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Panic attacks case study

Case study: panic disorder

Sharon was a 26-year-old single woman with a history of panic attacks that occurred out of the blue, including at night. Her first panic attack occurred some five years earlier while she was studying for her final exams at university. At that time she experienced intense symptoms of a pounding heart, trembling and shaking, tightness in her chest, shortness of breath, feelings of unreality (derealization) and dizziness. As she was alone at home at the time she immediately called an ambulance and was admitted to hospital via the Accident and Emergency department for 24-hour cardiac monitoring. She was discharged the following day with no abnormal cardiac symptoms detected. At the time of the initial panic attack she reported thinking she was having a heart attack and was about to die. Despite the hospital report she became increasingly concerned about the episode and in particular about the possibility of having future attacks and dying as a consequence of one. Her panic attacks persisted and occurred in a variety of situation, most notably when she was alone, when she was tired, or when she was ‘wound up’. Over time, she became particularly adept at monitoring her heartrate and pulse, and became very aware of any altered sensations in her chest, left arm and fingertips. If she noticed any symptoms in these areas she experienced an increase in her symptoms that she interpreted as indicating that there was something seriously wrong with her heart and that death was imminent. In an effort to reduce and control her symptoms she avoided any situation in which they occurred, specifically exercising, crowded places, funfairs, standing up quickly, and driving. These were all situations in which she had previously experienced her feared symptoms. In addition, she always carried her mobile phone with her to enable her to summon help in the event of an attack, avoided going out alone to strange places preferring to go out with a trusted friend, and sat down trying to think ‘positive thoughts’ if she noticed any symptoms.

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