Panic Attacks: A Classic Symptom of Several Anxiety Disorders
Panic attacks are a symptom of several anxiety disorders including Panic Disorder, Social Phobia, Specific Phobia, Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder. Since panic attacks are such an important symptom of many anxiety disorders, we will describe this symptom in greater detail, and discuss the three types of panic attacks that aid diagnostic discrimination.
Panic attacks are feelings of extreme fear and/or discomfort lasting for a distinct period of time, and generally peak in intensity after10 minutes, at which point they begin subside. There is often a sense of doom and gloom and a powerful desire to escape. To meet the definition of a panic attack, a person must have 4 of a possible 13 symptoms, most of which are bodily sensations including: palpitations and/or pounding heart; sweating; trembling; feeling short of breath; feelings of choking; chest pain; nausea; feeling dizzy or lightheaded; feelings of unreality or feeling detached; numbness or tingling; hot flashes or chills. The remaining possible symptoms involve fearful cognitions (thoughts) such as the fear of: losing control, going crazy, having a heart attack, or dying. When someone experiences less than four symptoms, this is known as a limited-symptom panic attack. The most common symptom of limited-symptom panic attacks is shortness of breath, due to hyperventilation. Panic attacks are different from other anxiety symptoms because they tend to have a sudden onset, are accompanied by intense fear or terror, and a powerful desire to escape. Also, panic is perceived as danger occurring in the present moment, while anxiety and worry are future oriented.
As previously discussed, a panic attack is different from a fear reaction. While both involve the fight-or-flight system, a fear reaction is in response to a very real, clear and present danger, and results in a true alarm; e.g., when someone is being chased by a bear. On the other hand, a panic attack occurs without any clear and present danger and results in a false alarm. But, even though it is a false alarm, the body will respond exactly the same way it does when there is a true alarm. Thus, during a false alarm a person experiences the same sensations, cognitions, and emotions of a true alarm. More information about panic attacks and false alarms is found in the section on the Development and Maintenance of Anxiety Disorders.
Because panic attacks occur in the context of many different anxiety disorders, it is important for the clinician to distinguish between three different types of panic attacks in order to make the most accurate diagnostic determination: 1)unexpected (uncued), 2) situationally bound (cued), and 3) situationally predisposed.
Unexpected (uncued) panic attacks seem to come from "out of the blue" and do not have an identifiable source that sets them off. It is believed these uncued panic attacks are in response to some kind of life stress, but this stress is often outside the immediate awareness of the person experiencing it. For example, suppose a woman who just lost her job, is out shopping for groceries. Suddenly, she feels short of breath and dizzy. She senses her heart is racing, and she becomes alarmed by these sensations that just "came out of the blue" for no apparent reason. This would be considered an uncued panic attack that was likely brought about by the necessity of having to shop for food, even though she has lost her job. Uncued panic attacks are a diagnostic requirement for Panic Disorder.
Situationally bound (cued) panic attacks invariably occur when a person is exposed to a certain situation, such as walking down a dark alley; or seeing a particular object, such as a dog. The onset is sudden and occurs immediately upon exposure. This type of panic attack is most often associated with Social and Specific Phobias, OCD, and PTSD. Unlike the unexpected (uncued) panic attacks, this type of panic attack has a clearly identifiable trigger.
Situationally predisposed panic attacks usually occur when confronted with a certain situation or a particular object, but not always, and the attack may not always begin immediately upon exposure. This type of panic attack is generally associated with Panic Disorder, but also occurs with Social and Specific Phobias. For instance, someone may usually have a panic attack whenever they are about to give a public presentation. However, this does not happen each and every time they engage in public speaking; and sometimes the attack doesn't begin until15 minutes into the speech, while at other times, it may not begin until 30 minutes afterwards.