What is Panic Disorder?
Panic disorder is an illness where a person experiences a series of recurrent, unexpected panic attacks, as well as persistent concern about experiencing them. Panic attacks are a dysfunction of the normal panic/anxiety reaction that would occur if you were in actual danger.  Panic disorder is one of the anxiety disorders.
Panic attacks occur when the body gives off the same distress signals that occur when a person is faced with a life threatening or similar event, yet no such trigger is present. This means that a person may be sleeping, relaxing or just going about their daily business when they suddenly feel some or all of the symptoms of a panic attack including- chest pain, trembling legs, the person may feel they are going crazy or that they are about to have a heart attack.

What Are Panic Attacks?
Symptoms of panic attack include:

• breathing difficulties
• heart palpitations
• chest pains or feelings of heaviness
• feelings of choking
• dizziness
• sweating
• trembling, weakness
• fear of dying, losing control or going crazy
• shortness of breath
• nausea
• hot and cold flashes
• feelings of unreality
• tingling, particularly in the hands and feet

Panic attacks are described as a terrifying experience. Feelings of apprehension, fear that something really terrible is happening may also be present.  Individuals with panic disorder often display characteristic concerns about the implication or consequences of the panic attacks.  For example, that a panic attack may signify a major illness, or that the person is losing control or going ‘crazy’.

Panic disorder typically begins between late adolescence and mid thirties.  The frequency and duration of panic attacks vary widely.  Some individuals have moderately frequent attacks (e.g. once a week) that occur regularly for months at a time.  Others experience short bursts of more frequent attacks (e.g. daily for a week) separated by weeks or months without any attacks. Panic disorder may also coexist with depression, generalised anxiety disorder and personality disorders.

Panic disorder can occur with or without agoraphobia. Some people with agoraphobia do not have panic attacks and many people with panic disorder do not develop agoraphobia; however large numbers suffer from both. Certain illegal drugs, such as marijuana, and other substances, such as caffeine, can trigger panic attacks as can fear of a specific object or social situation.

What Causes Panic Attacks?
The cause of panic disorder is not clear and is the subject of intense research.  These are some of the explanations that have been considered:
Genetic pre-disposition
Many people with panic disorder say they have family members with anxiety disorders and some research using twin studies has found some evidence for genetic pre-disposition to panic disorder (American Psychological Association)
Neurobiological causes
Medications traditionally used to treat depression can be helpful for some people with panic disorder; these medicines are called Selective Serotonin Reuptake Inhibitors (SSRIs).   These medications work in the brain to control levels of the neurotransmitter serotonin.  Depression often co-exists with anxiety disorders such as panic disorder.
The body’s natural ‘danger alarm’ system is improperly triggered
The first panic attack may occur following an illness, major life stress or another understandably stressful or frightening experience.  The person then fears more attacks occurring and interprets their feelings as being those of a panic attack.  A vicious circle results, with that fear actually helping to bring on another attack.

Family and Friends

• be supportive to your relative with panic disorder but acknowledge that you cannot do everything for them.  Ask them what help or support they feel would be helpful
• learn about panic disorder and encourage your relative to do the same
• encourage your relative to accept treatment and stay in contact with their medical professional.

If your relative experiences a panic attack, learn how to help them deal with the symptoms.  These suggestions come from the Better Health Channel website.

• breathe into a paper bag. Inhaling your exhaled carbon dioxide can quickly balance your blood gases and ease the symptoms.
• if you don't have a paper bag, hold your breath for the count of 10, and then take slow and deep breaths using your abdomen rather than your chest.
• avoid 'self-talk' that focuses your attention on your symptoms, such as 'Stop panicking!' or 'Relax!'  Focus your attention on something outside your own body and symptoms. For example, distract yourself by counting backwards in threes from 100; recall the words from a favourite song or concentrate on the sights and sounds around you.
• remind yourself that the symptoms of a panic attack are uncomfortable, but not life threatening. Reassure yourself that you've felt these feelings before and nothing bad happened to you.
• fleeing from the situation will only reinforce the perception that your panic attacks are unbearable. If you sit and allow the symptoms to pass, you gain confidence in your ability to cope.

For help with panic attacks, Therapeutic Axis provides Counselling in Sydney and Psychotherapy in Sydney.

Further Reading

100 Questions and Answers about Panic Disorder, by Berman, Jones & Bartlett Publishers, Incorporated, 2005, ISBN: 0763727156
Fear Is No Longer My Reality: How I Overcame Panic and Social Anxiety Disorder and You Can To, by Glatzer, Jenna / Blyth, Jamie, 2004, McGraw-Hill, ISBN: 0071447296

Panic Disorder and Its Treatment, by Mark H. / Rosenbaum, J. F., 1998, netLibrary, ISBN: 0585157510
The Mental Health Information Service sells the following books, please contact us to order info@mentalhealth.asn.au 1300 794 991:

• About Panic and Phobias by the Association of Relatives and Friends of the Mentally Ill (ARAFMI)
• The Panic Book by Neil Phillips, ShrinkRap Press