Causes and symptoms

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Causes

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. It is extremely difficult to study the brain and the underlying causes of psychiatric illness; and understanding the chemistry of the brain is the key to unlocking the mystery of panic disorder. The amygdala is the part of the brain that causes fear and the response to stress. It has been implicated as a vital part of anxiety disorders. Sodium lactate, a chemical that the body produces when muscles are fatigued, and carbon dioxide are known to induce panic attacks. These substances are thought to inhibit the release of neurotransmitters in the brain, which leads to the panic attacks. One hypothesis is that sodium lactate stimulates the amygdala and causes panic attacks. Another hypothesis is that patients with panic disorder have a hypersensitive internal suffocation alarm. This means that the patient's brain sends the body false signals that not enough oxygen is being received, causing the affected person to increase his or her breathing rate. Panic disorder patients have attacks when their overly sensitive alarm goes off unpredictably. Yohimbine, a drug used to treat male sexual dysfunction, stimulates a part of the brain called the locus ceruleus and induces panic symptoms thus pointing to this area of the brain's involvement in panic disorder. Brain neurotransmitters serotonin and GABA are suspected to be involved in causing the disorder, as well.

GENETICS. Genetics also plays a pivotal role in the development of panic disorder. Twin studies have demonstrated that there is a higher concordance in identical versus fraternal twins thus supporting the idea that panic disorders are inherited. Family studies have also demonstrated that panic attacks run in families. Relatives of patients with panic disorder are four to 10 times more likely to develop panic disorder. People who develop early onset of panic attacks in their mid-20s are more likely to have relatives who have panic disorder. When relatives of patients with panic disorder are exposed to high levels of carbon dioxide, they have panic attacks. Another hypothesis is that patients with panic disorder who develop agoraphobia have a more severe form of the disease. Current efforts to identify a gene for panic disorder have not been successful.

PERSONAL VARIABLES. There are several themes in the psychology of panic disorder. Research has shown that patients who develop panic disorder have difficulty with anger. They also have difficulty when their job responsibilities are increased (as in the case of a promotion), and are sensitive to loss and separation. People with this disorder often have difficulty getting along with their parents, whom they see as controlling, critical, and demanding, causing the patients to feel inadequate. Early maternal separation is thought to be an underlying cause of panic disorder.

Panic disorder patients also have a pattern of dependency in their interpersonal relationships. As children, people with panic disorder relied on parents to protect them from fear. As a result, they develop an angry dependence on their parents and fear detaching from them. They constantly feel as though they are trapped.

There is also an association between sexual abuse and patients who have panic attacks. Sixty percent of female patients with panic disorder were sexually abused as children. This explains their difficulty with developing trusting relationships.

Symptoms a

PANIC ATTACK SYMPTOMS. The DSM-IV-TR lists " thirteen symptoms to meet the criteria for a diagnosis of s panic attack. The affected person must have four or more d of these symptoms within ten minutes of the beginning of r an attack in order to meet the panic attack criteria:

• bounding or pounding heartbeat or fast heart rate

• shortness of breath

• feeling of choking

• pains in the chest; many people they feel as though they are having a heart attack

• nausea or stomach ache

• feeling dizzy or lightheaded as if he or she is going to pass out

• feeling of being outside of one's body or being detached from reality

• fear that he or she is out of control or crazy

• feeling of tingling or numbness

• chills or hot flashes

Symptoms of panic disorder without agoraphobia

The DSM-IV-TR criteria for panic disorder without agoraphobia include:

• recurrent panic attacks (see above) that occur without warning for one month

• persistent worry that panic attacks will recur

• possible change in behavior because of that fear

• no agoraphobia

• not due to a medical condition or substance abuse

• not due other mental illness like specific phobia, social phobia, obsessive-compulsive disorder, separation anxiety disorder, or post-traumatic stress disorder

Symptoms of panic disorder with agoraphobia

The DSM-IV-TR criteria for panic disorder with agoraphobia are the same as above, but agoraphobia is present. The symptoms of agoraphobia include fear of being in situations that can trigger panic attacks, and avoiding places where attacks have occurred because of the affected person's fear that he or she will not be able to leave, or will not be able to get help. People with this condition may need to have another person accompany them when going to a place that may trigger anxiety attacks.

<u Sometimes this fear can be so severe that the person "I becomes housebound. This fact is important to consider ™ because 15% of the general population can have one spontaneous panic attack without the recurrence of re symptoms.

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