Diagnoses of Panic Attacks

Introduction. Diagnosing panic attacks

A panic attack describes a state of intense fear emerging suddenly, often without warning, and for no apparent reason.

Panic attacks cause various psychological and physical symptoms. The person suffering of a panic attack experiences devastating fear.

During a panic attack the person develops irrational thoughts, such as: “I‘m dying”,” I‘m about to faint or lose control”, “I must escape from here”.

Especially with the first appearance of panic attacks the person is not able to recognize the condition. Because of the physical symptoms such as chest pain or tidiness the patient contacts the emergency suspecting a heart attack.

Some, notably first-time sufferers, may call for emergency services followed by series of diagnostic measures, especially those excluding a heart attack. Despite the severity of the symptoms occurring with panic attacks there is no underlying physical problem.

Differences from other anxiety

Panic is different from other forms of anxiety. The sever anxiety is appearing “out of the blue”, without any identifiably triggering factor. This impairs the ability of the affected person to use rational thinking in the form of positive intervention.

Panic attack versus panic disorder

The recurring panic attacks are called panic disorder. During a panic attack, psychological and biological mechanisms intersect and mutually reinforce each other. There are different neurobiological factors increasing the vulnerability for the occurrence of a panic disorder.

Symptoms of a panic attack

The leading symptom of a panic attack is severe anxiety with the feeling of losing control. Panic attacks are always associated with physical symptoms. The most frequent physical symptoms are chest tightness or chest pain. Other physical signs of panic attacks are heart racing, sweating, numbness, dizziness, blurred vision, sometimes loss of bodily control ending in fainting. Some people also suffer from tunnel vision.

A psychological reaction associated with panic attacks is depersonalization (being detached from oneself). Panic attack symptoms occur because of an inappropriate, “overdrive” of the autonomous nervous system. During a panic attack the person tends to over-breathe (hyperventilate). In consequence too much carbon dioxide is exhaled causing a rise of blood pH, known as respiratory alkalosis. A panic attack usually lasts 5-10 minutes. In rare cases it can reach a duration of a few hours. Additionally, the anxiety in panic attacks has its own specific characteristics, such as the fact of occurring suddenly, a tendency to repetition and a lack of recognition of the sequence of events leading to it.

Panic attacks, course of the disorder and its effect

Panic disorder is a condition where the patient experiences recurring panic attacks. In panic disorder the person will experience ongoing worries of getting further attacks (anticipatory anxiety). Anticipatory anxiety is the effect of conditioning. The course of a panic disorder varies. After the first occurrence, the panic attack will inevitably tend to manifest itself again. The result is a vicious circle where the attacks tend to reoccur and increase in intensity. In panic disorder the patient feels dominated by an escalating sequence of events which follow an unstoppable progressive course. The anxiety in panic attack feels real. Fully established panic disorder progressively affects more areas of a person’s life and may evolve into full invalidism.

Diagnosis of panic attacks

The current diagnostic manuals, DSM V, and ICD 10, describe and quantify the symptoms. The phenomenological approach makes sense as in most psychiatric disorders the root cause is unknown. At first glance the cause of panic disorder is not explicable but could be identified in the course of psychodynamic psychotherapy. The diagnostic manuals based on symptoms description are useful as a quick method creating a communication platform for psychiatrists.

The diagnostic manual (DSM V) of the American Psychiatric Association`s (APA) describes the panic attack, the panic disorder, and their diagnostic criteria.

Criteria

To sum up, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, light-headed, or faint

• Chills or heat sensations

• Paraesthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (being detached from oneself)

• Fear of losing control or “going crazy”

• Fear of dying.

Panic versus other anxiety disorders

Panic attacks are differentiated on the diagnostic level from phobias, in which the anxiety is triggered by certain situations. For example, such conditions as agoraphobia, or claustrophobia (anxiety appearing by exposure to wide or small spaces), phobias related to other circumstances, for example flying phobia, unleashes the same symptoms and dynamics as a panic attack.

Treatment for panic attacks

The most effective treatment for recurring panic attacks is the combination of medication and psychotherapy.  

The well-established psychotherapeutic method is Cognitive Behavioral Therapy (CBT). It involves analyzing the process of anxiety attacks, the triggers, the warning signs and identifying ways of assessing and controlling the anxiety. Individuals are also supported in confronting their fears and reducing avoidance behaviors.

The medication used for panic attack treatment is antidepressants belonging to two groups: selective serotonin reuptake inhibitors (SSRI’s) or selective serotonin norepinephrine reuptake inhibitors (SNRI’s). However, the antidepressants unfold their full efficacy after several weeks. In the meantime, panic attacks can be controlled by using benzodiazepines.

Remarks

• The abrupt surge can occur from a calm state or an anxious state.

• Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders (e.g., depressive disorders, posttraumatic stress disorder, substance use disorders) and some medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal).
• The root-causes of panic disorder are multifactorial.

• Culture-specific symptoms (e.g., tinnitus, neck soreness, ache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

• Panic attacks are a well treatable condition. The most effective treatment method for panic disorder is the combination of medication and psychotherapy.