Anxiety disorders are among the most prevalent mental disorders in society worldwide. They are of different types, and can be very disabling for the person who suffers them.

In this article we will talk about panic attacks , which are very common in different anxiety disorders. Currently, in the DSM-5, they are considered a specifier of any other disorder. They are defined as the sudden appearance of intense fear or discomfort, which reaches its maximum expression in minutes

Crisis of distress: characteristics

Anxiety attacks, also called panic attacks or panic or distress attacks, are listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The DSM-5 includes panic attacks as a specifier of any other disorder, and not so much as a disorder itself (in the DSM-IV-TR the panic attack was considered a separate “disorder”).

On the other hand, the ICD-10 (International Classification of Diseases) requires at least one of the symptoms to be a crisis of distress: palpitations, tremors, dry mouth or sweating .

Symptoms

The DSM-5 defines a panic attack as the sudden appearance of intense fear or discomfort, which reaches its maximum expression in minutes . During this time, 4 (or more) of the following symptoms occur:

  • Palpitations, heart pounding, or rapid heart rate
  • Sweating.
  • Trembling or shaking .
  • Feeling of shortness of breath or suffocation
  • Choking sensation.
  • Chest pain or discomfort.
  • Nausea or abdominal discomfort.
  • Feeling dizzy , unstable, dazed or faint.
  • Chills or a feeling of warmth.
  • paresthesias (numbness or tingling sensation)
  • Unrealization (feeling of unreality) or depersonalization (separating from oneself).
  • Fear of losing control or “going crazy”.
  • Fear of death.

On the other hand, the most frequent somatic symptoms in panic attacks are: first palpitations, followed by dizziness-dizziness and trembling (they are common in both children and adults).

Children, unlike adults, have fewer cognitive symptoms (fear of going crazy, for example).

Types of panic attacks

The sudden appearance of fear or discomfort can be produced from a state of calm or, on the contrary, from a state of anxiety. On the other hand, panic attacks are very common in different anxiety disorders.

According to the DSM, it is possible to diagnose a panic attack in the absence of fear or anxiety, which is defined as “cognitive or alexithymic panic attacks” .

Attacks that do not have all 4 symptoms are called “limited asymptomatic attacks”.

Differences in clinical and non-clinical population

Panic attacks are known to occur in non-clinical (non-mental) populations as well as in clinical (mental) populations. These attacks are similar in physiological experience, in that they occur in moments of stress and in that there is a similar family history of panic attacks.

As for the differences, we found that:

  • Clinical patients present attacks of an unexpected type, while non-clinical patients suffer them more in social situations (evaluative).
  • Clinical patients express more catastrophic cognitions .

Causes

We found different types of causes that have been referred to in an attempt to explain the emergence of panic attacks. These are, broadly speaking, of 3 types (although in most cases there is an interaction between several of them that end up causing the disorder).

1. Biological

The biological hypotheses allude to a certain predisposition to anxiety disorders, as well as to neurobiological aspects (alterations of the GABA, hyperactivity of the locus coeruleus, hypersensitivity of the serotonin receptors, etc.), neuroendocrine and psychophysiological aspects .

2. Learning

Learning theories refer to classical conditioning, Mowrer’s bifactorial model (which includes operant and classical conditioning as originators and maintainers of anxiety), Eysenck’s law of incubation and Seligman’s theory of preparation.

3. Cognition

The cognitive models allude to aspects more related to how we process information , referring for example to networks or brain structures of “fear” and a selectivity to attend to aversive stimuli, among others.

Treatment

The disorder of choice for treating panic disorder or panic attacks is a multi-component cognitive-behavioural treatment , which includes among its components:

  • Live exposure to interoceptive stimuli
  • Cognitive restructuring.

On the other hand, treatments with good efficacy are considered: Barlow’s panic control treatment, and Clark’s cognitive therapy .

As slightly less effective treatments, we found:

  • The applied relaxation of Öst.
  • The exposure therapy .
  • Pharmacotherapy (SSRI).

Finally, in the experimental phase, there are three types of data-based treatments for treating panic attacks:

  • The virtual reality exposure treatment (for agoraphobia distress disorder)
  • Intensive Sensation Focused Therapy (by Baker Morissette)
  • Increased Cognitive Behavior Therapy for Panic (by Levitt)

Bibliographic references:

  • WHO (2000). ICD-10. International Classification of Diseases, Tenth Edition. Madrid. Pan-American.
  • Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. Siglo XXI
  • Belloch, A.; Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
  • American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.