Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
"All of a sudden, I felt a tremendous wave of fear for no reason at
all. My heart was pounding, my chest hurt, and it was getting harder to
breathe. I thought I was going to die."
"I'm so afraid. Every time I start to go out, I get that awful feeling in the pit of my stomach and I'm terrified that another panic attack is coming or that some other, unknown terrible thing was going to happen."
Panic attacks are sudden feelings of terror that strike
without warning. These episodes can occur at any time, even during sleep. A person
experiencing a panic attack may believe that he or she is having a heart attack
or that death
is imminent. The fear and terror that a person experiences during a panic attack
are not in proportion to the true situation and may be unrelated to what is
happening around them. Most people with panic attacks experience several of the
following symptoms:
"Racing" heart
Feeling weak, faint, or dizzy
Tingling or numbness in the hands and fingers
Sense of terror, of impending doom or death
Feeling sweaty or having chills
Chest pains
Breathing difficulties
Feeling a loss of control
Panic attacks are generally brief, lasting less than ten
minutes, although some of the symptoms may persist for a longer time. People who
have had one panic attack are at greater risk for having subsequent panic
attacks than those who have never experienced a panic attack. When the attacks
occur repeatedly, a person is considered to have a condition known as Panic
Disorder.
Panic attacks may be symptoms of an anxiety disorder. These attacks are a
serious health problem in the U.S. At least 20% of adult Americans, or about 60
million people, will suffer from panic attacks at some point in their lives.
About 1.7% of adult Americans, or about 3 million people, will have full-blown
panic disorder at some time in their lives, twice as often for women than men. The peak age at which people have their first panic attack (onset) is 15-19 years. Another fact about panic is that this symptom is strikingly different from other types of anxiety; panic attacks are so very sudden and often unexpected, appear to be unprovoked, and are often disabling.
Childhood panic disorder facts include that about 0.7% of children suffer from
panic disorder or generalized anxiety disorder and that although panic is found
to occur twice as often in women compared to men, boys and girls tend to
experience this disorder at an equal frequency.
Once someone has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point at which the mere idea of
engaging in the activities that preceded the first panic attack triggers future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus, there are two types of panic disorder, panic disorder with or without agoraphobia. Like other major illnesses, panic disorder can have a serious impact on a person's daily life unless the individual receives effective treatment.
Panic attacks in children may result in the child's grades declining, avoiding school and other separations from parents, as well as substance abuse, depression, and suicidal thoughts, plans, and/or actions.
What are panic attack symptoms and signs
in adults, teenagers, and children?
As described in the first example above, the symptoms of a panic attack appear suddenly,
without any apparent cause. They may include
terror, a sense that something unimaginably horrible
is about to occur and one is powerless to prevent it;
a need to escape;
nervousness about the possibility of losing control and doing something
embarrassing;
fear of dying.
Although the duration of a panic attack can vary greatly, it typically lasts for more than 10 minutes, is one of the most distressing conditions that a person can experience, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause, or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include posttraumatic stress disorder (PTSD), schizophrenia, and intoxication or withdrawal from certain drugs of abuse.
Certain medical conditions, like thyroid abnormalities and anemia, as well as certain medications, can produce intense anxiety. Examples of such medications include stimulants like methylphenidate (Ritalin), diabetes medications like metformin and insulin, antimalarial medications like quinine, as well as corticosteroid withdrawal, such as withdrawal from dexamethasone (Decadron). As individuals with panic disorder seem to be at higher risk of having a heart valve abnormality called mitral valve prolapse (MVP), this possibility should be investigated by a doctor since MVP may dictate the need for special precautions to be taken when the individual is being treated for any dental problem.
While the development of panic attacks have been attributed to the use of food
additives like aspartame, alone or in combination with food dyes, more research
is needed to better understand the role such substances may have on this
disorder.
Anxiety attacks that take place while sleeping, also called nocturnal panic attacks, occur less often than panic attacks during the daytime but affect about 40%-70% of those who suffer from daytime panic attacks. This symptom is also important because people who suffer from panic
symptoms while sleeping tend to have more respiratory distress associated with their panic. They also tend to experience more symptoms of depression and
other psychiatric disorders compared to people who do not have panic attacks at
night. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. In contrast to people with sleep apnea and other sleep disorders, sufferers of nocturnal panic can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.
While panic disorder in adolescents tends to have similar symptoms as in adults,
symptoms of panic disorder in younger children
are less likely to include the thought-based or
so-called cognitive aspects. Specifically, teenagers are more likely to feel
unreal or as if they are functioning in a dream-like state (derealization) or be
frightened of going crazy or of dying.
Symptoms of panic attacks in women tend to include more avoidance of anxiety provoking situations, show more frequent recurrence, and more often result in the use of medical care compared to panic attack symptoms in men. The frequency of panic attacks may increase, decrease, or remain unchanged during pregnancy.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Vertigo is a feeling of spinning movement, and at times accompanied by nausea and vomiting occur. Vertigo is most often associated with an inner ear problem. The treatment for vertigo can be lifestyle changes and medication if necessary.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Chronic fatigue syndrome is a debilitating and complex disorder characterized by profound fatigue that lasts 6 months or longer, is not improved by bed rest, and may be worsened by physical or mental activity.
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Agoraphobia is a fear of being outside or of being in a situation from which escape would be impossible. Symptoms include anxiety, fear, disorientation, rapid heartbeat, diarrhea, or dizziness. Treatment may incorporate psychotherapy, self-exposure to the anxiety-causing situation, and medications such as SSRIs, benzodiazepines, and beta blockers.
ICU psychosis is a disorder (also a form of delirium or acute brain failure) in which patients in an intensive care unit or a similar setting experience a cluster of serious psychiatric symptoms. These symptoms include anxiety, reastlessness, hearing voices, hallucinations, nightmares, paranoia and more. Causes of ICU psychosis are generally from a combination of environmental and medical conditions.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Balance is defined as a state of equilibrium. It takes significant amount of
work for this to occur in the body. The brain uses inputs from many sources to
understand where the body is located in relationship to the world and to allow
it to function. Sensory information from the eyes, ears, and position receptors
in the rest of the body help keep the body upright and allow it to move in a
coordinated fashion.
Information comes to cerebellar lobes located in the base of the brain from
the vestibular system in the inner ear, vision from the eyes, and proprioception
(position) receptors located throughout the body that send signals through the
spinal cord. The cerebellum uses that information to maintain posture,
coordinate body motions like walking and also coordinate fine motor skills like
using a pen to write.
Vertigo, a feeling of spinning movement and sometimes accompanied by nausea
and vomiting, occurs when an...