The first time a person suffers a panic attack or anxiety crisis, he/she usually has a feeling of imminent death; the symptoms are so intense and unexpected that there is a feeling of real terror, often confusing it with a heart attack. People usually go to the emergency room in search of a physiological problem that explains this crisis, when in fact we are facing a problem that should be addressed by psychologists.
The most common symptoms of panic attack are:
- Tachycardia or palpitations
- Choking sensation
- Sweating
- Trembling
- Chest pain or discomfort
- Nausea
- Dizziness, blurred vision, unsteadiness or faintness
- Feeling of unreality
- Fear of going crazy or losing control
- Fear of dying
These symptoms reach their maximum intensity in a short time (about 10 minutes), they are usually accompanied by a feeling of imminent danger and there is an urgent desire to flee from the situation where the crisis has appeared.
We can distinguish three types of anxiety attacks:
- Unexpected: when the attack is not related to any stimulus. It appears spontaneously, without cause (for example: a person may be in bed, reading and suffer a panic attack).
- Situational: when the attack is triggered by some situational stimulus (for example: a person with social phobia may suffer an attack when thinking that the next day he/she has to present a work in public).
- Predisposed: they are similar to situational panic attacks but in this case there need not be any association with a stimulus. (e.g.: a person may suffer an episode of panic in a department store, occasionally; from here on, he/she may be more predisposed to suffer it when returning to a similar establishment, although this does not mean that the crisis has arisen from a situation of fear).
When these attacks are repeated unexpectedly and the person lives with the persistent fear of suffering a new panic attack, we already speak of a panic disorder.
Characteristics of panic disorder
One of the characteristics of panic disorder is the vicious circle produced by catastrophic interpretations. Faced with certain bodily sensations (such as palpitations or shortness of breath), the person makes a totally catastrophic interpretation of these symptoms: “I am going to lose control, I am going to choke, I am going to have a heart attack…”. These interpretations increase anxiety and initial bodily sensations, most likely triggering a panic attack.
There is also a tendency to continuously self-observe, looking for any internal signal. This focus on the symptoms makes it even more likely that some sensation will be noticed, setting the vicious circle in motion again.
Moreover, the more anxiety crises occur, the more fear there is of having them again; this is what is known as “fear of fear”. Anticipatory anxiety produces an intense fear and this makes a person begin to avoid more and more situations, and even avoid leaving home altogether, entering the “prison” of agoraphobia.
Complications of panic disorder
Among the most common complications, derived from this disorder, there are:
- Agoraphobia
- Abuse of anxiolytics and other medications
- Depression
- Alcohol abuse
- Marked impairment and social, occupational and personal disability.
Treatment for panic disorder
A few days ago a person called my office with the following question: “If I start a psychological treatment will it be able to improve my quality of life, even if I have to live with these panic attacks for life?”
Talking a little more with this person, I noticed that he had a resigned and defeatist attitude; he did not understand very well why this was happening to him, he had not even considered that his disorder could be totally solved.
Actually, if the anxiety disorder is not diagnosed and treated properly, it can acquire a very disabling chronic character, but the positive side is that with an effective treatment, the response is very good and the recovery rate is very high.
Psychological treatment will be aimed at:
- Teaching the patient to modify erroneous beliefs about anxiety and crises.
- Learn to interpret physical sensations appropriately, so as not to enter the following spiral: physical sensation — catastrophic interpretation — fear or distress — physiological arousal — panic attack.
- Exposure to various stimuli, both internal and external.
- Training in relaxation techniques.
- Elimination of safety and avoidance behaviors (taking medication at the slightest sign, running away from situations, avoiding certain places…).
As for the pharmacological treatment, it can help to regulate certain symptoms but if it is not combined with an adequate psychological treatment, the predisposition and vulnerability to the recurrence of these attacks will continue. Losing the fear of anxiety and tolerating its presence is the key to definitively overcome this disorder.