Panic attacks are distinct periods of intense fear and discomfort. Panic disorder occurs when these attacks continue over a period of time. Panic attacks are a common occurrence. Almost everyone at one time or another has felt the pounding heartbeat, sweating, trembling, and other symptoms of a panic attack. These attacks, which are the hallmark of panic disorder, are thought to occur when the brain’s normal mechanism for reacting to a threat—the so-called “fight or flight" response—becomes too easily triggered. Most panic attacks are short-lived, and are usually caused by a specific event.
Panic disorders are characterized by the spontaneous and unexpected return of these attacks over a period of time. At least four attacks must occur within a four-week period, or the panic attacks must be followed by a fear of having another attack, continuing for at least a month before the diagnosis can be made.
In some cases the person begins to worry about panic attacks even before they happen. They may begin to avoid places such as crowds or theatres where escape would be difficult should an attack occur. In its most extreme form, called agoraphobia (“fear of the marketplace”), the person may be afraid to leave the house or to be alone.
The causes of panic attacks are not well understood. The causes of panic disorder are still unknown. Family and twin studies, however, have shown that panic disorder has a strong genetic component.
Some believe that the nervous system in those who have panic attacks is more hyperactive, and thus responds more easily to stimuli. There are also indications that the brains of people with panic disorders may respond differently to certain neurotransmitters.
Some medications and illnesses can cause symptoms similar to those of a panic attack. Among the medical conditions that mimic the symptoms of panic disorder are irregular heart rhythms, an overactive thyroid gland, seizure disorders, and some respiratory diseases such as asthma. Theophylline (for asthma) and steroids can also cause panic-like symptoms, as can cocaine, amphetamines, and too much caffeine. Withdrawal from drugs such as alcohol, barbiturates, and benzodiazepines can also produce similar symptoms.
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