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What Is A Panic Attack? DSM-IV Definition, Causes, Treatments

A panic attack is defined as a sudden (or unexpected) surge of anxiety or fear. During this surge of fear, a person typically experiences a combination of cognitive and physical symptoms related to severe anxiety. These symptoms can include things like: fear of losing control, palpitations, hyperventilation, chest pain, and sweating.

The experience may become so distressing that an individual believes that they are going to die. Due to the extreme discomfort associated with panic attacks, many people that experience them withdraw from social situations and activities as a result of being unable to cope with the potential panic.

What is a Panic Attack? (DSM-IV Definition)

Panic attacks are defined as acute surges of fear or anxiety accompanied by at least four observable cognitive or bodily (physical symptoms of anxiety) lasting from minutes to hours. In most cases, panic attack symptoms reach a peak of intensity within 20 minutes, but can persist for hours after they’ve peaked. It should also be noted that individual experiences during panic attacks can vary in regards to symptoms. Additionally many individuals that experience panic attacks believe they are going to die of a heart attack or have a nervous breakdown.

The official DSM-IV criteria for a panic attack includes:

  1. A specific period of intense fear or discomfort
  2. Development of at least four symptoms:
  • Chills
  • Choking
  • Derealization or depersonalization
  • Dizziness or lightheadedness
  • Fear of dying
  • Fear of losing control (or going crazy)
  • Hot flashes
  • Palpitations
  • Increased heart rate
  • Nausea
  • Numbness
  • Shaking
  • Shortness of breath
  • Sweating
  • Tingling sensations

Note: According to the DSM-IV, specific symptoms such as tinnitus, neck stiffness, headaches, and/or crying spells may also be prevalent. However, these symptoms do not count as one of the four required for diagnosis.

What causes a panic attack?

Panic attacks can be caused by many things. Some people may experience panic attacks as a result of using or withdrawing from illicit drugs, while others may experience them as a result of PTSD. In other cases, panic attacks are thought to have a genetic basis or be caused by medical conditions. Based on the individual the cause of the panic attacks is subject to variation.

  • Anxiety disorders: If you have any type of anxiety disorder such as GAD, OCD, phobias, or PTSD, your chance of experiencing a panic attack increases.
  • Genetics: Individuals who have parents or siblings with panic disorder have a greater chance of developing it themselves. Many mental illnesses, including those caused by anxiety such as panic disorder can run in families.
  • Medical conditions: Things such as low blood sugar, thyroid dysfunction, and inner ear problems can all contribute to panic attacks. Other chronic and serious illnesses may lead someone to develop a significant amount of fear and panic.
  • Triggers: Certain things in your environment may trigger you to experience a panic attack. Stressful situations, traumatic experiences, and/or other conditions could provoke panic. Any stimulus that is fear-inducing could theoretically lead a person to experience a panic attack.

The majority of panic attacks will be caused by anxiety disorders and/or genetics. In some cases undiagnosed medical conditions such as hyperthyroidism can contribute to panic. In other cases, environmental experiences and triggers could be the culprit. Realize that a combination of factors could be the cause for your panic attacks as well.  For a more thorough elaboration, read the article “What causes panic attacks?”

Panic Attacks vs. Panic Disorder

In some cases experiencing panic attacks is a sign of a larger problem called panic disorder. Individuals who have frequent bouts of panic attacks and/or are very fearful of another attack are thought to have panic disorder. In the event of this disorder, most people have uncontrollable panic attacks that usually have no particular trigger.

It should be known that just because you have a panic attack does not necessarily indicate that you have panic disorder. Panic disorder is when you frequently experience panic attacks and feel as though they are interfering with your life and wellbeing. Fortunately there are many treatment options available for both panic attacks and panic disorders.

Panic Attack Treatments

If you have panic disorder, it may seem as if your panic attacks will never stop. Fortunately panic attacks are highly treatable with both therapy and medication. It is recommended to try therapy prior to going on a medication because therapy often targets the root of the problem, whereas (in certain cases) medication acts as a temporary patch. For more information, be sure to read how to stop a panic attack and how to deal with anxiety as both of these articles contain information that will benefit panic sufferers.

Therapy: There are many types of therapy that can benefit those with panic attacks. There is significant evidence supporting CBT (cognitive-behavioral therapy) to help with panic disorder and attacks. Other research has show that psychoanalytic therapy is also beneficial at treating panic and is associated with very few relapses. Many people with panic attacks respond extremely well to therapy and won’t even need medications if therapy works well enough.

Medications: Anxiolytic medications such as benzodiazepines are often used to treat panic attacks. These are very effective medications as they target GABA in the brain. Unfortunately these medications are associated with dementia if used over the long term. In most cases a doctor will prescribe an SSRI medication because these are considered safer over the long-term. If therapeutic intervention isn’t helpful, usually medication works very well.

Combined approach: Many people use both therapy and medications as a combined approach for dealing with panic attacks. In cases when someone has panic disorder or the attacks are based in genetics, medication may be necessary. Therapy tends to work well in teaching us how to deal with our symptoms and get an understanding of what’s going on in the body. Using medication adjusts neurotransmitters in the brain to help prevent panic.

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