triggers: It is helpful to identify specific triggers that may lead to panic attacks, such as certain situations, thoughts, or behaviors. By recognizing and avoiding these triggers, individuals can reduce the likelihood of panic attacks occurring.</li>
	<li>Stress Management: Learning effective stress management techniques can help reduce the likelihood of panic attacks. Techniques such as deep breathing exercises, mindfulness meditation, and progressive muscle relaxation can promote relaxation and decrease anxiety levels.</li>
	<li>Regular Exercise: Engaging in regular physical exercise can be beneficial for managing anxiety and reducing the risk of panic attacks. Exercise promotes the release of endorphins, which are natural mood enhancers, and can help regulate stress levels.</li>
	<li>Healthy Lifestyle: Maintaining a healthy lifestyle by getting adequate sleep, eating a balanced diet, and quitting use of substances like caffeine, alcohol, and illicit drugs can contribute to overall mental well-being and minimize the risk of panic attacks.</li>
	<li>Seeking Support: Building a strong support system and reaching out to trusted friends, family, or mental health professionals can provide assistance and guidance in managing anxiety and preventing panic attacks. 
	&nbsp;</li>
</ul>

Panic attacks typically occur out of the blue, leaving the person feeling out of control and in distress. A team of researchers from the University of Vermont is aiming to change that. The team recently published findings from their pilot study which aimed to identify triggers of panic attacks and help patients prepare for their attacks<a href="#accordion">[10]</a>.

They used a smartphone app called PanicMechanic that records the person&rsquo;s heart rate and allows users to log any anxiety triggers<a href="#accordion">[9]</a>. Based on the feedback from the study assessing the effectiveness of PanicMechanic, the team then explored other factors associated with the onset of panic attacks. They not only collected data on their panic attacks and wellness behaviors but also took into consideration population-level happiness levels using Twitter.

As per results, worse individual mood and state-based population-level mood were associated with a greater risk of a next-day panic attack. While a worse individually reported mood was linked to a greater chance of experiencing a panic attack the same day. Moreover, 95% of the participants were able to retrospectively identify a panic attack trigger<a href="#accordion">[10]</a>. 
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Key Points

<ul>
	<li>A panic attack is a sudden episode of intense fear or discomfort accompanied by physical and cognitive symptoms.</li>
	<li>Symptoms of a panic attack include rapid heartbeat, chest pain, shortness of breath, dizziness, trembling, sweating, and a sense of impending doom or loss of control</li>
	<li>Panic attacks can be triggered by specific situations or occur unexpectedly without an apparent cause.</li>
	<li>Panic attacks typically reach a peak within minutes and last for a short duration.</li>
	<li>Panic attacks can be debilitating and distressing, affecting various aspects of a person&#39;s life, including work, relationships, and overall well-being.</li>
	<li>Panic disorder is a mental health condition characterized by recurrent panic attacks and persistent worry about future attacks.</li>
	<li>Other conditions, such as anxiety disorders and certain medical conditions, may have symptoms similar to panic attacks and need to be ruled out during the diagnostic process.</li>
	<li>Treatment for panic attacks may involve a combination of psychotherapy, medication, relaxation techniques, and lifestyle changes.</li>
	<li>Seeking professional help from healthcare providers or mental health practitioners is important for accurate diagnosis and effective management of panic attacks. 
	&nbsp;</li>
</ul>

[1] Cackovic C, Nazir S, Marwaha R. Panic Disorder. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

[2] Mental Disorders. World Health Organization.

[3] Javaid, S.F., Hashim, I.J., Hashim, M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry 30, 44 (2023).

[4] What Is a Panic Attack? Verywell Mind.

[5] Panic attacks and panic disorder. Mayo Clinic.

[6] Panic Disorder Severity Scale (PDSS). NovoPsych.

[7] Sullivan GM. Panic disorder as an emotional disorder. Encyclopedia of Neuroscience. Published online 2009:427-433. doi:10.1016/b978-008045046-9.00843-3.

[8] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Publishing.

[9] McGinnis E, O'Leary A, Gurchiek R, Copeland WE, McGinnis R. A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study. JMIR Form Res. 2022;6(2):e32982. Published 2022 Feb 3. doi:10.2196/32982.

[10] McGinnis EW, Lunna S, Berman I, et al. Expecting the unexpected: Predicting panic attacks from mood and Twitter. Published online 2023. doi:10.1101/2023.01.26.23285057