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Fear, heart palpitations, terror, a sense of impending doom, dizziness, and fear of fear. These are the words used to describe panic disorder. But there is great hope: treatment can benefit virtually everyone who has this condition. It is extremely important for the person who has panic disorder to learn about the problem and the availability of effective treatments and to seek help. The encouraging progress in the treatment of panic disorder reflects recent, rapid advances in scientific understanding of the brain.

What is panic disorder?

In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations and dizziness) that occur repeatedly and unexpectedly in the absence of any external threat. These "panic attacks," which are the hallmark of panic disorder, are believed to occur when the brain's normal mechanism for reacting to a threat and the so-called "fight or flight" response becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.

Who has panic disorder?

The disorder typically begins in young adulthood, but older people and children can be affected. Women are affected twice as frequently as men. While people of all races and social classes can have panic disorder, there appear to be cultural differences in how individual symptoms are expressed.

Panic attack symptoms

During a panic attack, some or all of the following symptoms occur:

1. Terror and a sense that something unimaginably horrible is about to happen and one is powerless to prevent it
2. Racing or pounding heartbeat
3. Chest pains
4. Dizziness, lightheadedness, nausea
5. Difficulty breathing
6. Tingling or numbness in the hands
7. Flushes or chills
8. Sense of unreality
9. Fear of losing control, going "crazy," or doing something embarrassing
10.Fear of dying

Typically, a first panic attack seems to come "out of the blue," occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control.

This barrage of symptoms usually lasts several seconds but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic attack can attest to the extreme discomfort they felt and to their fear that they had been stricken with some terrible, life-threatening disease or were "going crazy."

Often people who are having a panic attack seek help at a hospital emergency room. Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, an illness, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.

Nevertheless, panic attacks usually take a person completely by surprise. This unpredictability is one reason they are so devastating. Sometimes people who have never had a panic attack assume that panic is just a matter of feeling nervous or anxious. In fact, even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, lose their minds, or be totally humiliated. These disastrous consequences don't occur, but they seem quite likely to the person who is suffering a panic attack.

Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, the attacks continue and cause much suffering.

In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. This fear, called anticipator anxiety or fear of fear, can be present most of the time and seriously interfere with the person's life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias about situations where a panic attack occurred. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the grocery store. People who develop these panic-induced phobias will tend to avoid situations that they fear will trigger a panic attack, and their lives may be increasingly limited as a result.

Treatment can bring significant relief to 70 to 90 percent of people with panic disorder, and early treatment can help keep the disease from progressing to the later stages where agoraphobia develops. However, before undergoing any treatment for panic disorder, a person should undergo a thorough medical examination to rule out other possible causes of the distressing symptoms.

This is necessary because a number of other conditions, such as excessive levels of thyroid hormone, certain types of epilepsy, or cardiac arrhythmias, which are disturbances in rhythm of the heartbeat, can cause symptoms resembling those of panic disorder.