PANIC DISORDER

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