Panic disorder

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Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

Palpitations, sweats and feelings of suffocation are typical symptoms of panic disorder. Those affected experience repeated panic attacks in which they are overwhelmed by massive fear. Many are convinced that a threatening physical cause triggers the symptoms. This even scares some of them to death. Read everything you need to know about panic disorder and panic attacks here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F40F41

Panic disorder: description

Panic disorder is also referred to by medical professionals as episodic-paroxysmal anxiety. The term "paroxysmal" comes from the Greek and can be translated as "paroxysmal". Recurring, unpredictable panic attacks are characteristic of panic disorder.

What are Panic Attacks?

Panic attacks are sudden attacks of intense anxiety that are associated with a variety of physical symptoms, including tremors, sweating, and palpitations, and thoughts that increase anxiety. Common ideas include having a heart attack, suffocating, or fainting. The threatening interpretation makes those affected fear that they will die from the symptoms. The panic attacks only last a short time, but they are very intense and exhausting.

It is only a panic disorder if the panic attacks are not associated with particular exertion or dangerous situations. They also do not relate to a specific object, such as a phobia, but occur in different situations.

Panic disorder with agoraphobia

Panic attacks are often associated with the mental disorder agoraphobia. Patients are then afraid, for example, of using public transport, going to a cinema or theater, or going to the supermarket to go shopping. If possible, avoid such places (avoidance behavior). If patients no longer dare to go out of the house alone, this has serious consequences, such as losing their job and being lonely.

Panic disorders associated with agoraphobia are more common than pure panic disorders.

Panic attacks can also appear in the context of depression. They are then not assigned to a panic disorder, but rather seen as a consequence of the depression.

Panic attacks in children

Even children and adolescents can develop an anxiety and panic disorder. When parents suffer from panic attacks themselves, many children take over the anxious behavior from them. For example, experts were able to show in experiments that toddlers shy away from unsafe situations when their mother has a frightened expression on her face. This behavior shows that the facial expressions and gestures of parents have a strong influence on people from a young age. An increased anxiety on the part of the mother and / or father increases the risk that the child will develop panic disorder later. Children who suffer from separation anxiety are also more likely to experience panic attacks.

As with adults, there are usually other psychological problems in addition to panic disorder, including depression, other anxiety disorders and addictions.

Panic Attacks: How Many People Are Affected?

Around two to three percent of the population will develop a panic disorder with panic attacks in their lifetime. It usually begins between the ages of 15 and 24. Panic disorder is diagnosed in women at least twice as often as men.

Panic attacks: symptoms

According to the ICD-10 classification of mental disorders, the following symptoms are characteristic of panic disorder or panic attacks:

• A panic attack is a single episode of intense anxiety that begins abruptly and reaches its maximum within a few minutes. It only lasts a few minutes.
• Panic disorder always has at least one of the following symptoms: changes in heart rate and palpitations, sweating, tremors, dry mouth.
• Other common chest and abdominal symptoms are difficulty breathing, tightness, chest pain, nausea and stomach discomfort.
• In addition, many patients complain of symptoms such as hot flashes or chills, numbness or tingling during a panic attack.
• Psychological symptoms include dizziness, insecurity, weakness, and lightheadedness. The fear and physical symptoms are so severe that people fear death from them.
• Since panic attacks come out of the blue, many people are afraid of losing control or worrying about going crazy.
• Often those affected perceive themselves or the environment as unreal and strange. Experts refer to this phenomenon as depersonalization or derealization.

The severity of panic attacks varies from person to person.

Panic Disorder: Symptoms of Nighttime Panic Attacks

Up to 40 percent of patients with panic disorder also experience panic attacks regularly at night. There is still no definite explanation for this phenomenon. It is difficult to explain because panic attacks do not occur in the dream phases at night. So panic attacks while sleeping are not a reaction to nightmares.

Experts therefore suspect that panic is learned as a reaction to physical changes during the day (such as a faster heartbeat). This trained reaction could then take place automatically at night.

Panic attacks: causes

The causes of panic disorder are not fully understood. It is now clear that genetic factors play a role. It is also known that impaired messenger activity in certain brain regions favors the development of the disease. These and the following factors play together in the development of panic attacks.

Traumatic childhood experiences

Scientists assume that trauma in early childhood is often the cause of an anxiety disorder later on. In childhood experience research, panic sufferers were more likely to report neglect, sexual abuse, loss of a parent, parental alcohol abuse, and domestic violence. However, stress in adulthood can also contribute to the development of a panic disorder, for example divorce or the death of a relative.

anxiety

People with increased anxiety are particularly at risk of developing panic attacks. They often interpret physical reactions to stress or exertion as life-threatening. This in turn increases the physical symptoms - the fear builds up.

