panic disorder - Psychologus

Storybook

This is a snapshot story from a storybook that contains clinical presentations of various mental disorders. The characters present maladaptive (and adaptive) psychological features that are associated with their disorders.

A 35 year old male, Paneck was employed as a manager at a beauty salon. This was his 3^rd year at the salon and he had had a troubled experience dealing with the recent issues at work.

Thanks to the marketing team and the staff’s work, the beauty salon had recently gotten a boom of new customers. This obviously required the staff to work that much harder than they normally were used to.

While Paneck liked that the owner, Ms. Rey increased his income, he found it difficult to manage the staff at times. The work hours had become more hectic. As a result, some of the employees had demanded an increase in pay. But Paneck’s duty was only to manage the beauticians. While he could recommend some employees, he was concerned that if he tried to vouch for everyone, the owner of the salon would stop taking him seriously.

And he did not want to quit his job.

A week ago, Paneck was approached by Rey and was scolded that he was cutting corners. Paneck had been taking off from work an hour earlier than normal. But that was only because he had to go home and take care of his mother, who was battling cancer.

However, this had cut short the end-of-day customers. The owner was not happy and she demanded Paneck to stay overtime to compensate for this.

During this conversation, Paneck became aware that his heart rate was increasing rapidly. He also felt his breaths become shallower. In a few minutes, Paneck was reaching out for some chair, doubling over, panting and sweating. Rey called the other employees for help, and a crowd gathered around Paneck. He was offered water. Rey then took him inside her office and Paneck calmed down after about 10 minutes. Paneck apologized but he felt that his heart was about to burst from his chest.

In the week that followed, Paneck experienced these instances where his heart rate seemed to increase drastically in a very short period of time. Each time this happened, he found it difficult to breathe and he had to sit down, separate himself from the environment he was in for a few minutes. After that, he found it somewhat difficult to work, but he tried his best to remain at the salon until it was off-time.

The coworkers were apprehensive. They were generally satisfied with how Paneck conducted affairs at work, but these new problems that Paneck reported feeling made them sure that he needed a break from work. On days where there was greater workload, the employees noticed that he felt more distressed, often leading to these ‘attacks.’

But Paneck wanted to work. He did not understand why he was going through this. All he knew was that at times his heart-rate seemed to shoot up. In fact, he noticed that his heart-rate went up particularly when he was in the lobby of the salon. He was becoming increasingly afraid of the next time he was going to feel this rush of bodily fluctuations. The worst thing was that he did not understand when this would happen. It looked as if it could happen at any time.

Still, Paneck was managing everything. His family needed the money. And he figured that the next time it happened, he would simply have to seclude himself from everyone else, in order to not cause anyone else any problems. Moreover, the way the crowd gathered around him made him even more confused and angry at himself.

Life at work was not really going that well. And Paneck had an idea that this was only going to get worse.

A lot of people in the general community have panic disorder. It is one form of anxiety disorder that is characterized by recurrent, sudden panic attacks. Many ideas and models try to explain how panic disorder might start. Most of them point to a biological imbalance as a major cause, such as problems with gamma-aminobutyric acid, cortisol, and serotonin. Genetic and external factors are thought to play a part in how panic disorder can happen. Studies have found that bad experiences in childhood may cause panic disorder as an adult. Newer study suggests that neural circuits may play a bigger role in panic disorder. This means that some parts of a person’s brain are overactive, which makes them more likely to develop the disorder.

There are some studies that suggest genetics may have something to do with how panic disorder starts. People who are first-degree cousins of someone who already has the syndrome have a 40% chance of getting it themselves. There is also a high chance that people with panic disorder will develop other mental illnesses.

Lifetime rates of panic disorder in people in the US are estimated to be between 2% and 6%. 2.7% of people will have it in a year, and 44.8% will be considered “severe” cases. According to the empirical evidence, lifetime rates of panic disorder are pretty high; they are only slightly lower than rates of social anxiety disorder, PTSD, and generalized anxiety disorder. Notably, people with panic disorder are much more likely than the general population to have heart, lung, digestive, and other health problems throughout their lives. People from Europe are more likely to have panic disorder than people from Asia, Africa, or Latin America. Women are more likely to be impacted than guys. Teenagers and young adults are most likely to have panic disorder, while kids younger than 14 are less likely to have it.

