Panic Disorder is the fear of having an 'uncued'..spontaneous panic attack. It was first recognised and included in the American Psychiatric Association's Diagnostic& Statistical Manual (DSM) 111 in 1980.
Ongoing research has increased the knowledge and understanding of this Disorder and is clearly evident in the current version of the DSM...No-4. In the DSM-111 and the DSM-111R no distinction was made in the different types of panic attacks. A panic attack was a panic attack.
DSM 4 recognises three different types of panic attacks.
- uncued (spontaneous) panic attacks
- cued (specific) panic attacks
- situationally predisposed panic attacks
Specific panic attacks relate to social anxiety disorder, obsessive compulsive disorder and post traumatic stress disorder
Situationally predisposed panic attacks may occur on exposure to the situational cue or trigger, but do not necessarily occur immediately after the exposure.
The symptoms of a panic attack are described in the DSM-4 as a "discrete period of intense fear or discomfort in which four (or more) of the above symptoms develop abruptly and reached a peak within ten minutes.
Symptoms of a panic attack are palpitations, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealisation or depersonalisation, fear of losing control or going 'crazy', fear of dying, paresthesias, and chills or hot flushes'.... 'Attacks that have fewer than 4 symptoms are referred to as 'limited - symptom attacks.'
While the DSM-111R acknowledged that the avoidance behaviour (agoraphobia) relating to the panic disorder was a result of a fear of having a Panic Attack, this lack of distinction upheld the prevailing view of the time that a panic attack and the avoidance behaviour resulting from the attack was a "phobic" response to situations and/or places. Many of the earlier treatment methods for panic disorder/ agoraphobia focussed on gradual exposure to the avoided situation and/or place and did not directly deal with the panic attack itself. It is now recognised that a spontaneous panic attack is not associated with specific situations and places.
The avoidance behaviour associated to Panic Disorder is recognised "as anxiety about being in situations and places from which escape may be difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic like symptoms".
The spontaneous panic attacks attack comes without any apparent warning warning, day or night irrespective of what the person is doing. Many people report that panic attacks happen when they are relatively 'calm' or 'relaxed' eg when they are watching TV or reading a book. In fact, a study we undertook in 1993 on the uncued/ spontaneous panic attack showed that 78% of Panic Disorder participants reported experiencing a panic attack when relatively 'calm'. 69% of Panic Disorder participants report they experience a panic attack while going to sleep and 86% report that the panic attack wakes them from sleep at night.
Three internationally recognised experts in Panic Disorder describe a panic attack as follows:
- "An intense recurring spasm of panic that
start ... just below the breastbone and seem to spread like a white hot
flame .. passing through the chest, up the spine, into the face, down the
arms and even down into the groin to the tips of the toes" C.Weekes.
- "The attacks start with a tingling feeling
going up my spine which enters my head and causes a sensation of faintness
and nausea" J.Hafner.
- "A rushing sensation of a hot flash through
the body .. sometimes associated with a sick feeling and a sensation of
fading out from the world but this faintness is more like a 'white out'
than a 'black out' and that the head may literally feel light." Sheehan
- C. Weekes (1962): Self Help for your Nerves.
London: Angus & Robertson pp33.
- J. Hafner (1986). Marriage and Mental Illness.
New York: The Guildford Press pp 39
- Sheehan (1983). The Anxiety Disease. Charles
Scribner's Son N-1.
In our own research into the subjective experience of the spontaneous panic attack, we found that many people with Panic Disorder can experience a various sensations moving through their body - either before or during the actual panic attack. These sensations can change from one 'attack' to the next which only adds to the confusion people feel. These sensations can include:
- electric current moving through the body
- hot prickly sensation moving through the body
- intense heat or burning pain moving through the
- "unusual" intense flows of energy throughout
- rushes of 'energy' shaking the body
- tingly sensation moving through the body
- creeping sensation moving through the body
- wave-like motion of energy moving through the
- vibration moving through the body
- white hot flame through the body
- ice cold sensation through the body
- "ants crawling" sensation over the
Our research also found many people can dissociate first and then panic as a result of the dissociation. Dissociation can include depersonalisation and derealisation. For more information see:
As with the other anxiety disorders, people with panic disorder also experience other symptoms including racing heart beat, 'missed heart beats', palpitations, difficulty breathing, chest pain, left arm pain, jaw pain, nausea, shaking and trembling, a choking sensation.
Many people who experience spontaneous panic attacks feel as if they are dying and / or having a heart attack, feel as if they are going insane or will lose control.
The fear of having a spontaneous panic attack leads to panic disorder. This is turn can lead to the secondary conditions associated to panic disorder which include avoidance behaviour (agoraphobia), major depression and/or prescribed drug addiction and/or alcohol abuse.
While the experience of spontaneous panic attacks can be minimised to a large degree, the development of panic disorder, and the secondary conditions can be prevented.
Bronwyn is the author of Power Over Panic: Freedom From Panic/Anxiety Related Disorders.
You can read Bronwyn's latest transcript here