Part one : An insight into Panic Disorder

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Panic Attacks

Panic attacks are a sudden overwhelming feeling of acute and disabling anxiety. There's an intense wave of fear which is characterized by it's unexpectedness and debilitating, immobilizing intensity. Panic attacks are actually an exaggeration of your body’s normal response to fear, stress , or excitement. It is the rapid build-up overwhelming physical sensations. So the body automatically gears itself up for danger, by producing quantities of adrenalin for 'fight or flight'.

There are two different types of panic attacks: Expected and Unexpected

Expected: panic attacks are those that are triggered by some type of stimulus in the environment. For example, a person with an irrational fear of being closed-in small confined spaces( Claustrophobia ) or a fear of being trapped i.e trapped in a lift or locked room with no escape (Cleithrophobia) So these panic attacks are anticipated when a person is subjected to specific panic triggers.

Unexpected: These panic attacks occur suddenly without any known cause or trigger. The person can be completely relaxed before symptoms develop.They could be sleeping,but suddenly awaken to find themselves in the middle of a panic attack. This type of panic attack does not accompany any conscious internal cues, such as having fearful thoughts, feelings of intense dread and anxiety, or uncomfortable physical sensations. Unexpected attacks also do not occur with external cues, such as specific phobias or being exposed to a frightening event or situation.

Unexpected ,persistent,frequent panic attacks are the hallmark feature of panic disorder.

The physical symptoms of a panic attack are unpleasant, frightening and distressing and they can also be accompanied by thoughts of fear and terror.The person feels a sense of impending doom ,as if they are going to die or faint . For this reason, people start to fear the next attack, which creates a cycle of living in ‘fear of fear’ and this adds to the sense of panic. Fear of the next panic attack can actually bring on one.This creates the Panic Loop.

Panic Disorder

Panic disorder is characterized by ,recurring ,frequent, unexpected panic attacks, combined with major changes in behaviour ,and persistent anxiety over having further attacks.They strike out of the blue, without any warning.The person will start to live in constant fear of the next attack, and persistently worry about the physical symptoms . So they'll start to modify their behaviour, in order to avoid certain situations or places where they've previously panicked.Panic disorder can also co-occur with agoraphobia, or the person may live within a perimeter ,either within their home or their city ,they'll be too fearful to go beyond that perimeter they created for themselves. People who suffer from panic disorder usually have another disorder, social phobia, or depression.

The panic attack cycle

Panic Attacks produce very real physical symptoms,which includes a variety of the following symptoms :

a sensation that your heart is beating irregularly ( heart palpitations)

sweating

trembling

hot flushes or chills

hyperventilation /shortness of breath

a choking sensation

chest pain or abdominal pain

nausea

dizziness

feeling faint or dizzy

numbness or pins and needles

dry mouth

a need to go to the toilet

ringing in your ears

a feeling of dread or a fear of dying

a churning stomach

a tingling sensation in your fingers

shivering

shaking

fear of losing control or going crazy

In extreme cases of Panic Disorder a person may also suffer from Derealization Depersonalization and persistent Hyperventilation

Derealization And Depersonalization

Depersonalization

Depersonalization is a condition in which the person experiences “detachment” from one’s self - detached from their body. Their surroundings appear strange and unreal. It is as if the individual is not a person with a set of feelings, emotions, thoughts, sensations and physical activity...as if their thoughts and actions are not their own. It's as though they are watching themselves from the outside ,watching themselves from a distance .Like an out of body experience .

Derealization

Derealization occurs when people feel dissociated from their environment. The experience might include perceiving objects as unsolid, or diminished in size or two-dimensional; it can be likened to being inside some glass-like container or peering at the world through a fog, with the world unreachable and meaningless. During Derealization,they feel grounded in themselves, but the world seems distant or strange, and they may feel unsteady on their feet.People and objects may appear distorted or magnified

Hyperventilation

Hyperventilation can be terrifying . It feels like you can't breathe. As though you aren't getting enough oxygen ,you feel your throat tightening up,as if you're choking, but the most important thing to understand about hyperventilation is that although it can feel as if you don’t have enough oxygen, the opposite is true.It is a symptom of too much oxygen.

When someone is hyperventilating they breathe unnaturally, fast or deep. They breathe at an abnormally rapid rate, it increases the rate of loss of carbon dioxide, so it makes the blood lose more carbon dioxide than usual. There's excessive ventilation of the lungs, beyond what is required to achieve normal arterial blood gases. When you hyperventilate, your body actually experiences what's known as a paradoxical effect - it makes you feel like you're not getting enough oxygen, so you try to breathe deeper,by taking in long deep breaths , only to make your hyperventilation worse.

With hyperventilation, your body has too much oxygen. To use this oxygen (to extract it from your blood), your body needs a certain amount of Carbon Dioxide (CO2).When you hyperventilate, you do not give your body long enough to retain CO2, and so your body cannot use the oxygen you have. This causes you to feel as if you are short of air, when actually you have too much.So in fact ,you are actually over- breathing

Fight or Flight Response

Our bodies are designed to respond to danger; we have an inbuilt defence mechanism known as the ‘fight or flight response’, which triggers psychological and physical changes in our bodies. The fight or flight response is an involuntary, spontaneous reaction to an impending danger. It is a physiological response to a stimulus which our bodies consider dangerous or life threatening. This response—also called the acute stress response—The sympathetic nervous system then sends a message to the adrenal glands which results in the release of the stress hormones, epinephrine (adrenaline,) norepinephrine (noradrenaline,) and cortisol into the bloodstream. . These hormones, in turn, lead to the symptoms associated with the response .This release causes immediate physical reactions in preparation of the muscular activity needed to fight or flee the threat. So although panic attack symptoms are terrifying ,it's our body’s own protective response to danger and, in essence, it is a mechanism designed to protect us, and not as it feels, destroy us.

Panic attacks are most commonly associated with panic disorder, but have also been known to occur along with other mental health disorders, such as mood and anxiety disorders, such as agoraphobia, post-traumatic stress disorder(PTSD), social anxiety disorder (SAD), specific phobias, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), bipolar disorder, major depressive disorder. These attacks can also occur in conjunction with a variety of mental health disorders, including personality disorders, eating disorders, and substance-related disorders.

Many people with panic disorder deal with loneliness and isolation, feeling ashamed of their symptoms and fearing that others would negatively judge them for their panic symptoms.

Mental Illness is nothing to be ashamed of,but stigma and bias shame us all

Panic Attacks by Christine Ingham provides an in-depth insight into panic attacks,symptoms and treatments