Panic Disorder
He did to allow us to have friends or any kind of social interaction outside our home. It was his decision to hemlocks us but retained little, if anything, he taught us. When my mom finally had enough of my father, she left. She tried to take us with her, but my father intervened. It felt like pure abandonment when she went to live with her parents, even though she was fighting desperately to gain custody of us. When she was finally awarded full custody, we ended up living with her and my grandparents, and our world was a thousand times better.
But the damage stayed with me-?and has to this day. ” Panic is the state of feeling fear, uneasiness and worry of an unproductive outs mom according the Merriam Webster Dictionary. According to Anxiety Depression Association of America, Panic Disorder is did nosed in people who experience spontaneous seemingly outfielder panic attacks and are p reoccupied with the fear of a recurring attack. They go on to say that panic attacks occur Unix affectedly, sometimes even during sleep. Many people don’t know that their disorder is real and highly responsive to TRW tenement.
Some are afraid or embarrassed to tell anyone, including their doctors and loved ones, bout what they experience for fear of being considered a hypochondriac which is a person w ho is abnormally anxious about their health.. Instead they suffer in silence, distancing themselves eves from friends, family, and others who could be helpful or supportive. The disorder often occurs with other mental and physical disorders, including g other anxiety disorders, depression, irritable bowel syndrome, asthma, or substance abuse( CDMA, 2010201 5).
This may complicate of getting a correct diagnosis. Agoraphobia Agoraphobia is an anxiety disorder that one may experience as a result of pa ICC disorder. Some people stop going into situations or places in which they’ve previously h ad a panic attack in anticipation of it happening again. These people have agoraphobia, and they typically avoid public places where they feel immediate escape might be difficult, such as shopping malls, public transport action, or large sports arenas. About one in three people with panic disorder develops agar phobia.
Their world may become smaller as they are constantly on guard, waiting for the next pan ICC attack. Some people develop a fixed route or territory, and it may become impossible for the m to travel beyond their safety zones without suffering severe anxiety. HISTORY OF THE CONCEPT OF PANIC ATTACK In 1 959, research psychiatrist Donald F. Klein was studying embracing, a new drug synthesized by a minor alteration in the chemical structure of the “major tranquilizer” Chloe reportable. Kelvin’s decision to prescribe embracing for these atypical schizophrenics was born of frustration.
Other approaches had failed, and the new drug was known to be safe and to have some incinerating properties. Based on these observations, Klein inferred that embracing was effective against acute panic attacks, but not against chronic anxiety. Indeed De, their chronic anxiety was itself the consequence of panic; they lived in dread of these recur rent episodes of terror. These observations also suggested a qualitative distinction between pep geodic panic attacks and chronic anticipatory anxiety’. Klein reasoned that the effects of mapping e would make no sense if panic were just an extreme form of anxiety.
Kelvin’s experience with IM praline not only motivated his distinction between panic and anxiety, it also led him to conclude De that agoraphobia was chiefly a consequence of panic attacks. Klein subsequently delineated thro e types of panic attack. Spontaneous panic attacks are sudden, unexpected surges of terror AC accompanied by intense (especially corporeality’s) symptoms. Spontaneous panics are often n accompanied by catastrophic thoughts that one is about to die, “go crazy,” or lose cholesterol. S demodulations panics refer to the sudden surge of intense fear experienced by people with s pacific phobias (e. . , of animals, of heights) when they encounter, or anticipate encountering, their feared object. Because research has indicated that spontaneous panic attacks occasionally o occur in people with other disorders (e. G. Social phobia, major depressive disorder), DISMISS define s panic attacks separately from panic disorder. That is, recurrent spontaneous panics are ins efficient for the diagnosis of panic disorder: the person must also alter his or her life to coma moderate the attacks, develop a chronic fear of the attacks, or both.
