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What is panic disorder?

A panic attack is a period of intense fear or discomfort that reaches a peak within ten minutes, and is associated with at least four symptoms including breathlessness, palpitations, dizziness or trembling, nausea, and tingling sensations in the arms and fi ngers. As noted earlier, this may be a severe element of a phobic response. It may also be given a separate diagnosis in DSM of panic disorder. According to DSM-IV-TR, to be given this diagnosis, the individual will report recurrent unexpected panic attacks, at least one of which has been followed by at least one month of one or more of the following:

persistent concern about having further attacks

worry about the implications of the attack or its consequences (e.g. having a heart attack, ‘going crazy’)

a signifi cant change in behaviour related to the attacks.

A common feature of a panic attack is known as hyperventilation, which involves rapid short inhalations and exhalations. As a consequence, carbon dioxide is rapidly exhaled and not absorbed into the bloodstream, while oxygen is over-absorbed, leading to the symptoms described above. As the breathing response is triggered by high levels of carbon dioxide within the circulation, the physiological trigger to breathe does not occur, resulting in feelings of shortness of breath, which encourage further over-breathing. It is at times such as this that the eponymous ‘brown bag’ can come in useful. Placing one over the mouth and nose ensures that the person re-breathes the carbon dioxide they are exhaling, increasing its absorption from the lungs into the blood, stabilizing the breathing pattern and stopping the symptoms.

Charles Darwin provided one of the fi rst descriptions of a panic attack when he described one of his own. He was not unusual, and the prevalence of panic attacks may be increasing. The prevalence of US citizens to report having had at least one panic attack rose between 1980 and 1995 from 5.3 to 12.7 per cent. However, the number of people achieving the diagnostic criteria for panic disorder is much less. Batelaan et al. for example, estimated that about 2 per cent of the general population will develop repeated panic attacks, diagnosable as panic disorder. The condition is universal and consistent across geographical and cultural boundaries, although triggers to panic may vary across cultures. In the Arctic, a fear of being alone, known as kayak angst, and a Chinese anxiety syndrome involving the fear of penile retraction into the body resulting in death known as koro, show striking similarities to panic disorder.

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