The term “anxiety crisis” is something we probably all know. In fact most people have experienced one or have seen someone do it throughout their life. But in some cases these crises occur relatively frequently and generate a great fear of suffering them again, which in turn causes situations to be avoided. We are talking about those people who suffer from panic disorder
The so-called panic disorder is one of the most common types of mental disorder, which is characterized by the recurrent appearance of sudden and unexpected panic attacks (the subject may be calm or in an anxious situation before their appearance).
Panic attacks, also known as anxiety attacks, are the appearance of sudden and temporary episodes of feelings of anxiety, discomfort and high intensity fear that can have a variable duration and that usually generate a maximum peak of activation after a few minutes and resolve in around fifteen minutes (although sometimes they can last hours).
During these attacks a wide variety of symptoms appear, among which tachycardia, profuse sweating, tremors, hyperventilation and feeling of suffocation, hyperthermia numbness, chest pain, intestinal discomfort and psychological symptoms such as the fear of dying or having a heart attack, the idea of losing control over one’s body or even going crazy and possibly dissociative symptoms such as derealization (feeling that what is happening is not real) or depersonalization (strangeness with the subject’s own existence).
After the anxiety crisis or attacks, there is concern for a month or more that they may occur again or that the same sensations will be experienced again at some point. The subject anticipates the occurrence of these attacks and this generates great fear and anguish, a fear that causes a state of great tension in the subject and can lead to the implementation of mechanisms and behaviors that allow us to avoid either these sensations or the possible appearance of new attacks. Thus, if, for example, we had a panic attack on the subway, it is likely that we will avoid using public transportation again.
This will generate consequences of different magnitude that will alter your daily life to a greater or lesser extent, both on a personal, social and work level. The functionality and daily life of the person with this problem will be limited by panic and avoidance of circumstances that may generate it. In fact, It is common for the subject to also end up suffering from depressive problems or even substance use and abuse.
Anxiety attacks as something non-pathological
Experiencing a panic attack is certainly an extremely unpleasant and aversive experience. As we have said, it is common for the fear of dying or going crazy to appear. Furthermore, many symptoms are to some extent reminiscent of those of a heart attack, which reinforces the idea that something very serious is happening and increases panic and anxiety and reinforces the symptoms described above.
Despite this, it must be taken into account that panic attacks are not an indication per se of any disorder unless they occur very recurrently and generate avoidance in anticipation of their occurrence. In fact, a relatively high percentage of the world’s population will suffer from an anxiety crisis or panic attack at some point in their lives. This is especially common in demanding societies with a high level of demand a common thing nowadays.
But despite what has been said, they should be taken into account when evaluating psychopathology, given that it is not uncommon for them to appear in both panic disorder and other mental problems.
Relationship with agoraphobia
Panic disorder has traditionally been closely linked to another psychological problem called agoraphobia, in which there is fear and anxiety at the idea of exposing oneself to places where escape would be difficult or one might not receive help. in the case of suffering a panic attack or other embarrassing situations (Although the majority of the population considers that it is the fear of open spaces, in reality the underlying fear and what would cause avoidance of these and other types of spaces would be this).
This is because it is very common for agoraphobic subjects to anticipate anxiety and panic attacks and avoid these situations. In fact, although they are currently diagnosed separately, until a few years ago a distinction was made between panic disorder with or without agoraphobia.
One of the most common fears that arise when suffering a panic attack is that of being about to die due to a heart attack. This is a logical confusion, considering that many of the symptoms are similar to angina or a myocardial infarction: tachycardia, chest pain, sweating…
However, it must be taken into account that there are differences between a panic attack and a heart attack. Among them, they highlight that in a heart attack, unless other problems appear or anxiety arises, there is no hyperventilation or feeling of loss of body control. The pain is different and is usually more generalized, in addition to While in a heart attack there is a link with exertion, this does not occur in anxiety The duration of the symptoms is also different. In any case it is advisable to go to a medical center.
What is the cause?
As with other disorders, the exact cause of why some people develop panic disorder and others do not is not completely known.
The appearance of the first crisis may be due to situational factors while some authors propose that the recurrence, anticipation and concern about panic attacks occur due to the generation of negative and aversive interpretations of bodily sensations not linked to anxiety.
The fact that some sensations are interpreted as anxiogenic It generates fear and anxiety, which ultimately ends up generating the appearance of a crisis.
Likewise, there is also speculation about the possible influence of genes, with anxiety disorders generally being more frequent in families with previous cases. Learning from behavioral models or previous experiences may also have some influence.
Treatment and therapy
Panic disorder is a highly disabling problem for those who suffer from it and usually has a tendency to be chronic if it is not treated. Fortunately, studies carried out on this anxiety disorder indicate that The most common and recommended treatments available tend to have very high efficacy specifically more than 80% recoveries.
One of the most frequent and most effective treatments is, as with phobias, exposure. This technique is based on putting the subject in situations in which he gradually experiences situations that he avoids and that generate anxiety so that he can reduce the level of fear and anxiety in the face of these and the avoidance that they usually entail.
It is important to keep in mind that exposure must be gradual, it is necessary to agree with the patient on a hierarchy of feared situations to gradually reduce the anxiety generated. In the case of panic disorder, we are talking about both situations that are avoided for fear of suffering a panic attack and work at an interoceptive level, including exposure to sensations linked to panic (for example hyperventilation).
Another of the most effective treatments, which can be given together with the previous one, is cognitive restructuring. In this case we aim to combat the dysfunctional thoughts and beliefs that have generated and/or maintain the problem. The aim is to decatastrophize the situation and change the negative interpretations of bodily sensations so that they are not attributed to the occurrence of an anxiety crisis. Behavioral experiments are also used in which the patient is asked to carry out tests to check whether his thoughts and hypotheses about what is happening (being in a certain way a small exposure) adjust or not to reality.
Teaching relaxation techniques can be used to reduce the level of anxiety and anguish or learn to control it, being very useful for the patient.
Drug use
Sometimes psychotropic drugs are also used, and it is common for benzodiazepines and tranquilizers or even some antidepressants such as SSRIs to be prescribed. The use of these drugs can be useful to reduce the level of anxiety but it is necessary to combine it with psychotherapy so that the subject learns to modify his beliefs and stops avoiding situations and sensations, so that relapses do not occur after withdrawing the drug.
