situations. The patients try to avoid becoming embarrassed by their behavior. The most prominent criterion is the presence or recurrent unexpected attacks. They cannot be predicted and come out of the blue. They can occur during a time of existing anxiety or during a previously calm state—even when sleeping. Typical signs include an accelerated heart rate, pounding heart beats, chest pain, trembling, dyspnea, sweating, nausea, dizziness, choking feelings, detached feelings, chills or heat sensations, numbness, fear of losing control, and/or fear of dying. There is persistent fear over having another attack. The fear over having another attack involves changing habits in order to avoid having a panic attack in public, such as avoiding specific places where panic attacks have occurred. Missing school and work may also be a problem. Social isolation can lead to sadness, depression, and problems with interpersonal relationships. The patient may have concerns about their health as the symptoms can mimic a real cardiac or neurological problem. Panic disorder is the most common cause of noncardiac chest pain. The prevalence of panic disorder is about 2-3 percent in adults and adolescents. Risk factors include having an anxious temperament, child abuse, and heredity (with a twin-twin concordance rate of 30-40 percent). No specific gene has been identified. People with depression, anxiety, or bipolar disorder have an increased risk of panic disorder as well. There are many medications that exist to decrease the symptomatology of panic disorder but they are much more effective with therapy. Dialectical Behavioral Therapy or DBT seems to help people who struggle overcoming anxiety and panic. Group therapy can help patients with similar symptoms. Children with panic disorder need to have family involvement to teach the family about the problem and how to address it.
SPECIFIED PANIC ATTACK Panic attacks can occur in other types of anxiety disorders. There are three types of panic attacks that will be discussed. As mentioned, panic attacks are sudden and extreme feelings of discomfort to fear that lasts for a distinct time period. It peaks within minutes and then 82
