Panic Disorder is a disorder that manifests recurrent unexpected
panic attacks with persistent concerns about having more attacks. There is also significant fear as to the implications and
consequences of the attacks, such as the fear of a medical or mental crisis. These fears may cause a significant change
in behavior related to the attacks.
A Panic Attack involves a sudden onset of fear that reaches a peak
within 10 minutes, and involves four or more of the following:
* palpitations, pounding heart or accelerated heart rate
* sweating
* trembling or sweating
* sensations of shortness of breath or smothering
* feeling of choking
* chest pain or discomfort
* nausea or abdominal distress
* feeling dizzy, unsteady, lightheaded or faint
* derealization (feelings of unreality) or depersonalization (being detached from oneself)
* fear of losing control or going crazy
* fear of dying
* parasthesias (numbness or tingling sensations)
* chills or hot flushes
Panic attacks may occur with or without Agoraphobia which is defined
as:
Anxiety about being in places or situations from which escape may be difficult or
embarassing, or in which help may not be readily available in the event of having a panic attack. These fears often include:
* being outside of ones home alone
* being in a crowd
* standing in a line
* being on a bridge or in a tunnel
* travel in a car, bus, train or airplane
These fearful situations are avoided or are endured with significant anxiety of
having a panic attack or a related mental or medical crisis.
(adapted from: Diagnostic and Statistical Manual of Mental Disorders IV,
American Psychiatric Association, 1994).
Treatment of Panic Disorder
There are several different approaches taken in treating PD. These include:
* Psychopharmacology (medication)
* Psychoanalytic
* Psychodynamic
* Hypnosis
* Relaxation Techniques
* Insight
* Cognitive - Behavioral Therapy (CBT)
Some therapists will attempt to use psychoanalytic or psychodynamic therapy in
an attempt to understand the underlying issues that may be symbolically manifesting in panic attacks. These approaches however
are often lengthy, and therefore expensive, and may be of limited benefit. Hypnosis and relaxation approaches are of
very limited value when used alone, but may increase the effectiveness of other approaches when used as an additional tool.
And insight oriented therapy can be effective but usually if it is used in addition to the most effective treatment method:
Cognitive-Behavioral Therapy or CBT. Many research studies have demonstrated the effectiveness of CBT when used alone or in
conjunction with medication or insight therapy.
I have found that the most effective form of treatment for PD is: CBT used along with insight therapy,
and sometimes with medication.
In addition to CBT and insight therapy, I also have patients complete a "timeline":
a chronological review of important life events. This provides me with important information regarding events that may have
contributed to the development of anxiety symptoms, and provides greater insight for the person completing such a journal.
I also always advise "Bibliotherapy": or recommended reading of the issue, topic or problem being addressed in therapy. I
almost always recommend to new patients that they read a book on anxiety disorders and their treatment, usually recommending
"Anxiety and Phobia Workbook." This is the single best book I have thus far found for providing an overview of all anxiety
disorders. I have sent many patients to local bookstores in search of it, but it can be obtained through this link to Amazon.com
at a significantly reduced price compared to purchasing in a store. Also, go to the
RECOMMENDED READING page on this site for more advised reading including valuable articles included on this site.
