A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience.

A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack.

• racing heartbeat
• difficulty breathing, feeling as though you 'can't get enough air'
• terror that is almost paralyzing
• dizziness, lightheadedness or nausea
• trembling, sweating, shaking
• choking, chest pains
• hot flashes, or sudden chills
• tingling in fingers or toes ('pins and needles')
• fear that you're going to go crazy or are about to die

You probably recognize this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms seem to rise from out of nowhere. They occur in seemingly harmless situations--they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following conditions:

• it occurs suddenly, without any warning and without any way to stop it.
• the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.
• it passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks can continue to recur for hours.

Physical and psychological are the causes of panic disorder.

Body: There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had a panic disorder or some other emotional disorder such as depression. Studies with twins have confirmed the possibility of 'genetic inheritance' of the disorder. Panic Disorder could also be due to a biological malfunction, although a specific biological marker has yet to be identified.

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack.

Both: Physical and psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack.

For example, if a person with panic disorder experiences a racing heartbeat caused by drinking coffee, exercising, or taking a certain medication, they might interpret this as a symptom of an attack and, because of their anxiety, actually bring on the attack. On the other hand, coffee, exercise, and certain medications sometimes do, in fact, cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack. That's why the right therapy for panic disorder focuses on all aspects -- physical, psychological, and physiological -- of the disorder.

The experience of panic can range from mild (where the person will have limited interference in their daily routine) to extremely severe (possibly resulting in being partially or completely housebound). The experience of panic for most panic sufferers is frightening and the avoidance can greatly alter one's lifestyle (e.g., inability to drive to work). As a change in their lifestyle becomes apparent, there is also a change in their personal relationships. Others around the person must take on more of the day-to-day routine and responsibilities (e.g., going to grocery stores or taking the kids to school). This may cause those around the panic sufferer to feel more stress from their increased duties. The additional stress experienced by the family can cause resentment and anger towards the person and then worsen the panic symptoms. At the same time, she or he may begin to show signs of depression as a result of their changed family role. The negativity that comes with depression may then lead the person to believe that they don't have the capability to improve their condition, and consequently increase their dependency, depression, and panic symptoms. If left untreated, this disorder can be consuming.

In general, a person should consider seeking help when the anxiety occurs too frequently, intensely, or is becoming disruptive in daily functioning (e.g., going to fewer parties or social gatherings, going out to stores or movies less than usual). A good rule to follow is to be conservative and consider seeking help from a mental health professional when you notice the following:

• Frequently occurring panic attacks. If you have noticed that the attacks are increasing in either frequency or intensity, it may be a sign that they are becoming more difficult to control. At these times, it is advisable to seek help before the attacks begin to greatly interfere in your life.
• The appearance of avoidance behavior. If you notice a decrease in the amount of time you spend in activities you have typically done in the past, you may want to consider seeking help, especially if the reason for the decrease is related to experiencing panic attacks. The same can be said for activities that may bring on some of the sensations of panic (e.g., coffee). If you are changing your behavior to reduce the number of activities that are associated with panic symptoms, you may be letting the fear of the sensations control your behavior at a subtle level, and should consider seeking help from a qualified mental health professional.
• Dependency. If you notice that you are becoming more dependent on others to accomplish tasks that you would normally do because of the possibility of experiencing a panic attack, you may want to seek help. While this behavior is functional in the short-run, in the long-run dependency may intensify your anxious symptoms.
• Use of safety-signals. Safety-signals are objects or people that you feel comfortable with and signal that you are less likely to experience a panic attack. As such, it is common for individuals with panic to seek safe objects or people. If you notice that you want others (e.g., spouse or partner) to accompany you more during usual activities, then you may want to seek help.

Treatment for panic disorder with agoraphobia usually involves psychotherapy, medication, or a combination of the two. A qualified family therapist can work with you to determine which treatment will work best for your circumstances. Psychotherapy usually involves some form of behavior therapy. This basic approach consists of in-vivo exposure, which involves repeatedly entering the feared situations, gradually over time. The exposures can be conducted with or without the direct assistance of the therapist. A variation of this approach (cognitive behavioral therapy) involves conducting behavior therapy exposures in combination with helping you manage the troublesome thoughts that often accompany periods of intense anxiety. Cognitive behavioral therapy is a comprehensive treatment designed to influence the negative thinking (e.g., "I might die") that is common with panic disorder. It provides accurate information regarding the nature of panic and teaches specific techniques that allow the patient to correct the catastrophic thoughts that contribute to panic attacks. In this treatment, the patient is also taught to utilize breathing techniques to alleviate some of the physical sensations. This type of therapy has been shown to greatly reduce the return of panic symptoms in the future. Either of these treatments can be conducted individually, or in a couples or group format.

Anti-panic medications may be recommended, including benzodiazepines such as alprazolam, clonazepam, and lorazepam. These medications work well and are generally considered safe, quick acting, and have fewer side effects than other types of medications. While both medications and psychotherapy are effective, some patients have a preference for one type versus another. 

Panic can be very distressing, but the good news is that it is treatable, and the treatments outlined here are very successful. The suffering does not have to last for an extended period of time. A qualified family therapist can help you explore your treatment options and recommend a treatment plan that is appropriate for you.

Books

• Overcoming Panic, Anxiety & Phobias, by Babior and Goldman,
• Self-help book about anxiety and panic recovery
• The Anxiety & Phobia Workbook by Edmund J. Bourne
• Self-Coaching: How to Heal Anxiety and Depression by Joseph J. Luciani
• Overcoming Panic Disorder : A Woman's Guide by Lorna Weinstock, Eleanor Gilman
• The Anxiety and Phobia Workbook, by Edmund J Bourne
• Mind over Mood, by Dennis Greenberger and Christine Padesky - concentrates on identifying and challenging the way we think and encouraging more realistic, balanced thoughts and beliefs, to manage how we feel and behave.