ASSESSING PANIC ATTACKS Most research on spontaneous panic attacks has been based on the patients’ retrospective selector. Patients are often asked to recall their most recent, most severe, o r most typical attack, and then indicate the presence and severity of the ADSM symptoms on some scale. Regrettably, these ratings are subject to unintentional distortion. Research us guests that atypically intense, and therefore memorable, attacks are often described as “t happily,” and patients often overestimate the frequency and severity of their attacks when asked ABA out them days or weeks later.
To circumvent this problem, clinical researchers now have patients prospective Ely solemnity their attacks and record them In structured diaries designed for this purpose shortly after the attack occurs. Because classic panic attacks occur unpredictably, they have rarely been capita rued in the psychophysiology laboratory. Indeed, most laboratory research on panic involve eves attacks provoked by biological challenges (see below). Nevertheless, about 20 unsure cited attacks have been recorded while patients were undergoing various assessments while wire De for psychophysiology assessments.
These recorded episodes have indicated the at panics do, indeed, begin abruptly, as patients say, and are marked by increases in heart rate, ski n conductance (i. E. , sweating), facial muscle tension, and hyperventilation. PANIC ATTACK VARIANTS During the midi sass, researchers noted that about nonwhite of the young ad alt (non alnico)population reported having experienced a “panic attack” during the pr obvious year. These monomaniacal panic attacks seemed to suggest that a phenomenon so common might not be indicative of psychopathology.
Subsequent studies revealed, however, that m cost Of these attacks were not especially severe and nor were many the spontaneous, unexpected attacks that characterize panic disorder. Consensus now holds that between 2 % and 7% o f the general young adult population experiences at least one spontaneous panic attack that meet s ADSM criteria each year. Occasional panic attacks may presage the development of panic disorder in people who also have elevated anxiety sensitivity. Researchers have described the seemingly oxymoron condition of non fear LU panic attacks among cardiology patients seeking help for unexplained chest pain.
These Indo epidurals complain of sudden rushes of somatic symptoms identical to those of panic attacks, but do not experience fearful thoughts about imminent death and so forth. Comparisons between t happily panicked and non fearful panicked on variables such as age of onset, average number of sys MOTOS per attack, duration of disorder, depressive, agoraphobic symptoms, and so forth indicate that the two groups are nearly indistinguishable except for the fact that typical panicked e experience terror during their attacks, whereas non fearful panicked do not.
Non Fearful panic i indicates that sudden rushes of autonomic symptoms are not equivalent to panic attacks, the robbery raising the possibility that a person’s interpretation of the symptoms as threatening may partly determine whether they experience the episode as terrifying. THE DEVELOPMENT OF PANIC DISORDER AND AGORAPHOBIA Panic attacks usually start in late adolescence or in early adulthood; they rarely y begin before puberty or late in life. They typically emerge during periods of life stress such as after the death of a loved one, in anticipation of a major life event (e. . , wedding), after losing a job, and so forth. Occasional panic attacks are not uncommon in the general population, but if individuals become persistently fearful of them or alter their lives in response to them, p manic disorder is diagnosed. The vast majority of people who develop agoraphobia do so as a consequence e Of their fear of panic attacks. It is very unusual for someone to become agoraphobic without first having had panic attacks. Rarely, clinicians encounter people who appear to have agora’s hobbit without a history of panic.
But close inspection of these cases reveals that such patients fear other forms of sudden bodily incapacitation that do not qualify as panic per SE (e. G. , diarrhea , migraine headaches). Some panicked become agoraphobic within days of their first attack; others b come increasingly agoraphobic over weeks, months, and years; and still others never become gag orphic. Researchers have studied what factors predict which panicked develop agar phobia by comparing panicked with and without agoraphobia.
