The Fear Inside:

Your heart begins to race. You have chest pains, can’t breathe and are trembling. You’re afraid you’re having a heart attack. Or going crazy. You’re not. You’re suffering from a common, and treatable, condition called panic disorder.

The National Institute of Mental Health estimates that 2.4 million Americans suffer from panic disorder in any given year. The condition belongs to a family of illnesses called anxiety disorders, which, though slightly different, share one commonality: irrational, debilitating fear and dread.

What are the symptoms of panic disorder?

Panic attacks bring with them overpowering and inexplicable terror. Sufferers may not know what they’re afraid of; they just know they’re afraid. Panic attacks strike suddenly and without warning, with symptoms often mimicking those of a heart attack. During a panic attack, a person may:

–feel weak, dizzy or faint
–feel extremely hot or cold
–suffer from nausea or chest pains
–feel like they’re smothering
–have tingling or numbness in their hands
–sweat profusely
–feel like they’re losing control
–have a distorted sense of reality and an overwhelming feeling of doom
–believe they’re having a heart attack or are about to die

Panic attacks can occur at any time, even when a person is sleeping, and usually seem to have no apparent cause. They generally reach their peak within 10 minutes, but can last longer. Sufferers often believe their illness is physical rather than emotional, and they may seek medical help for several years before a correct diagnosis is made.

The anxiety and dread suffered between attacks is almost as great as the attacks themselves. Because sufferers cannot predict when and why an attack will occur, they often avoid any situation that could trigger an attack, and may stay away from public places because they feel helpless. They may fear even routine activities such as grocery shopping, and may be unable to face stressful or fearful situations unless accompanied by someone they trust. They may also fear places or situations in which panic attacks occurred, and in extreme cases will avoid anything they associate with a panic attack. About one-third of people with panic disorder develop agoraphobia, a condition in which they are too terrified to even leave their house. People with panic disorder may also develop depression, or have problems with drug and alcohol abuse.

What causes panic disorder?

Scientists still don’t have a complete understanding of panic disorder, or any of the anxiety disorders, but ongoing research is producing telling clues. Anxiety disorders appear to be a complex combination of genetic, behavioral and developmental factors, and may have numerous causes. Researchers believe certain parts of the brain controlling sensory signals and fear response may play a key role.

Panic disorder usually starts between the ages of 18 and 24, often when a person is already under stress. A death in the family, the birth of a baby or any major life change can trigger the onset of the condition. The disorder can last anywhere from a few months to several years, and afflicts twice as many women than men. Risk for developing the condition seems to be inherited.

How can panic disorder be treated?

Fortunately, the disorder is highly treatable; in fact, it is one of the most treatable of all the anxiety disorders. Medication can help ease the symptoms, often taking effect within a few weeks. Psychotherapy, also called talk therapy, is also often used, and may help patients better understand what causes their attacks and how to cope with them. There are several ways to find help, including talking to your doctor, who can advise you on where to get treatment.


Panic disorder responds to several medications, which fall into two categories: antidepressants and anti-anxiety medications. Several types of antidepressants are used; the newest are selective serotonin reuptake inhibitors, or SSRIs. These drugs boost levels of serotonin, a chemical that facilitates communication in the brain and seems to enhance mood. These drugs have fewer side effects than older antidepressants. Monoamine oxidase inhibitors, or MAOIs, are also used, and for panic disorder, the most commonly prescribed MAOI is phenelzine. Patients on MAOIs must follow a prescribed diet, because the drugs can interact with certain foods and beverages, and can also interact with other medications. Benzodiazepines, a class of anti-anxiety medications, are also effective at treating panic disorder, but aren’t good for patients with drug or alcohol problems, because they can become addictive. Some patients may experience withdrawal when they discontinue the medication, and may need to gradually wean themselves off the drugs. They may also have a recurrence of symptoms. Benzodiazepines used for panic disorder include alprazolam and lorazepam.

Cognitive-Behavioral Therapy

This form of psychotherapy has two components: the cognitive aspect helps people change their thinking patterns, and the behavioral aspect focuses on how they react to situations that trigger anxiety. People with panic disorder would be helped to realize the true nature of their panic attacks: that they’re not heart attacks, and that they’re not going to die. Through therapy, they would be taught to remember that they can control their physical symptoms, and that, though frightening, these symptoms aren’t necessarily signs of impending death. For the behavioral component, sufferers would be taught to change how they respond to anxiety-provoking situations. Often, this is accomplished through exposure, in which sufferers confront situations they’re afraid of. This is done several times, until the person comes to realize their fears are unwarranted, and their anxiety diminishes.

Living with Panic Disorder

Panic disorder can be a frightening and debilitating illness, but with treatment, most patients can control their symptoms. When undergoing treatment, the key point to remember is that recovery takes time. Many medications take weeks or months to completely take effect, and psychotherapy requires a long-term commitment as well. Certain medications and approaches may not work, and the therapist and patient will need to work together to find the most effective treatment plan. With time, patience and commitment, however, most people with panic disorder can regain a normal life.

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