The nature of Panic Disorder

Panic Disorder is a psychological illness that is characterized by two interrelated components:

1. The unexpected occurrence of Panic attacks.
2. A permanent concern about the possible occurrence of a future panic attack, even when the person has not experienced one for a considerable amount of time.

Panic attacks are experiences of unanticipated and intense fear in the absence of any explicable threatening stimuli. The intense fear is usually preceded by a feeling a discomfort. This feeling of discomfort interrupts the peaceful flow of consciousness and speedily transforms the internal experience of the sufferer from a state of calm into a state of panic. The panic experience may last from a few seconds to several minutes. Progressively, the panic subsides and gives its place to a state of guarded calmness. After the attack has completely receded and the organism has returned again to a full state of tranquility, a sense of dreadful attentiveness is introduced into the everyday functioning of the sufferer. The sense of dreadful attentiveness centers on the possible catastrophic consequences of a future panic attack.  

The nature of panic attacks is not limited to the emotional experience of fear. The emotion of fear during a panic attack is accompanied by the simultaneous presence of somatic symptoms. The symptoms are also frightening in themselves and include:

• Surprising accelerated heart rate
• Sweating in the absence of somatic activity
• Trembling or shaking
• 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 or depersonalization (experiencing reality as if through a glass screen)
• Fear of losing control or going crazy
• Fear of dying because of heart failure or brain stroke
• Paresthesias (numbness or tingling sensations)
• Unanticipated increases or decreases of body temperature (hot flushes or chills).

The number of somatic symptoms of panic and the intensity with which they are experienced by the sufferer may vary. Some people may be more afraid of their pounding hearts during a panic experience, while others may be more anxious at the thought that they are going crazy. Despite their frightening nature, the somatic symptoms are harmless from a medical point of view.  What is in danger is the psychological health of the person who experiences panic attacks.

Progressively, people who frequently experience panic attacks become increasingly preoccupied with them. The unexpected emergence of the panic experience makes it impossible to predict when the next attack will actually take place. Therefore, sufferers engage in prophylactic behaviors in order to minimize the imagined negative consequences of a future panic attack. The prolonged preoccupation with and sustained engagement in either imaginary or behavioral protection from the consequences of a future panic attack marks the emergence of Panic Disorder.

Panic Disorder is one of the major clinical diagnoses of anxiety. When the clinical profile of a patient appropriates the diagnosis of panic disorder, an expert psychological intervention is necessary for the complete removal of the illness.