What is Panic Disorder? | Diagnosis | Symptoms | Treatment Options

What is Panic Disorder (PD)?

Panic Disorder is a type of anxiety disorder characterised by having panic attacks over a prolonged period of time. It tends to begin in the late teens or early adulthood and more females are diagnosed with it than males [1].

Diagnosis of Panic Disorder

To meet the criteria for PD, individuals must have experienced recurrent unexpected panic attacks and at least one panic attack must have been followed by at least a month of either or both of the following:

  1. Persistent anticipatory anxiety or concern or dread about having another attack or the consequences of having an attack; 
  2. A significant and problematic behavioural change related to the attack 
    • E.g., avoiding any form of exercise because the person believes that exercise might induce a panic attack.

Symptoms of Panic Disorder

When a person is having a panic attack, and they notice that their heart is beating faster than usual, they often do not think to themselves, “The reason my heart is racing is that I’m anxious”. Instead, they think to themselves, “My heart is beating so fast. I must be having a heart attack”.

The physiological symptoms that are part of the definition of this disorder tend to be interpreted in a catastrophic way in terms of physical health.

Treatment Options:

1. Psychotherapy

Cognitive Behavioural Therapy (CBT), is a form of psychotherapy often used by therapists to teach individuals with PD different ways of responding to overwhelming feelings during a panic attack. As CBT recognises that one’s thoughts, feelings and behaviour are linked, learning to react differently by changing one’s thinking patterns could reduce the frequency of panic attacks.

2. Panic-Focused Psychodynamic Psychotherapy (PFPP)

PFPP is a form of therapy specifically targeted toward the symptoms of panic disorders.  It focuses on the presence of unconscious conflicts and fantasies in one’s mind, and how one uses natural defence mechanisms to address those conflicts and fantasies. In the case of those with PD, their defence mechanism is to experience a panic attack. Hence, PFPP helps to identify one’s internal conflicts and decouple them from panic attacks by finding alternative mechanisms of defence [2].

3. Medication

  • Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-norepinephrine reuptake inhibitors (SNRIs)
    • These antidepressant medications are mainly used to treat depression, but they have been adopted in the treatment of PD.
    • They prevent the brain from absorbing serotonin, a neurotransmitter, involved in the regulation of certain processes like mood and sleep.
    • This serves to improve mood and reduce feelings of fear and anxiety.
  • Beta-blockers target the physical symptoms of PD, such as rapid heart rate. However, these are not as commonly prescribed as SSRIs and SNRIs.

References:

[1] National Institute of Mental Health. (2016). Panic Disorder: When Fear Overwhelms. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/

[2] Busch, F. N. & Milrod, B. L. (2008). Panic-Focused Psychodynamic Psychotherapy. Psychiatric Times, 25(2). https://www.psychiatrictimes.com/view/panic-focused-psychodynamic-psychotherapy