Avoiders and non avoided RSI do not differ in their age of onset or duration of panic disorder, and there are few differences in the severity of the attacks themselves: agoraphobic panicked do not seem to have worse ATT sacks than non agoraphobic panicked. There are no differences in the frequency of attacks. T he best predictors of avoidance are cognitive. Predictors of agoraphobic avoidance include expo citations of panicking in certain situations, perceived negative consequences of panic, fee RSI of dying or going crazy during attacks, and lack of confidence in one’s ability to cope with panic.
BIOLOGICAL ASPECTS OF PANIC One early hypothesis was that chronic hyperventilation are prone to panic be cause they are more likely than other people to experience hypersensitiveness’s sensations (e. G. , dizziness) that may frighten them, causing further overheating greater fear, and so forth u until flyblown panic results. However, most subsequent research indicates that panic patients are usually not chronic hyperventilation. But excessive ventilation is a common accompaniment Of pa nice attacks and can worsen the symptoms associated with panic.
Therefore, hyperventilation doe s not seem to cause manic attacks, but it does seem to intensify attacks that do occur. An important tool for studying panic in the laboratory has been the biological challenge test. Biological challenge tests produce intense bodily sensations, and incite panic attacks far more often in panic patients than in patients with other disorders or in healthy subs sects. They are designed to stress specific neurological systems, and if panic occurs, then dysfunction in the stress system may constitute a vulnerability to naturally occurring panic attach KS.
A purpose of this research is to identify procedures that will reliably initiate attacks in the la oratory that strongly resemble spontaneous panic attacks. These procedures, in turn, Ana blew researchers to investigate the mechanisms of panic in controlled experimental situations. However, panic attacks occurring in response to biological challenges have b en interpreted in two principal ways. One interpretation holds that challenges directly incite pa nice by exacerbating a neurological dysfunction.
The other interpretation holds that they incite attacks merely by generating intense bodily sensations that these patients are prone to fear PSYCHOLOGICAL ASPECTS OF PANIC Psychological theorists hold that physiological symptoms are insufficient to pr educe the experience of panic. For panic qua panic to occur, the person must react to the see bodily sensations with fear. Responding to one’s own bodily sensations as if they we re phobic stimuli, panicked worsen these symptoms, and thereby amplify their terror. Moreover r, only those people who dread these symptoms will qualify for panic disorder.
According to psych logical theorists, panic disorder is in large part a “fear of fear” itself. There have been several versions of the forbearer hypothesis of panic disorder re. One view olds that Bolivian interrogative conditioning figures in development of pan ICC disorder. Initial panic attacks establish certain bodily sensations (e. G. , heart palpitations, break wholeness) as conditioned stimuli that evoke subsequent panic attacks. Another view holds that panic attacks occur because individuals catastrophic Ill misinterpret certain benign bodily sensations as harbingers of imminent psychological or p hysterical disaster.
Thus, a person might misinterpret palpitations as an impending heart attack, become more anxious, and thereby intensifying these sensations until they culminate into a manic attack. According to this view, catastrophic misinterpretations of bodily sensations AR e necessary for a panic attack to occur. A third approach emphasizes that not everyone is equally likely to respond fee earfuls to their own bodily sensations. People who hold mistaken beliefs about rapid heartbeats, dizziness, and so forth are presumably more likely than other people to react fearfully when the see sensations occur.
This notion is embodied in the anxiety sensitivity hypothesis. Anxiety s insensitivity is an individual difference variable that may constitute a cognitive risk factor for pa ICC disorder. It is conceptually and empirically distinguishable from trait anxiety. Trait anxiety r offers to a proneness to react fearfully to a wide range of potential stress, whereas a anxiety sensitivity refers to the specific tendency to react fearfully to bodily sensations associate d with anxiety. PSYCHOPHYSIOLOGY TREATMENTS FOR PANIC As noted earlier, the tricycle antidepressant, embracing, was the first comps undo shown effective against panic attacks.
