The term “anxiety attack” is something we probably all know. In fact, most people have experienced one or have seen someone else do it in their lifetime. But in some cases these crises occur relatively frequently and generate a great fear of suffering them again, which in turn makes situations avoidable. We are talking about those people who suffer from a panic disorder .

Panic disorder

So-called panic disorder is one of the most common types of mental disorder, which is characterized by the recurrent occurrence of sudden and unexpected panic attacks (the subject may be calm or in an anxiety situation before the onset).

Panic attacks, also known as panic attacks, are the appearance of sudden and temporary episodes of feelings of distress, discomfort and fear of high intensity that can have a variable duration and usually generate a maximum activation peak within a few minutes and resolve in about fifteen minutes (although they can sometimes last for hours).

During these attacks a wide variety of symptoms appear, including tachycardia, profuse sweating, tremors, hyperventilation and a feeling of suffocation, hyperthermia , numbness, chest pain, intestinal discomfort and psychological symptoms such as fear of dying or having a heart attack, the idea of losing control over one’s body or even going crazy and possibly dissociative symptoms such as de-realization (feeling that what is happening is not real) or depersonalization (strangeness with the subject’s own existence).

After the anxiety attack(s), there is concern for a month or more that the same sensations may return or be experienced again at some point. The subject anticipates the occurrence of these attacks and this generates a great fear and anguish, a fear that provokes a state of great tension in the subject and can even provoke the setting in motion of mechanisms and behaviours that allow the avoidance of either these sensations or the possible appearance of new attacks. Thus, if, for example, the panic attack hit us in the underground, it is likely that we will avoid using public transport again.

This will generate consequences of different magnitude that will alter their day-to-day life to a greater or lesser extent, both on a personal and a social and work level. The functionality and the daily life of the person with this problem will be limited by the panic and the avoidance of circumstances that can generate it. In fact, it is common for the subject to end up also suffering from depressive problems or even from substance use and abuse.

Anxiety attacks as something non-pathological

Experiencing a panic attack is certainly an extremely unpleasant and aversive experience. As we have said, it is not uncommon for the fear of dying or going crazy to appear. In addition, many symptoms are somewhat reminiscent of a heart attack, which reinforces the idea that something very serious is happening and increases the panic and anxiety and reinforces the symptoms described above.

However, it should be noted that panic attacks do not indicate any disorder per se unless they occur in a highly recurrent manner and generate avoidance in anticipation of their occurrence. In fact, a relatively large percentage of the world’s population will suffer some anxiety crisis or panic attack at some point in their lives. This is especially frequent in demanding societies with a high level of exigency , which is frequent nowadays.

But despite what has been said, they should be taken into account when evaluating psychopathology, given that it is not uncommon for both panic disorder and other mental problems to appear.

Relationship to agoraphobia

Panic disorder has traditionally been closely linked to another psychological problem called agoraphobia, in which there is fear and anxiety at the idea of being exposed to places where escape would be difficult or might not receive help in the case of suffering a panic attack or other embarrassing situations (although most people believe that it is the fear of open spaces, in reality the underlying fear and what would cause avoidance of these and other types of spaces would be this).

This is because it is very common for agoraphobic subjects to anticipate anxiety and panic attacks and avoid such situations. In fact, although they are currently diagnosed separately, until a few years ago a distinction was made between panic disorder with or without agoraphobia.

Confusion with heart problems

One of the most common fears that arise at the time of a panic attack is that you are about to die from a heart attack. This is a logical confusion, taking into account that many of the symptoms are similar to angina or a heart attack : tachycardia, chest pain, sweating…

However, it should be noted that there are differences between panic attack and heart attack. Among them, it is worth mentioning that in a heart attack, unless other problems appear or anxiety arises, there is no hyperventilation or feeling of loss of body control. The pain is different and tends to be more generalised, in addition to the fact that while in the heart attack there is a link with the performance of effort, in anxiety this does not occur . The duration of the symptoms is also different. In any case, it is advisable to go to a medical centre.

What’s the cause?

As with other disorders, the exact cause of why some people develop a panic disorder and others are not fully known.

The appearance of the first crisis may be due to situational factors , while some authors propose that the recurrence, anticipation and concern about panic attacks are due to the generation of negative and aversive interpretations of bodily sensations not linked to anxiety.

The fact that some sensations are interpreted as anxious generates the appearance of fear and anxiety, which ultimately leads to the appearance of a crisis.

There is also speculation about the possible influence of genes, with anxiety disorders generally being more common in families with previous cases. Learning from role models or previous experiences may also have some influence.

Treatment and therapy

Panic disorder is a highly disabling problem for sufferers and often has a tendency to become chronic if left untreated. Fortunately, studies carried out on this anxiety disorder indicate that the most common and recommended treatments available tend to have a very high efficacy , specifically over 80% of recoveries.

One of the most frequent and effective treatments is, as with phobias, exposure. This technique is based on putting the subject in situations where he or she gradually experiences situations that he or she avoids and that generate anxiety so that the level of fear and anxiety in the face of these situations and the avoidance that they usually entail can be reduced.

It is important to bear in mind that the exposure should be gradual , and it is necessary to agree with the patient on a hierarchy of situations to be feared in order to gradually reduce the anxiety generated. In the case of panic disorder, we are talking about both situations which are avoided for fear of suffering a panic attack and work at an interoceptive level, including exposure to sensations linked to panic (for example hyperventilation).

Another of the most effective treatments, which can be given together with the previous one, is cognitive restructuring. In this case we intend to combat the dysfunctional thoughts and beliefs that have generated and/or maintained the problem. The aim is to decatastrophize the situation and change the negative interpretations of body sensations so that they are not attributed to the event of an anxiety crisis. Behavioural experiments are also used in which the patient is asked to carry out tests to check whether or not his or her thoughts and hypotheses about what is happening (being in a certain way a small exposure) are in line with reality.

Teaching relaxation techniques can help lower the level of anxiety and distress or learn how to control it, which is very helpful to the patient.

Drug use

Sometimes psychotropic drugs are also used, and benzodiazepines and tranquilizers or even some antidepressants such as SSRIs are commonly prescribed. The use of these drugs can be useful to reduce the level of anxiety , but it is necessary to combine it with psychotherapy so that the subject learns to modify his or her beliefs and stop avoiding situations and sensations, so that relapses do not occur after the withdrawal of the drug.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • National Institute of Mental Health (n.d.). Panic disorder: when fear is exhausted. [online publication]. Available at: https://www.nimh.nih.gov/health/publications/espanol/trastorno-de-panico-cuando-el-miedo-agobia/index.shtml#pub8