Avoidance behavior

The avoidance behaviors that sufferers develop cause the fear to be perpetuated and the panic attacks to recur. Carrying medication with you or being constantly accompanied by other people also tends to make the problem worse. Those affected believe that they only got through the situation because they had help in an emergency. As long as they do not experience that the panic can be defeated without help, the panic disorder persists.

stress

Severe stress (for example as a result of partner conflicts, unemployment, existential worries) can promote the onset of panic disorder. With constant inner tension, a small trigger (like shopping in a crowded supermarket) is often enough to trigger the vicious circle of fear that ultimately leads to a panic attack.

Substances that cause panic attacks

Substances like alcohol, caffeine, and various medications promote the occurrence of panic attacks. Cigarettes in particular often do not have the supposed calming effect: Nicotine usually has a stimulating effect on the body. If you are already in a state of inner excitement, smoking a cigarette increases the restlessness. The level of tension that triggers the panic attack is reached more quickly. If anxiety attacks occur frequently, panic disorder develops.

Panic attacks: examinations and diagnosis

If you suspect a panic disorder, you can first see your family doctor. They will talk to you and carry out various examinations to rule out any physical causes of the symptoms. Anik-like conditions can also occur in connection with physical illnesses. These diseases include:

• Cardiac arrhythmias
• Tightness of the heart (angina pectoris)
• Overactive thyroid gland (hyperthyroidism)
• Low blood sugar (hypoglycaemia)
• bronchial asthma
• Chronic obstructive pulmonary disease (COPD)
• Sleep apnea syndrome
• epilepsy
• Caffeine poisoning
• Drug use, especially cocaine, amphetamines, ecstasy, hallucinogens and opiates

Your family doctor will refer you to a therapist or a psychosomatic clinic for an exact diagnosis of the panic disorder and to determine whether there are any other mental disorders.

In a conversation to collect the medical history (anamnesis), a doctor or psychologist can differentiate the panic disorder from other anxiety disorders by asking specific questions. The therapist might ask the following questions to help diagnose panic disorder:

• Do you ever experience bouts of severe anxiety?
• Does the fear occur together with physical symptoms such as tremors, shortness of breath or dry mouth?
• After an anxiety attack, are you afraid of another attack?
• Is there a specific trigger for the anxiety attacks?

The doctor or therapist can also use questionnaires and tests. A panic attack test is, for example, the Hamilton fear scale (HAMA), which the doctor fills out in conversation with the patient (third-party assessment sheet).

But there are also self-assessment sheets with the help of which anxiety patients can describe their symptoms more concretely (State-Trait-Anxiety-Inventory, STAI).

If those affected experience four panic attacks within four weeks, one speaks of a moderate panic disorder. If four panic attacks occur per week within a month, it is a serious panic disorder.

Panic attacks: treatment

For the treatment of panic disorder with panic attacks, experts recommend cognitive behavior therapy and the use of medication. Alternatively, psychodynamic psychotherapy also shows success. Sport and the connection to self-help can support the therapy in a meaningful way.

Cognitive behavioral therapy

The first step in panic attack therapy is usually to provide the patient with detailed information about the mental disorder (psychoeducation). The sufferer is made familiar with the typical characteristics of panic disorder. Just knowing that many people suffer from the same symptoms and that the physical symptoms belong to the disorder often relieves those affected from fear of the unknown.

In the next step, the patient should deliberately induce a panic attack. For example, the patient is asked to breathe quickly and deeply or to turn in circles to create dizziness. It may seem paradoxical to deliberately create the dreaded situation. However, there are two important aspects to this intervention. For one, the patient has control over when the panic attack starts for the first time. On the other hand, he learns that the physical symptoms are not caused by a heart attack, but can be triggered by breathing alone.

In the further course of the panic disorder treatment, the patient should then repeatedly face his fears. Gradually, the fear will decrease and panic attacks will no longer occur. Those affected, who also suffer from agoraphobia and therefore avoid public places, have to go to such places. Even people with panic attacks while driving can defeat them if they manage to get back in a car and drive off. Some clinics even cooperate with driving schools for this purpose.

To prevent relapse, the therapist prepares the patient for possible panic attacks. If strong symptoms of anxiety return, the person affected knows how to deal with them and how to fight the panic attacks.

