What Are Panic Disorders?

BY Stuart Shipko, M.D., Reprinted with permission

NOTE: For additional resources on panic attacks see Panic Disorder by Dr. Shipko.

Panic Disorders are typically characterized by sudden, inexplicable feelings of terror and a fear that one is going crazy, losing control, or on the verge of death. Because they can appear spontaneously and seem unpredictable, these "anxiety attacks" often produce a companion state of persistent worry about when the next attack will occur. Left untreated, panic disorders are seriously debilitating and can progress into the development of phobias and severe limitations on the enjoyment of life.

DISCLAIMER: While these symptoms are listed for your information, it is important that you DO NOT DIAGNOSE YOURSELF. The material on these pages is provided as an educational resource. If you believe you have a panic disorder, you should visit a qualified medical or psychiatric practitioner to confirm your self-diagnosis and rule out the number of medical conditions that mimic the symptoms of PD.

The official DSM - IV definition of PD (the diagnostic manual; for the American Psychological Association) involves the abrupt onset of fear/discomfort peaking in 10 minutes with four or more of the following symptoms:

palpitations, pounding heart or rapid heart rate

sweating

tremor

sensations of smothering or shortness of breath

feeling of choking

chest pain or discomfort

nausea or abdominal distress

dizziness, lightheadedness or faints

derealization, depersonalization

fear of losing control or going crazy

fear of dying

parasthesia

hot flashes

The diagnosis also requires that your panic attacks be unexpected and recur every two weeks or that a single attack be followed by one month or more of persisent concern about future attacks, worry about the attacks causing physical illness or going crazy, or significant behavioral changes related to the attacks.

Prolonged Panic Disorder can lead to agoraphobia, a debilitating conditition defined by anxiety about being in situations from which escape might be difficult or in which help may not be available in the event of an attack. Going out of the home; crowds; social activities. Often the person requires a companion to go out. These situations are avoided or endured with marked distress or with anxiety about having a Panic Attack or situation which reguires assistance. Panic disorder is categorized into with and without agoraphobia It may be subtle at first, but the Panic Disorders Institute believes that panic disorder is always accompanied by agoraphobia as a logical compensation.

In the view of the Panic Disorders Institute, the hallmark of Panic Anxiety is that it occurs unexpectedly, usually when relaxing or sleeping. Panic anxiety, phobic anxiety, obsessive compulsive anxiety, dynamic conflictual anxiety, post traumatic stress disorder, and organic anxiety all share some key features of diagnose:

severe difficulty both falling and staying asleep, often preceeds the attacks by weeks or months, as does agoraphobia

panic attacks may not be discreet, but can persist as a continued status panicus that lasts days or weeks

panic attacks are not random and unexpected, but occur when going from periods of higher to lower stress levels (CCK theory) must have at least some nocturnal attacks

gastroesophageal reflux disease -- nocturnal, nonprandial dyspepsia / complications of aspiration and sinusitus

myalgias, particularly along the trapezius muscle

dizziness with or without true vertigo cant get breathing on automatic

40% are incontinent of bowels or bladder episodes of confusion during and following attacks

present with a chief complaint of feeling stressed or depressed may not complain of anxiety at all

Additionally, the following comorbid conditions often accompany a diagnosis of PD:

Substance Abuse - alcohol abuse in 1/3 of patients

Severe Depression - about 2/3 of patients

OCD - about 10% of patients

Histrionic personality disorder - develops over time due to social deformity of illness

Family denial and dysfunction - generations of isolation or rejection Overlaps with seizures and migraines

Hypercholesterolemia - Often occurs in response to medical illnesses with abrupt onset, mimicing the medical illness

Panic Disorder is very common, occuring in 1 out of 75 people worldwide. Recent studies estimate that one in five emergency room visits are panic related and that panic disorder patients are twelve times more likely to visit emergency departments and represent 15% of all medical visits. According to other statistics, those with panic disorders require an average of ten different physician evaluations before being correctly diagnosed. One out of five patients will have 5 or more medically unexplained symptoms for which they have seen physicians in the 6 mos. prior to diagnosis. In the attempt to get a proper diagnosis, it is estimated that PD sufferers visit doctors 700% more than the general population (20 visits per year).

The fear motivating this disparity in visits is not unjustified as Panic Disorder is not entirely benign. According to recent studies, a panic disorder:

Increases risk of hypertension by factor of 1.91

Increases risk of heart attack by factor of 4.5

Increases risk of stroke by factor of 11.95

Only half of Panic Disorder patients are able to work full time — disability is common

Illness is chronic: at 20 year follow-up evaluation, 70 to 90% of patients were still symptomatic

Illness is inherited with incomplete autosomal dominance

These sobering facts make it clear that panic disorders are not mere psychological quirks. The Panic Disorders Institute reommends that if you suspect you have a panic disorder that you discuss it with your physician or therapist for treatment advice.

The material on this page is reprinted with permission of Stuart Shipko, M.D., a psychiatrist and neurologist who has treated over 1500 patients with panic disorder. Dr. Shipko has published original research relating panic disorder to abnormalities of bile flow that result in reflux-based sinusitus and heartburn (see Mechanisn of CCK related Stress Disorder). Dr. Shipko has used this and other research to formulate a more precise conceptualization of panic disorder and practical treatment approaches and created the Panic Disorders Institute in Pasadena, California. You can contact him at shipko@ix.netcom.com or visit the Panic Disorder Institute website.