Here is a clinical presentation of panic disorder.

The high prevalence of panic disorder signals early detection and treatment of the condition to avoid its harmful consequences. The following diagnostic criteria and features, as suggested by DSM 5 TR, can help diagnose panic disorder:

Diagnostic Criteria

A. Sudden panic attacks that happen over and over again. A panic attack is a sudden, strong feeling of fear or pain that gets worse quickly and lasts for minutes. During this time, four or more of the following signs happen:
Note: The sudden rise can happen whether you are calm or worried.
1. Palpitations, a racing heart, or a fast heart rate.

2. Sweating.

3. Shaking or trembling.

4. Having trouble breathing or feeling suffocated.

5. Sense of choking.

6. Pain or stiffness in the chest.

7. Feeling sick or having stomach problems.

8. Feeling dizzy, shaky, light-headed, or weak.

9. Feelings of chills or heat.

10. Paresthesias (feelings of numbness or tingle).

11. Feelings of not being in the real world or being cut off from oneself (depersonalization).

12. The worry that they will lose control or “go crazy.”

13. The fear of dying.

Note: Symptoms that are unique to a culture may show up, such as deafness, neck pain, headaches, or screaming or crying uncontrollably. These signs shouldn’t count as one of the four needed ones.

B. After at least one of the attacks, there was at least one of the following for at least one month:

1. Constant worry or fear of having more panic attacks or the bad things that could happen as a result, like losing control, having a heart attack, or “going crazy.”

2. An important change in behavior that isn’t helpful because of the attacks, like staying away from exercise or situations you’re not used to in order to avoid having them.

C. The problem is not caused by the body’s response to a substance (like an illegal drug or a prescription drug) or a medical situation (like hyperthyroidism or heart trouble).
D. Another mental disorder cannot explain the problem better. For example, panic attacks don’t only happen when people are afraid of social situations (social anxiety disorder), when they are afraid of specific objects or situations (specific phobia) when they are obsessed with something (obsessive-compulsive disorder), when they are reminded of a traumatic event (post-traumatic stress disorder), or when they are separated from people they care about (separation anxiety disorder).

Diagnostic Features

Recurrent, spontaneous panic attacks indicate panic disorders.
Panic attacks are brief, acute feelings of terror or discomfort that worsen to the last minute.
At least four of thirteen physical and mental indications must occur simultaneously.
Recurrent refers to many unexpected panic attacks.
A sudden panic attack has no known cause.
Nocturnal panic attacks occur when the person is resting or waking up.
When there is a clear indicator or reason, such as being in a panic attack-prone environment, expected panic attacks occur.
Clinicians decide if panic episodes are predictable or unexpected. They accomplish this by carefully interrogating the subject about events before or during the incident and if the attack appeared random.
The culture determines whether panic episodes are anticipated or surprising.
About half of US and European panic disorder sufferers have planned and spontaneous panic episodes.
Having predicted panic episodes does not rule out panic disorder.
Panic attacks can occur at many times and methods.
Attacks might occur daily or weekly for months.
Over many years, there may be weeks or months without episodes or attacks that occur twice a month.
People who do not suffer panic attacks frequently share indicators, demographics, co-occurring disorders, family background, and biological facts with those who do.
Panic disorder can cause full-symptom (four or more symptoms) and limited-symptom attacks.
Symptoms vary from attack to attack.
A person must experience many abrupt, full-blown panic attacks to be diagnosed with panic disorder.
Nighttime panic attacks are different from morning worries.
One-quarter to one-third of Americans with panic disorder have suffered a midnight panic episode.
Daytime panic episodes affect most of these folks.
Panic episodes throughout the day and at night are indicative of a more severe panic condition.
People who fear panic attacks worry about their health. They may fear their panic episodes indicate a life-threatening ailment like heart disease or seizure disorder. They also worry about social situations, such as being embarrassed or judged for their evident panic symptoms. They fear “going crazy” or losing control and their mental health. Panic disorder sufferers who fear death have more severe symptoms.
Bad behavior modifications are attempts to reduce or prevent panic episodes and their complications.
Avoiding physical activity, rearranging daily life so help is easy to find in case of a panic attack, limiting normal daily activities, and avoiding situations that make you think you have agoraphobia, like leaving the house, taking public transportation, or shopping, are examples.
Agoraphobia is diagnosed differently if present.