PANIC DISORDER

Michael Menaster, MD

Jane Doe is a healthy woman who has never suffered from a mental illness. One day, she suddenly experiences episodes of shortness of breath, sweating, chest pain, dizziness, nausea, and stomach pain. Fearful that she's having a heart attack, Jane goes to the emergency room. The physician evaluates Jane, reassures her that she's healthy and that "nothing is wrong," and sends her home. Nevertheless, episodes of these symptoms continue and become more and more frequent. Jane even becomes afraid to leave her house out of a fear of having another attack. Finally, Jane sees a mental health professional and receives psychotherapy and medications that resolve these symptoms.

Jane suffers from panic disorder, a condition of recurring anxiety attacks that affect one out of ten people. An anxiety attack, also known as a panic attack, involves four of the following symptoms simultaneously: sweating; shaking; shortness of breath; feelings of choking; chest pain; nausea or stomach upset; dizziness or fainting; feeling that oneself or reality is not real (derealization or depersonalization); a fear of dying; a fear of losing control; numbness or tingling in the arms or legs; chills or hot flushes (DSM IV, American Psychiatric Association Press, Washington, DC, 1994).

Non-psychiatric conditions, such as alcohol consumptions, thyroid disorders, and diabetes, can cause panic attacks. Heavy exercise, caffeine, tobacco, and hyperventilation can also bring about panic attacks. Absent physical factors that cause panic attacks and without another psychiatric condition such as depression, the diagnosis of panic disorder can be made.

Untreated, panic disorder sufferers can develop high blood pressure, ulcers, and abnormalities in the circulatory system. They also become heavy users of health care services, particularly the emergency room. Alcohol and drug abuse, depression, and phobias are other complications. As discussed in the above example, some panic attack sufferers can develop a complication of panic disorder called agoraphobia, which is a fear of leaving the house, open spaces, or enclosed spaces. People with agoraphobia can become fearful of situations that they perceive an inability to escape from, such as traffic jams, lines, and crowds.

The controversy of "nature versus nurture" applies to many conditions, including panic disorder. Because panic disorder runs in families, but not all family members suffer from panic disorder, we believe that a combination of heredity, psychological factors (such as personality), and environment result in panic disorder. However, panic disorder is not a "weakness of character" or "something in your mind." It's a disease, just like diabetes and high blood pressure. The difference between these conditions involves panic disorder having predominantly psychological symptoms and thus a classification as a mental disorder.

Fortunately, panic disorder is a very treatable condition. More than 80 percent of sufferers respond to treatment. Depending upon the patient's condition, psychotherapy and/or medications can be used to treat panic disorder. Psychotherapy commonly entails teaching the patient relaxation techniques, such as breathing exercises, and ways of challenging inappropriate ways of thinking.

Dr. Michael Menaster is a San Francisco based psychiatrist in private practice. His office is located at 2107 Van Ness Avenue, Suite 102A in San Francisco. He can be reached at (415) 204-2344.

This article is intended only for educational purposes. It is not intended and should not be construed or used as medical or psychiatric advice. This article does not substitute for medical, psychiatric, or psychological evaluation or treatment by a trained professional, nor does it establish a doctor-patient or psychotherapist-patient relationship between Dr. Menaster and you. Readers who have concerns as to whether they may suffer from the condition(s) discussed in this article should consult a medical and/or mental health professional.

For more information, please go to Dr. Menaster's website.