Specified Panic Attack

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

subsides. The diagnosis is made by having four of the symptoms listed here:

• Palpitations and/or sensation of heart pounding

• Sweating

• Shaking or trembling

• Dyspnea or feeling smothered

• Choking sensation

• Chest pain

• Nausea

• Dizziness or lightheadedness

• Heat or cold sensations

• Numbness or tingling

• Derealization or depersonalization

• Fear of dying

• Fear of losing control

When a patient has fewer than four symptoms, it is called a limited-symptom panic attack with

typical symptoms being hyperventilation and shortness of breath. Patients perceive danger as

occurring at the present time and have intense terror or fear. This is different from a typical

fear reaction as there are a lot of physical symptoms. There are two other types of panic

attacks: 1) expected (cued) panic attack; and 2) unexpected (un-cued) panic attack.

An un-cued panic attack will come out of the blue without an identifiable trigger. There may be

underlying stress that triggers them. In order to have panic disorder, the attacks have to be un-

cued. Expected or cued panic attacks have an obvious trigger that the patient usually knows

about. This type of attack is commonly seen in social anxiety disorder, specific phobia, and

agoraphobia.