Panic disorder is an emotional disturbance found in about 1-2% of all American adults, women more than men; it is rare among children. People with this disorder have a fairly constant state of moderate anxiety and an over responsive sympathetic nervous system; they respond to even mild stressors or mild exercise with a sudden increase in heart rate and blood adrenaline. That arousal sometimes provokes a full-fledged panic attack, accompanied by chest pains, difficulty in breathing, sweating, faintness, and shaking. A panic attack generally lasts only a few minutes, although it may last an hour or more. During an attack, most people worry about fainting, dying, or going crazy. People often interpret a panic attack as a heart attack or as sign of an impending heart attack. After a few such attacks, those worries may grow more intense and may even trigger further panics.
Panic disorder can become self-perpetuating. Many people deal with anxiety by taking a deep breath or two, to help calm themselves down. On the theory that “if a little is good, a whole lot will be better,” they may continue breathing deeply, or hyperventilating. Hyperventilation expels carbon dioxide and therefore lowers the carbon dioxide level in the blood. Then if something happens that increases the carbon dioxide level, such as sudden physical activity or an experience that excites the sympathetic nervous system, the carbon dioxide level in the blood increased by a large percentage and stimulates an increased heart rate, trembling, and other symptoms of a panic attack-the very thing the person was trying to avoid. After a few such episodes, the likelihood of further attacks increases. One treatment for panic disorders is to teach the person to avoid hyperventilating. Another is to teach the person to recognize sudden increases in heart rate and trembling as a sign of an impending heart attack.
When people discover that physical exertion sometimes triggers a panic attack, they may decide to avoid any sort of physical activity. As a result, they grow even more sensitive to the effects of physical activity; even slight exertion will raise the level of carbon dioxide in their blood. Consequently, some authorities recommend regular exercise as a treatment for panic disorder.
Panic disorder is frequently linked with agoraphobia-an excessive fear of open places or public places, from agora, the ancient Greek work for “marketplace”. Most psychologist believe that the people with panic disorder are not primarily afraid of the open places themselves; they are afraid of being incapacitated or embarrassed by having a panic attack in a public place. In a sense, they are afraid of their own fear. To avoid the prospect of a public panic attack, they stay home as much as possible and almost never go out alone.
Some psychologists advise people with panic attacks to stop worrying about their attacks, to take the attitude, “If it happens, it happens.”
Worrying about anything-even panic attacks themselves-often prompts people to hyperventilate, and hyperventilation can lead to another panic attack.