American Medical Association Family Medical Guide - American Medical Association [458]
People with anxiety disorders seem to have a biological vulnerability that makes them easily aroused by stress. Factors that contribute to an increased risk for anxiety disorders include an inherited tendency, family behavior that may be learned, abnormalities in brain chemistry, and a chemical hypersensitivity to such substances as high levels of carbon dioxide. Traumatic events in childhood, such as physical or sexual abuse, also can bring about an anxiety disorder in childhood or later in life.
Anxiety disorders represent the most common form of psychological illness in the United States— more than 19 million Americans are affected by an anxiety disorder each year. Depression (see page 709) often accompanies an anxiety disorder, which can lead a person who has an anxiety disorder to contemplate suicide (see page 711) at some time in his or her life. The most common anxiety disorders are panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, phobias, acute stress disorder, and generalized anxiety disorder.
Panic Disorder
Panic disorder is an anxiety disorder that produces sudden, unexpected episodes of overwhelming fear accompanied by alarming physical symptoms, such as a rapid heartbeat or a choking sensation. Initial episodes often occur when the person is experiencing severe stress such as from overworking or going through a dramatic life event such as getting married. After having the first panic attack, a person often lives in fear of having another attack. This anticipatory fear causes some affected people to limit their activities to avoid situations that could trigger another attack.
Panic disorder can progress to a higher level, known as agoraphobia, in which the person fears being in a place where escaping or finding help might be difficult. Such people avoid being in a crowd, standing in line, going to the store, or riding in cars or on public transportation. In severe cases, people are afraid to leave their home.
Panic attacks appear to occur when the brain’s usual way of reacting to a threat, called the flight or fight response, is activated inappropriately. The disorder is twice as common in women as in men. Initial attacks can appear anytime between late adolescence and middle age. Other psychological conditions, including specific phobias (see page 721), social phobia, and depression (see page 709), often coexist with panic disorder.
Symptoms
Panic disorder causes episodes of extreme terror and dread, accompanied by physical symptoms such as heart palpitations, light-headedness, difficulty breathing, chest pains, hot flashes or cold chills, and tingling or numbness in the hands. The physical symptoms may appear first, making you afraid that you suddenly have a life-threatening condition, such as a heart attack, and are going to die. You may feel that you can’t get enough air and you begin breathing rapidly, triggering light-headedness. Some people report feeling waves of energy flowing down their body.
These episodes of panic accompanied by uncomfortable physical sensations occur unpredictably and take you completely by surprise, triggering the urge to flee or escape. The physical symptoms usually last from a few minutes to an hour, and can recur at any time. Some people experience periods of remission (when they have no panic attacks) that can sometimes last for months or even years.
Diagnosis
Panic disorder can convincingly mimic some serious medical conditions, such as a heart attack, so it is important to get an accurate diagnosis. To diagnose panic disorder, your doctor will give you a thorough