Psychodynamic psychotherapy

In "Panic-Focused Psychodynamic Psychotherapy" the therapist explores the conflicts behind a patient's panic disorder and the importance of panic attacks. For example, a panic attack can be an expression of suppressed feelings that only manifest through the attacks of anxiety. Talking to the therapist gives the person concerned access to his or her suppressed feelings. The panic attacks decrease when the patient realizes that unresolved conflicts are the root cause of their fears.

Many panic patients generally tend to feel helpless and dependent on other people. An important starting point for psychodynamic psychotherapy is therefore to strengthen its self-determination and independence (autonomy).

Medication

For the treatment of panic disorders, drugs from the class of antidepressants have proven particularly effective. These include newer antidepressants, so-called selective serotonin reuptake inhibitors (SSRIs). They have fewer side effects than older representatives of this group of active ingredients. However, they cause nausea or sexual dysfunction in some people.

Benzodiazepines with their calming (sedative) and anxiolytic (anxiolytic) effects are also effective. However, they are highly addictive. Therefore, they should only be taken if the administration of SSRIs was unsuccessful, and then only for a short time.

In the past, typical antipsychotics (neuroleptics) were also used to treat panic disorders - i.e. drugs that primarily have an antipsychotic effect (e.g. against delusions and hallucinations). These days, they are no longer recommended for panic disorders and are only used in rare cases.

Panic disorder in children - treatment

Therapy is often successful in children and adolescents with panic disorder. It usually makes sense to involve the parents in the therapy. Because anxiety disorders in children are in some cases based on dysfunctional relationships within the family. Even if this is not the case, the parents can learn in therapy how to support their children.

Tips against panic attacks

What helps against panic attacks? The best cure for anxiety is to face fear. By confronting their own fears, those affected can get rid of panic attacks. Watch yourself carefully and try to discover and discard avoidance strategies. For example, this can mean that you only leave the house with medication or with other people. Remember: anything you do not do out of fear weakens you and increases your fear.

Control thoughts

What to do against panic attacks if they have already started Even if panic attacks occur without warning, you are not helpless at the mercy of them. During a panic attack, you will experience the familiar signs such as strong palpitations, dizziness or nausea. Recall that you can influence how the fear develops. What matters is how you assess the situation. Instead of assuming life-threatening causes, try to understand that while the symptoms are uncomfortable, they are not putting your life at risk.

Breathing exercises

Recall that a panic attack will last a few minutes at most. Breathing exercises are a great help with panic attacks to bridge the gap. Try to breathe slowly, paying particular attention to the exhale as this will calm the body. With hyperventilation, for example, it is easy to exhale too much carbon dioxide. The discomfort that arises during hyperventilating creates fear. By breathing into a bag, you can quickly overcome hyperventilation and, with it, panic attacks. Carbon dioxide accumulates in the bag, so that its content and acidity in your blood return to normal.

Avoid or reduce stress

Make sure your stress level doesn't get too high. Treat yourself to breaks in the hectic pace of everyday life. Getting enough sleep and avoiding caffeine also prevent panic attacks. Exercise is also effective against panic attacks. During exercise, you will experience physical symptoms similar to those of panic attacks: the heart beats faster, breathing changes. They get used to this condition over time and no longer evaluate the symptoms as a danger.

to accept help

Despite many helpful exercises that you can do on your own, it is advisable to seek professional help. Confronting fear becomes easier with good guidance and support. And only through this can you ultimately defeat the panic attacks. Self-help groups are a good addition because they offer support not only during but also after therapy.

Panic attacks: disease course and prognosis

If left untreated, panic disorders often persist for years. Phases of increased and low frequency of anxiety attacks can alternate. Especially in connection with a fear of public places (agoraphobia), panic disorder can severely limit the life of the person affected. At some point, some affected people stop leaving the house at all for fear of renewed anxiety attacks and / or become depressed.

People with panic disorder often resort to anti-anxiety drugs (anxiolytics) or alcohol to get their anxiety under control without consulting a doctor. Alcoholism and drug addiction (particularly those related to sedatives and anxiolytics) can result.

With the help of psychotherapy and medication that make the fear reaction bearable, panic disorder can be managed well. The therapy shows long-term success in around 80 percent of patients. Above all, it is important to seek medical help in good time, as the panic disorder does not go away on its own.

Treating panic disorder is also very important in children and adolescents. If left untreated, the mental illness can be chronic and have a very negative effect on children's development. The social effects are particularly serious, as children with panic disorder continue to withdraw out of fear.

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