“The best use of creativity is imagination. The worst use of creativity is anxiety.” – Deepak Chopra.

“There is hope, even when your brain tells you there isn’t.” – John Green

What Is Panic Disorder?

Worry often gives a small thing a big shadow. Panic disorder is a common but often misunderstood mental health condition, affecting millions of people worldwide. It is defined as recurring and unexpected panic attacks, which can significantly impact daily life. 

As per the National Institute of Mental Health, Panic Disorder is an anxiety disorder characterised by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These episodes occur “out of the blue,” not in conjunction with a known fear or stressor, leaving individuals feeling overwhelmed and vulnerable.  

Despite its challenges, panic disorder is highly treatable with the right approach. Understanding the condition’s triggers, symptoms, and treatment options is essential for those experiencing it and their loved ones.  

Unveiling Characteristics

Panic disorder falls under the umbrella of anxiety disorders. It is defined by frequent and unexpected panic attacks, which can occur without any warning. While most people experience occasional anxiety or fear, panic attacks are far more intense and often feel life-threatening.  

The exact cause of panic disorder remains unclear, but research suggests a combination of genetic predisposition, brain chemistry imbalances, and an impact from environmental factors. The risk of developing panic disorder is heightened in people with a family history of anxiety or depression, those who experience prolonged stress, or individuals who have gone through traumatic events.

Unlike other anxiety disorders, panic disorder can lead to anticipatory anxiety—a constant dread about when the next attack might occur. This fear can restrict a person’s activities, leading to social withdrawal and difficulty maintaining normal routines, amongst other emerging complications.   

What Sparks a Panic Attack?

Panic attacks can sometimes occur spontaneously, but certain factors may increase the likelihood of an episode. Common triggers include:  

• Stressful life events including sudden changes or traumatic events, such as losing a loved one, job instability, car accident, or major life transitions, can heighten vulnerability to panic attacks.  
• Medical conditions like hyperthyroidism, cardiovascular disorders, or chronic pain can mimic or exacerbate panic symptoms.  
• Substance use and stimulants like caffeine, nicotine, or recreational drugs can trigger panic attacks in susceptible individuals. alternatively, withdrawal from substances such as alcohol or sedatives can also lead to episodes.  
• Phobias triggered by exposure to specific fears, such as confined spaces, crowded environments, or heights, can bring on panic symptoms in those predisposed.  

While these triggers can vary from person to person, identifying them is a key step in managing the condition effectively.  

What Does a Panic Attack Feel Like?

 Both physical and emotional symptoms often peak within 10 minutes and leave individuals feeling drained. Symptoms may include:  

• A sudden feeling of intense fear or impending doom.  
• Physical signs like chest pain, racing heart, sweating, trembling, shortness of breath, tingling sensations or chills.
• Dizziness, nausea, or a sense of unreality (depersonalization or derealization). 
• Hot flashes or feeling faint.  
• A choking sensation or difficulty swallowing.  
• A fear of losing control, “going crazy,” or even dying.  

These symptoms can be so severe that many individuals experiencing a panic attack for the first time seek emergency medical care, fearing a life-threatening condition like a heart attack or stroke.  

The unpredictability of these episodes is particularly distressing and may lead to significant changes in a person’s behavior or lifestyle as they attempt to avoid situations where they fear an attack could occur.  

How Is Panic Disorder Diagnosed? 

Diagnosis of panic disorder involves a thorough evaluation by a healthcare provider, often a primary care doctor or a mental health professional. The process typically includes:   

• Detailed medical history to rule out medical conditions that could mimic panic attacks, such as thyroid problems or heart conditions.  
• Psychological assessment for underlying mental health conditions. It includes any history of anxiety, depression, or trauma. 
• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, outlining specific criteria for diagnosing panic disorder, including recurring, unexpected panic attacks and persistent concern about additional attacks or behavioural changes due to them.  

Treatments To Break The Cycle

Panic disorder is highly treatable, often through a combination of the following: 

• Psychotherapy: Cognitive-behavioural therapy (CBT) is the gold standard. It helps individuals identify and reframe distorted thinking patterns, gradually reducing the frequency and severity of panic attacks.
• Medications: Antidepressants (e.g., SSRIs) and benzodiazepines can help manage symptoms but should be prescribed and monitored by a healthcare provider.
• Lifestyle changes: Regular exercise, adequate sleep, and stress management techniques can improve outcomes when combined with formal treatment.

A healthcare provider will tailor treatment plans based on individual needs and may adjust medications to minimize side effects.  

Self-Help Tools For Managing Panic Attacks

In addition to professional treatment, individuals can adopt techniques to manage panic attacks effectively:  

• Breathing techniques to manage hyperventilation, which can worsen symptoms. Practicing slow, controlled breathing can help restore balance.  
• Grounding exercises are techniques like focusing on the five senses (e.g., noticing sounds, textures, or colors) can help bring attention back to the present moment and reduce feelings of detachment. 
• Relaxation practices like yoga, meditation, or progressive muscle relaxation can decrease overall anxiety levels.  
• Regular exercise is a natural stress reliever and can improve mood and reduce the likelihood of panic attacks.  
• Avoiding stimulants like caffeine and alcohol can help prevent triggering symptoms.  
• Building a support network for emotional reassurance. Talking openly with trusted friends, family, or joining support groups can provide emotional comfort and reduce feelings of isolation.  

Ignoring Panic Attacks: The Ripple Effect

If left untreated, panic disorder can lead to several significant complications:  

• Agoraphobia involves avoiding places or situations where escape might be difficult or help unavailable, such as crowded spaces, public transport, or being outside alone. Severe cases can lead to individuals being homebound.  
• Disruption of daily life: Persistent fear of panic attacks can interfere with work, education, relationships, and social activities, reducing overall quality of life.  
• Comorbid disorders, including depression, generalized anxiety disorder, or substance abuse as individuals may turn to alcohol or drugs to self-medicate.  In addition, chronic stress can contribute to conditions like hypertension, heart disease, or gastrointestinal problems.  

Although panic disorder can be overwhelming, many individuals successfully manage their symptoms and lead fulfilling lives with the right support. Education about the condition is vital—not only for those affected but also for their families and friends. Understanding that panic disorder is a medical condition, not a sign of weakness, helps reduce stigma and encourages individuals to seek help.  

Final Thoughts

“You don’t have to control your thoughts. You just have to stop letting them control you.” – Dan Millman. 

Panic disorder is a manageable condition that, when treated, does not have to define a person’s life. Early recognition, professional personalised intervention, and consistent self-care are key steps toward recovery.  

If you or someone you know is experiencing symptoms of panic disorder, do not hesitate to seek professional guidance. These platforms developed by the Lebanese National Mental Health Program can assist individuals during episodes, or provide affordable/free mental health services:

• Step-by-step mobile application.
• Call 1564: The National Emotional Support & Suicide Prevention Hotline, in Collaboration with Embrace.

References:

• U.S. Department of Health and Human Services. (n.d.). Panic disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/panic-disorder#part_2657 

• Mayo Clinic. (2019, May 4). Panic attacks and panic disorder – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

• American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™(5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596