Between 3 and 6 million people in the United States alone will develop panic disorder at some time in their lives. Women in young adulthood are the most typical but the disorder can manifest itself to anyone regardless of age, sex and ethnicity.

There is hope for those who suffer: treatment can benefit virtually everyone with panic disorder and is becoming more widely available. It is critical for panic suffererers to learn as much as they can about their condition and treatment options and seek help

WHAT IS PANIC DISORDER?

Panic disorder is a chemical inbalance of the brain in which distinct episodes of acute fear are accompanied by multiple physical symptoms. These panic attacks occur repeatedly and unexpectedly and have no discernable threat. They appear to occur when the brain's normal threat reaction is inappropriately aroused. This is called the "fight or flight" response

Symptoms of panic vary from individual to individual but typically include chest pain, heart palpatations, choking sensations, disorientation, nausea, headaches, upset stomach, dizziness, difficulty breathing, numb or tingling hands, trembling, flushes or chills, insomnia, feelings of unreality, sense of impending doom, and the fear that you are going crazy or dying.

Panic attacks usually take a person by complete surprise and it is this unpredictability that makes them so devastating. Those who have never had a panic attack might assume that panic is just the familiar feeling of being nervous or anxious. However, feelings experienced during an attack are so overwhelming and terrifying that the sufferer is convinced disastrous consequences will occur, even if their symptoms are not obvious to others.

COURSE OF PANIC DISORDER

Typically, the first panic attack seems to come "out of the blue" and occurs while a person is engaged in some ordinary activity such as driving a car or shopping in a grocery store. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms including terror, a sense of unreality and a fear of losing control. These symptoms can last for several seconds to several minutes and gradually fade over the course of about an hour. Most often, people experiencing their first panic attacks seek help at a hospital emergency room, convinced they have been stricken with a life-threatening emergency.

Initial panic attacks may occur when people are under considerable mental or physical stress. An overload of work, the loss of a loved one, surgery, a serious accident, illness, or childbirth are all examples of possible situations that may trigger panic. Other triggers include an excessive consumption of caffeine and the use of cocaine or other recreational drugs as well as stimulant medicines such as those used in treating asthma.

Most people with panic disorder also develop a "fear of the fear". This fear can seriously interfere with a person's life even in the absence of an actual panic attack as phobias develop about places and situations where attacks have occured. These phobias may cause someone who has experienced panic while driving to develop an irrational fear about getting behind the wheel of a car again, even to drive around the block. Anticipatory anxiety and the resulting avoidance can lead to disability in panic disorder.

The fallout from the avoidance behavior is tremendous as limitations increase. Careers may suffer due to a person's inability to travel and relationships may become strained because of phobic behavior and the difficulty in getting a loved one to understand the severity of the disorder. Also, sleep may be disturbed due to nocturnal panic attacks and chronic anxiety. Panic attacks that awaken slumbering victims are so harrowing that those who have experienced them may fear going to sleep and suffer from exhaustion.

Many people with panic disorder continue to go to doctors or emergency rooms even after their diagnosis, convinced a life-threatening condition has been missed. Some sufferers visit a dozen doctors and go through multiple unnecessary tests in an effort to find out what is causing their symptoms.

Adding to this problem has been a lack of knowledge about panic disorder in the medical community which is slowly but surely becoming familiar with the cause, course and treatment. The statistics regarding misdiagnosed panic disorder are staggering as it is still considered a rule out rather than rule in condition. This means that unfamiliar doctors do not often recognize it in spite of all the tell-tale symptoms. And sometimes when doctors do recognize the disorder, it is often downplayed as nerves or stress which can be disheartening to a worried patient with recurring symptoms. They need to be reassured that panic disorder is very real and that there are many effective treatments.

AGORAPHOBIA

Agoraphobia occurs when panic disorder advances to the stage where a person fears being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. It affects about a third of all people with panic disorder.

Typically, agoraphobics are afraid of being in crowds, standing in line, going to malls or large stores, and riding in cars or public transportation. Often, they create a "safety zone" and restrict themselves to their homes or neighborhood. Leaving this zone causes them increased anxiety. Sometimes they can travel only if they accompanied by their "safe person"- usually a family member or friend. Even when restricted to "safe" situations, most agoraphobics have panic attacks at least a few times a month.

Agoraphobia can be a serious disability with those afflicted leading lives of extreme discomfort and dependency. Sufferers are typically unable to work and rely heavily on others for shopping, errands, and other appointments. They also need to be accompanied in the event that necessity forces them to travel outside of their "safety zone".

TREATMENT FOR PANIC DISORDER AND AGORAPHOBIA

Panic Disorder is highly treatable, bringing significant relief to almost 90% of patients. Early diagnosis and treatment is critical to keeping the disorder from progressing to agoraphobia.

Even if panic disorder is diagnosed, patients should undergo a thorough medical examination to rule out all other possible causes of their symptoms before treatment. This is necessary because other conditions, including thyroid disease, epilepsy, and cardiac arrhythmias, can cause symptoms resembling those of panic disorder.

Effective treatments available for panic disorder and agoraphobia include cognitive-behavioral therapy and many different forms of medications. Individual needs and patient preferences should be considered in selecting treatment with reassessment being necessary if significant effects are not produced within 6 to 8 weeks.

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