Physical and Emotional Symptoms of Panic Attacks and Panic Disorder

It can be difficult to decipher whether your panicky symptoms are "normal" or, rather, consistent with clinically-defined panic attacks.

Criteria for Panic Attacks and Panic Disorder

Recurring panic attacks are the hallmark features of panic disorder, though a few changes have been made in the diagnosis according to the DSM-5.

Panic disorder is an anxiety disorder marked by recurring and bothersome panic attacks.

To meet the criteria for panic disorder, one of two behaviors are required over a period of at least one month: A continual and marked fear of having panic attacks in the future, or a shift in a person's behavior designed to avoid the attacks.

Panic attacks are the sudden and intense feelings of terror, fear or apprehension, without the presence of actual danger. The symptoms of a panic attack usually happen suddenly, peak within 10 minutes and then subside. However, some attacks may last longer or may occur in succession, making it difficult to determine when one attack ends and another begins.

Types of Panic Attacks

There are two main types of panic attacks:

• Unexpected - Unexpected panic attacks occur suddenly without any external or internal cues. In other words, they occur without a fearful situation or a fearful thought or feeling. They may seem to happen "out of the blue" when someone is completely relaxed.

• Expected - Expected panic attacks occur when someone is exposed to a situation for which they carry a fear. For example, someone who has a fear of flying may have a panic attack after being seated in a plane or during take-off.

Unexpected panic attacks are more common among those with panic disorder, but people may experience both types of panic.

Physical and Emotional Symptoms of Panic Attacks

According to the DSM-5, a panic attack is characterized by four or more of the following symptoms:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Feelings of unreality (derealization) or being detached from oneself (depersonalization)
10. Fear of losing control or going crazy
11. Fear of dying
12. Numbness or tingling sensations (paresthesias)
13. Chills or hot flushes

The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack. In order for a diagnosis of panic disorder to be made, recurring, spontaneous panic attacks must be present.

Intensity of Panic Attack Symptoms

The symptoms of a panic attack are usually so intense they are often described by sufferers as the worst experience of their lives. After having a panic attack, the individual may continue to experience extreme anxiety for several hours. More often than not, the panic episode causes continuous worry about having another attack.

It is not unusual to be become so consumed with worry and fear that behavioral changes occur with the hope of avoiding another attack.

This may lead to the development of agoraphobia, which complicates recovery and limits one’s ability to function in usual daily activities.

The Importance of Getting Treatment

The symptoms of panic disorder can be frightening and potentially disabling, but it is a treatable disorder, and most people will find significant relief with therapeutic intervention. The sooner treatment begins after the onset of panic disorder, the more quickly symptoms will lessen or disappear. However, even those with long-term symptoms generally experience improvement with treatment, and most can resume many of the activities they once enjoyed.

The Importance of an Accurate Diagnosis

Panic disorder can both mimic and coexist with many other medical and psychological disorders, making a careful diagnosis very important. For example, just as some people fear that an erratic heartbeat during a panic disorder is a symptom of a heart problem, recurrent cardiac arrhythmias (abnormal heart rhythms) may also be misdiagnosed as panic disorder.

Until a diagnosis of panic disorder is made, and because many of the symptoms are physical, many people have made frequent runs to the emergency room. In fact, it's been estimated that between 20 and 25 percent of emergency room visits for chest pain are due to panic attacks, and those who visit the emergency room more than eight times in one year are three times as likely to suffer from panic attacks than the general population.

An accurate diagnosis of panic disorder is thus needed from both sides. A thorough history and physical is needed to "make sure nothing is missed" and to prevent the compounding of panic attacks by adding the trauma of emergency room visits to the mix.

The Bottom Line

Panic attacks can be literally terrifying, but help is available. Panic disorder is a very treatable condition. Unfortunately, due to the mental health stigma, and perhaps some embarrassment among those who have made multiple visits to the emergency room, the diagnosis is often delayed.

If you are experiencing symptoms of panic attacks or panic disorder, even if your symptoms do not meet the "criteria" listed above, talk openly to your doctor. Panic disorder can affect every area of your life, but many people find that their lives feel like they are restored once they seek treatment.

_Sources

_{Imai, H., Tajika, A., Chen, P., Pompoli, A., and T. Furukawa. Psychological Therapies Versus Pharmacological Interventions for Panic Disorder with or without Agoraphobia in Adults. Cochrane Database of Systematic Reviews. 2016.} 

_{Zane, R., McAfee, A., Sherburne, S., Billeter, G., and A. Barsky. Panic Disorder and Emergency Services Utilization. Academic Emergency Medicine. 2013. 10(10):1065-9.}