Fear of Fear
Panic disorder is a type of anxiety disorder characterized by intense and constant fear of having a panic attack.
This can result in avoidance of many situations and places where a panic attack may occur, or extreme safety behaviors and rituals to manage the severe anxiety in these situations.
Left untreated, panic disorder can significantly can be disabling, interfering with daily functioning. It can also give rise to agoraphobia.
- Fast heartbeat or palpitations
- Chest pain
- Ringing ears
- Feelings of choking or lump in throat
- Muscle “freezing” or tension
- Tunnel vision
- Breathing difficulty and hyperventilation
- Nausea or stomach distress
- Weakness or heaviness in limbs
- Dearealization (feelings of things being unreal or dreamlike)
- Depersonalization (being detached from oneself)
- Uncontrollable crying
- Dizziness, lightheadedness, or feeling faint
- Feeling hot or a cold chills
- Tingling, numb hands, face, or head
- Feelings of loss of control
- Impending sense of doom, danger, or death
- Intense fear that something bad is happening
These symptoms peak in just a few minutes, and start to wind down after 10-15 minutes. Though they can leave someone feeling “off” and fatigued for several hours after.
Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer symptoms of less severity. They can still be perceived as distressing.
Panic disorder is diagnosed when spontaneous panic attacks without an obvious trigger or warning occur, as well as preoccupation with fear of a recurring attack. They can occur unexpectedly during a calm state, or in an anxious state. Panic attacks occur unexpectedly, sometimes even when waking up from sleep (nocturnal panic attacks). Because of the intensity of symptoms, sometimes overlapping with potentially dangerous health conditions, many people with panic disorder make several trips to the emergency room and medical appointments.
About 2-3% of Americans experience panic disorder in a given year. Panic disorder usually begins in adulthood, but children can also have panic disorder. Many children experience panic-like symptoms (“fearful spells”). Panic disorder often co-occurs with other anxiety disorders such as PTSD, OCD, phobias, health anxiety, social anxiety, and generalized anxiety. Adults with untreated ADHD can experience panic attacks secondary to difficulty managing multiple responsibilities and constantly feeling overwhelmed.
Many people don’t know realize that panic disorder is real and highly responsive to treatment. Instead they suffer in silence, distancing themselves from many situations, places, and people that would enrich their lives and meaning.
Fear as a Protector:
Fear and anxiety are natural emotions. They occur for self-protection, so they are adaptive. Anxiety is a powerful motivator, so can be very productive.
Physical panic sensations are connected to normal physiological changes in the fight/flight/freeze response designed to protect the person during an imminent threat. They prepare the body to survive immediate serious threats to safety. Physiological symptoms of anxiety are harmless. When no real imminent threat is present, the symptoms themselves become the focus of threat. Shifting the (often faulty) perception of threat and perception of symptoms in panic disorder is the focus of treatment.
The most effective treatments for panic disorder are:
- Exposure and Response Prevention (ExRP)
- Interoceptive Exposure (IE)
- Mindfulness-Based CBT (MCBT)
- Acceptance and Commitment Therapy (ACT)
- Breathing retraining, progressive muscle relaxation, and somatic work
If you struggle with panic attacks and would like to learn healthy ways to manage symptoms, contact me for a complimentary consultation.