Panic attacks can be highly distressing when it strikes. The following are the top 20 things you should know about panic attacks (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000):
- Panic attacks have a sudden onset and peaks rapidly
- Anticipatory anxiety may be more debilitating
- A panic attack can occur with any anxiety disorder and some medical conditions
- Three types of panic attacks
- Unexpected (uncued) panic attacks
- Situationally bound (cued) panic attacks
- Situationally predisposed panic attacks
- A panic attack can feel like a heart attack
- Panic disorder runs in families
- Agoraphobia and panic attacks
- Problems with relationships and employment/schooling
- Fear of witchcraft or magic
- Intoxication with stimulants and cannabis
- Withdrawal from central nervous system (CNS) depressants
Panic attacks occur without warning, and usually lasts 5 to 10 minutes. Some will talk about having a panic attack all day…this is not a panic attack, and more likely the person is experiencing generalized anxiety. Panic attack are different from generalized anxiety, as panic attacks are sudden and discreet episodes which peak in minutes, not hours or days. Also, panic attacks are much more severe in intensity.
The actual panic attacks are the least of your problems, believe it or not. What can become more debilitating is the anticipatory anxiety one gets when awaiting for the next panic attack to hit. One may watch the clock, or scan their body for any changes, in anticipation of the next panic attack. And when a panic attack does occur, this just validates their attempts to look for the next panic attack, locking in the person in a vicious cycle of anticipatory anxiety.
A panic attack can occur with any anxiety disorder, which is described in more detail below. Medical conditions may manifest as a panic attack, such as hyperthyroidism, seizure disorder, cardiac conditions, hyperparathyroidism, pheochromocytoma, and vestibular problems.
The three types of panic attacks are: unexpected (uncued), situationally bound (cued), and situationally predisposed.
Unexpected (uncued) panic attacks usually occur out of the blue and can occur when one is resting or when sleeping. Also, in uncued panic attacks, one may have a fear of going crazy, fear of dying, fear of losing control can be a symptom. Unexpected panic attacks are required for a diagnosis of Panic Disorder. Over time, uncued panic attacks may transform into cued or situationally predisposed panic attacks, although uncued panic attacks may still occur.
Cued panic attack occur immediately after a trigger in the environment, or occur in anticipation of a trigger occurring. As examples, someone with social phobia may experience cued panic attacks each time they are exposed to social situations, or someone with a specific phobia may have cued panic attacks when exposed to heights.
Situationally predisposed panic attacks are similar to cued panic attacks, but the situationally predisposed panic attacks may be triggered in the environment, but the attack does not necessarily start immediately after the trigger, and there are times when the panic attack occurs without a trigger. Situationally predisposed panic attacks occur typically in generalized anxiety disorder (murders in the vicinity gets one so worried that it culminates in a panic attack) and post traumatic stress disorder (when one is exposed to the site of the car accident, it may trigger a panic attack).
People who get panic attacks may feel like they are experiencing a heart attack, and may present to the emergency department with normal physical and laboratory findings.
The first degree relatives of people with panic disorder are at increased risk of developing panic disorder, and twin studies show there is a genetic component to developing panic disorder.
Agoraphobia is anxiety about not being able to escape in certain situations or anxiety about being in situations where help may not be available. Panic attacks can lead to avoidant behaviors of situations which lead to a panic attack. Although some individuals report that the panic attacks are reduced with avoidance, one becomes so avoidant that it transforms into agoraphobia.
People may have significant problems associated with panic attacks that their relationships suffer, or they have employment problems or problems in school.
Some cultures may have panic attacks manifesting as a fear of witchcraft or magic.
Intoxication with stimulants (such as cocaine, amphetamine) and cannabis can induce a panic attack.
Withdrawal from CNS depressants, such as alcohol, can induce a panic attack.
In summary, panic attacks can be highly distressing, and can occur in the context of all anxiety disorders, some medical conditions, and can be induced by intoxication with stimulants and withdrawal from alcohol. There are three types of panic attacks which are associated with different anxiety disorders, if not secondary to a medical condition or to intoxication/withdrawal. If the panic attacks go untreated, they may contribute to disruptions in relationships, employment, or schooling.