A panic attack is defined as a sudden and unpredictable period of intense fear associated with physical and psychic signs with a sense of imminent danger. It is marked by a severe sense of impending death, a sensation of going insane or losing control of one’s faculties, and the commission of an unnatural act (for example, jumping out of a window, inducing an accident, rolling about screaming…).
Panic attacks often occur out of nowhere, set in usually within minutes, and can last between several minutes and several hours. A panic attack can cause chest pain, suffocation or dizziness, nausea, or shortness of breath.
When panic attacks are recurrent and cause excessive worry about future attacks and avoidance behavior in patients, we talk of panic disorder.
The number of people suffering from panic attacks is difficult to assess because the various attacks do not necessarily lead to medical consultation and therefore escape any form of collection. It is estimated that about 11% of adults suffer from panic attacks each year. Panic attacks seem to be more common in women, and rather between the ages of 15 and 45.
Panic attacks can manifest themselves in anxious pathologies such as:
- Post-traumatic stress;
- Generalized anxiety disorder;
- And panic disorder in the majority of cases.
They can also be present in other pathologies, for example, depression, or under the effect of certain psychoactive drugs.
Panic attack symptoms
A panic attack results in the sudden onset of intense fear or discomfort accompanied by one or more symptoms including:
- Chest pain or discomfort;
- A feeling of suffocation;
- Dizziness, malaise;
- An irrational fear of death, going crazy or losing control;
- A feeling of unreality;
- Hot flashes or chills;
- Stomach pain;
- A feeling of numbness or tingling;
- Shortness of breath;
- Palpitations or accelerations of the heart rate;
Please note! The majority of patients with panic disorder often also have symptoms of depression.
The intensity of the symptoms is maximum after about ten minutes, then the signs fade in a few minutes leaving no symptoms testifying to the past crisis except the fear of a new episode.
Since the manifestations of a panic attack involve many vital organs, patients often have the fear of suffering from a medical disorder that is dangerous to the heart, brain, or lungs. For example, some of them have the impression during a panic attack of having a heart attack. Thus, patients in whom attacks are recurrent have a strong tendency to consult a doctor or to go to the emergency for this type of problem.
Although panic attacks are sometimes very uncomfortable for the patient, they are absolutely not dangerous, and in no way put their vital prognosis at stake.
The frequency of attack varies greatly. Some patients will have it every week, sometimes every day for several months, while others will have several a day before a more or less long remission of a few weeks to a few months.
What causes anxiety attacks
The onset of panic attacks is thought to be the result of a combination of genetic, biological, and psychological factors. Heredity seems to play a role. In the majority of those affected, other family members also suffer from panic attacks.
From a psychological point of view, people who have experienced emotional separation very early in their life are more vulnerable to panic disorders and other forms of anxiety.
Who affected by panic attacks
Panic attacks can occur at any age, but they start most often in young adults, between twenty and thirty years. The first can occur after a period of stress, but it is not always the case. Sometimes no event can explain the onset of the first attacks.
Between 2 and 4% of the population are said to have panic disorders. Women are twice as affected as men.
Diagnosis of panic disorder
The diagnosis is clinical and consists of a first step to eliminate any other cause that may cause the same symptoms as a panic attack. It is therefore a question of ruling out physical causes that are potential medical emergencies, for example, a myocardial infarction.
Panic disorder is evoked when the patient speaks of repeated, sudden attacks without any particular trigger, associated for at least 1 month with:
- A persistent concern at the idea of a new crisis and its consequences;
- A change in behavior related to the crises. For example, the patient avoids situations in which they think a panic attack may occur.
Some patients, those who manage to cope with the situations in which the attacks occur, manage to recover without treatment. For others, treatment by a specialist may be required.
Furthermore, for patients who have changed their behavior by adopting avoidance strategies in risky situations, drug treatment and/or psychotherapy are often required.
The medications used to treat this disorder are antidepressants or benzodiazepine-type anxiolytics. Indeed, several families of antidepressants are effective against panic disorder. Benzodiazepines act faster than antidepressants but expose to a greater risk of addiction and adverse effects (drowsiness, memory loss, motor slowdown, etc.).
Initially, an antidepressant and a benzodiazepine may be prescribed with the antidepressant. The benzodiazepine is then decreased and then stopped. It should be noted, however, that in some patients, only benzodiazepine is truly effective in the long term.
Drug treatment helps reduce and prevent panic attacks. However, it is important to combine it with psychotherapy in order to act on the fear of a new crisis and avoidance behaviors.
Several types of therapy can be proposed:
- Exposure therapy, which consists of exposing patients gradually and repeatedly to the situation that frightens them. The exposure can be real or virtual. Generally, the patient learns various relaxation techniques in order to be able to cope with their anxieties. The most common of these is to learn to breathe slowly and regularly to reduce the anxiety responsible for the crisis. Doctors start with a low level of exposure that is easily tolerated by the patient. Once it is comfortable, the level of exposure is increased to a higher notch;
- Cognitive-behavioral therapy, which consists of teaching the patient not to avoid situations that generate the attacks, recognizing that the fear is unfounded and using breathing as a means of relaxation;
- A supportive psychotherapy that aims rather to train and advise the patient on their pathology and treatments.
Depending on the therapy chosen, the number of sessions required may vary. On average, 12 to 14 sessions are performed to obtain good results. Some therapies are shorter and require only 5 to 6 sessions.