Panic disorder is a common anxiety disorder characterized by sudden and unexpected episodes of intense fear or panic attacks. Individuals with panic disorder often experience recurrent episodes of abrupt fear or anxiety that peak within around 10 minutes. During these episodes, they may exhibit at least four of the following symptoms:

Physical symptoms:

Rapid heartbeat, sweating, trembling, difficulty breathing, chest discomfort, dizziness, feeling cold or hot, tingling sensations, or numbness.

Emotional or cognitive symptoms:

Fear of losing control or going crazy, fear of dying, feeling detached from reality, feeling like being out of one's body, and more.

Other signs and symptoms:

Avoidance of going out alone due to the fear of recurrence, low mood, decreased self-confidence, concerns about the aftermath of panic attacks, and other related manifestations.

Panic attacks can last a few minutes to several hours, occur without warning, and happen at any time and place.

Data indicates that panic disorder is relatively common among adults in Hong Kong, with an estimated prevalence rate of around 3.4%. The male-to-female ratio is approximately 1:2 to 1:3. This means that about 2 to 3 out of every hundred individuals are affected by panic disorder, highlighting its significant prevalence.

Panic disorder can have various causes, similar to other emotional disorders. These causes may include external stressors, genetic factors, and triggers from sudden events. It is believed that an imbalance in brain neurotransmitters plays a role in the physiological basis of the disorder. Environmental stressors and cognitive patterns are also recognized as common factors that can trigger and exacerbate panic disorder. An individual's thought patterns directly influence their emotions, which in turn affect their behavior, leading to physiological changes in the body.

Let's provide an example to illustrate the thought-behavior pattern of a person with Panic Disorder.

Objective Event: Mr. Chan is driving from Kowloon to Hong Kong Island and needs to enter a tunnel.

Negative subjective thoughts arise, amplifying the worst and most dangerous aspects: "Oh no! I'm starting to feel dizzy and my heart is racing. I will definitely lose control and need to turn back!"

As a result, Mr. Chan's emotional response becomes anxious and tense, triggering a fight-or-flight response in his body, including an accelerated heartbeat and difficulty breathing. Mr. Chan experiences intense fear, reaching a state of panic and losing control. His immediate behavioral response is to turn back and avoid entering the tunnel.

Consequently, Mr. Chan develops a fear of driving into tunnels or avoiding situations that may trigger panic attacks, significantly impacting his daily life.

This example demonstrates how the thought and behaviour patterns of individuals with Panic Disorder operate, as well as the process through which they develop fear in specific situations. This cycle of negative thoughts and fear responses can gradually deepen, leading to the persistence of panic disorder and its impact on daily functioning.

Panic disorder is diagnosed through a combination of medical history assessment and psychological evaluation conducted by a healthcare professional. Unlike some medical conditions that can be identified through laboratory tests or imaging scans, panic disorder relies primarily on understanding a person's symptoms and experiences. The healthcare professional will ask about the individual's medical history, conduct a thorough evaluation of their symptoms, and may also perform a physical examination to rule out any underlying medical conditions that could be causing the symptoms.

If you suspect that you or a family member may have a panic disorder, it is advisable to undergo a panic disorder assessment to understand the risk of developing the condition.

Read more: Self-assessment of panic disorder

Medication Treatment

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed as the first-line medication for treating panic disorder. These medications help regulate serotonin and other neurotransmitters in the brain, effectively reducing the symptoms of panic disorder. It usually takes approximately 4 to 6 weeks for the full effects of SSRIs to be noticeable. In certain cases, doctors may also prescribe short-term and low-dose sedatives to provide temporary relief from symptoms.

Psychotherapy

Psychotherapy plays a crucial role in helping individuals manage and control anxiety and fear, leading to a reduction in panic disorder symptoms. Cognitive-behavioral therapy (CBT) is a widely used form of psychotherapy for panic disorder. It enables patients to gain a better understanding of panic disorder, develop effective coping strategies for managing symptoms, learn relaxation techniques, and regain control over their breathing patterns. CBT can be highly beneficial in the long-term management of panic disorder.

Virtus Medical Psychiatry Specialists