Text 4. Panic

More than three million Americans will experience panic disorder during their lifetime, and there is no typical victim. According to the American Academy of Child and Adolescent Psychiatry, panic disorder can begin during childhood or before age 25.

While it is not clear what causes the disorder, there is a strong suggestion that the tendency is inherited and runs in families. At one time, researchers believed panic disorder was due primarily to psychological problems. Experts now believe that genetic factors or changes in body chemistry, in combination with stressful circumstances or events, play a pivotal role.

According to the American Psychological Association, each panic attack peaks within about 10 minutes. Sometimes attacks repeat in clusters for up to an hour after the initial attack, with associated fear over the possibility of another attack. Subsequent attacks may occur days and even weeks later.

This element of fearfulness is called anticipatory anxiety. People fear having another attack while performing the same activity or being in the same situation as when a previous attack occurred. Anticipatory anxiety can be so extreme that people turn away from the outside world for fear that another attack will be set off.

For example, if an attack occurred while driving on the freeway, a person may fear that repeating this type of driving will cause panic again. He will, then, limit himself to driving only on secondary roads. If panic was experienced while sleeping in bed in the dark, a person might sleep on the couch with the light on to try to prevent another attack.

If an attack was experienced outside while walking through a park or shopping at a mall, a fear of having a future attack in public can occur. This can lead to complete avoidance of any outside activity, which can result in a condition called agoraphobia ─ the inability to go beyond known and safe surroundings because of intense fear and anxiety.

While a great deal of research has been conducted on panic disorder, the exact cause is unclear. Research does suggest that panic disorder is more prevalent in women than in men.

According to the National Institute of Mental Health panic disorder can also happen with other disorders. Depression and substance abuse commonly occur simultaneously with panic disorder. About 30 percent of people with panic disorder abuse alcohol and 17 percent abuse drugs, such as cocaine and marijuana. This drug abuse can be attributed to unsuccessful attempts by a person with panic disorder to alleviate the anguish and distress caused by his condition.

Major advances have been made through research funded by the NIMH to produce effective treatments to help people with panic disorder. Treatment includes medication and a type of psychotherapy known as cognitive-behavioral therapy.

Appropriate treatment by an experienced professional can reduce or prevent attacks in 70 to 90 percent of people with panic disorder. Most people show significant progress after a few weeks of treatment. Relapses can occur, but they can often be treated effectively.