Patients need not be depressed for this drug t o work against panic. The effects of embracing are potential by combining it with exposure in vivo, a behavior therapy method (see below). Unfortunately, a substantial minority of panic patients fail to tolerate the side effects of embracing, which include increased heart rate and jitteriness. Some clinic Cain s suggest slowly increasing dosage until a therapeutic effects are reached as a means of manna gin side effects. Highpoint painlessness’s, such as Alabama, have been used to treat p manic disorder.
Their side effects are less disagreeable, and these medications begin to exert their antipasti effects within days of commencing treatment in contrast to embracing, which often sakes weeks before benefits begin to appear. Disadvantages of these compounds include their ca opacity to induce pharmacological and psychological dependence; panic patients often find it dif cult to cease taking Alabama. This can pose a problem for women who wish to become pregnant, and therefore need to be free Of Alabama.
Moreover, cessation of these comps ends often results in the return of panic attacks, and sometimes these rebound panics are more in tense than the attacks that had been occurring before the patient began taking Alabama. Some eve iodine suggests that manic patients with agoraphobia who undergo otherwise effective in vivo expo sours treatments do worse at followed if they had been taking Alabama than if they had been TA king placebo. The selective serotonin eruptive inhibitors (Girls) have been widely prescribe De for many psychiatric conditions in recent years.
Originally developed as antidepressant s, Girls, such as Florentine, have been recently used as antipasti agents. Indeed, the study rep Rotting the most impressive evidence for the pharmacological treatment of panic disorder tested the SIR fulmination. Although controlled research on the treatment of panic disorder tit Girls has only recently begun, the consensus among spectrographically is that USSR Is are the drug treatment of choice for panic disorder. The Girls appear to have more tolerate blew side effects than tricycle antidepressants and they appear to be less likely to produce depend nice than highpoint painlessness’s.
Limited data also suggest that relapse upon dry GU discontinuation may be less likely than relapse following distinction caution of Alabama and is Mila compounds. PSYCHOLOGICAL TREATMENTS FOR PANIC Despite differences in emphasis, most cognitive behavior therapists treat pain as follows. Early sessions usually are designed to reduce the patient’s anxiety sensitivity by pro viding the patient with basic information about panic attacks that counteracts the patients ACTA stropping tendencies.
For example, one approach emphasizes that panic attacks reflect an adaptive, evolved fishtailing response that fires at inappropriate times. Under this view, panic attacks are not dangerous events but rather reflect an evolved mechanism for protecting gag insist danger. Patients are also shown how they may inadvertently maintain their disorder by hyper vigilantly monitoring their bodies for feared sensations and then misinterpreting them as harbingers of harm. Some clinicians next train patients to use symptom (or panic) management et chinches.
These include respiratory control procedures for counteracting patients’ tendencies to hyperventilate during panic attacks (and thus worsening them). Patients are taught to breath e by using their abdomen rather than just their upper chest, and are taught to breathe at a co enforceable pace instead of gasping for air and making things worse. They are taught to breath e through the nose, not the mouth, as an additional means of counteracting hyperventilation. Patti .NET are taught a technique called applied relaxation as another means of managing symptoms .
This method first involves teaching them how to ensue and relax different muscle groups in the clinic and to detect signs of tension. They are then given practice in applying these procedures w while they engage in everyday activities. It is unclear whether these methods are effective because they blunt symptoms during episodes of panic, or whether they enhance the patient’s SE nose of restoring control. Inspired by the notion that panic attacks are akin to conditioned responses to he phobic stimuli of one’s own bodily sensations, clinicians structure interrogative exposure ex irises.
Interrogative exposure refers to graduated, structured induction of feared boo dilly sensations done in a fashion so as to reduce the patient’s fear of the sensations. Patients may be asked to run up stairs to increase heart rate, to breathe through a straw to increase breathless senses, and so forth. The rationale is that structured exposure to harmless bodily sensations reduce SE the patient’s fear of them. Finally, most patients with panic disorder have developed varying degrees of agoraphobic avoidance behavior.
