Now, we’re going to talk about panic,
one of the very common disorders and
symptoms under the anxiety class.
Here’s a case example.
Jennifer is a 32-year-old woman who complains
of fear of going to the grocery store.
But beyond fear, she experiences physical
symptoms like shortness of breath,
chest pain, numbness and
tingling in her extremities,
and nausea whenever she
goes out shopping.
For these reasons,
she avoids going out
and has completely stopped
grocery shopping altogether
and rather she has a food delivery
service come to her apartment.
Keep that case in mind as we talk
a little bit more about panic.
So there’s a difference between having
a panic attack and a panic disorder.
A panic attack is not
actually a mental disorder.
It’s a discrete period
of heightened anxiety
that affects much of the
Panic disorder, however, is characterized
by the experience of panic attacks
that are accompanied by a persistent
fear of having additional attacks.
So what’s the different between a
panic attack and panic disorder?
Well, here’s a little quiz.
Which one is a mental disorder?
Panic disorder is, not an attack.
And which one is chronic?
Panic disorder, which is
what makes it a disorder.
It’s not only an acute state,
but it actually lingers with associated
fears of having another attack.
So what’s the chance of
developing panic disorder?
As we just said, panic
attack is very common.
Almost all of us will experience panic
to some degree or another
throughout our lives,
but only 2-5% of us will
actually develop panic disorder.
Women are going to be twice more
likely to develop this than men.
And the usual onset
is by early thirties
and it’s more common people
who have a family history
or other mental disorders
in that individual.
So what are some of the comorbidities
or other mental disorders
that are highly associated
with panic disorder?
Well, PTSD is one.
Well, this is posttraumatic
And it’s a response to a
catastrophic life experience
in which the patient reexperiences the
trauma, commonly through a flashback,
and they avoid reminders
of the events
and experience emotional
numbing and hyperarousal.
PTSD is very disruptive to
people’s day to day lives.
Another common mental disorder that
goes along with panic disorder is this:
Generalized anxiety disorder.
This is a persistent excessive anxiety and
hyperarousal about general daily events.
It tends to last
more than six months
and does not generally interfere
with activities of daily living.
So how does panic
Well, it results from a combination
of underlying predispositions
interacting with or triggered
by some kind of stress.
So we consider it
double diaphysis model.
There’s some kind of underlying,
maybe genetic predisposition,
and then there’s a life event or stress
that just exacerbates the panic disorder.
Their vulnerability factors
including genetics as I just said,
also childhood adversity
and personality traits
sometimes also make one vulnerable
to a panic disorder later in life.
So in terms of the
if a first degree relative is affected,
then a person is four to eight times greater
at risk for having a panic disorder.
Anxious temperaments are also vulnerable
to developing panic disorder.
And neuroticism, which is poor stress
resilience to catastrophic events
and also any kind of
poor stress resilience
when it comes to regarding
can lead to vulnerability
for panic disorder.
A history of physical and sexual
abuse also increases one's risk.
And smoking also creates a
greater likelihood of panic.
So can asthma.
And now, I ask, how can a neurotic
personality lead to panic?
Well, people with neurotic personalities
tend to misinterpret things.
So for example, they may go out for a
run and experience a rapid heartbeat.
But instead of linking that to the
fact that they just exercised,
this person who’s very neurotic may think,
“Oh, my gosh. My heart is beating fast."
And therefore they start to panic.
Neuroticism can lead to panic,
which actually can worsen
and prolong the experience.
So it’s really a viscous cycle.
In terms of neurobiology,
there are differences in the brains
of those with panic disorders.
Many intricate neural pathways involved
and the various areas of
the brain are affected.
Certain receptors and neurotransmitters
can also be altered.
So when we think
there’s a proposed neuroanatomical
model for panic disorder
that focuses on specific areas
within two regions of the brain.
The amygdala and hypothalamus.
And these tend to be sites for neural
triggers to having panic attacks.
This suggests that individuals may inherit
specific areas that are hyperexcitable
and yet, another theory for
how a patient develops panic
is that exposure to internal
or external stressors
leads to lighting up the excitable parts
of their brain and precipitating a panic.
The brain areas that are involved
in panic include the amygdala,
the prefrontal and temporal cortex,
the anterior cingulate, the insula,
hippocampus, and hypothalamus.
That suggests that the human
panic response is very complex.
And it actually involves a broad set
of neural networks and processes.
Alterations in the GABA benzodiazepine
receptor and serotonin receptor systems
also show that panic disorder patients
have increased fear generalization,
meaning that even the smallest
trigger can incite fear in them
whereas with other people, they’re
able to keep their emotions at bay.
Spontaneous episodes of fear in people with
panic disorder tend to begin abruptly,
lasts for anywhere from
a minute to an hour
and patients with panic attacks
can develop agoraphobia.
This is an anxiety about and
avoidance of situations
where help or easy escape
may not be quite ready.
And people will often fear
having embarrassing symptoms
when they’re out in a public
place when they’re agoraphobic.
Panic and spontaneous
episodes of fear also
are often accompanied by somatic features,
things like faster breathing,
rapid heartbeat, sweating,
sometimes are associated with agoraphobia,
which is where the patient won’t leave the
house for months or even days on end,
they avoid social contact in
situations where they perceive
that they’re going to be caused
to be in a fearful situation.
So let’s go back to
this woman, Jennifer.
So we know that she’s quite fearful of
the marketplace and grocery shopping.
She’s pretty much starting
to seclude herself at home
and so I asked does
Jennifer have agoraphobia?
Well, yes. She does.
She’s fearful of going
out in public because
she fears having another panic
attack in a very public space
that she may not be able to
get out of very readily.