Panic Disorder
Barney M. Davis Jr., MD, Godspeed Missionary Care

"...then the king's face grew pale, and his thoughts alarmed him; and his hip joints when slack, and his knees began knocking together...
Dan 5:6, NASB

Everyone has had the experience of a feeling of fear, sometimes in response to a real threat, other times in response to an artificial one such as a frightening movie, or a roller coaster ride. The basic physical reaction is a God-given normal response, meant to provide protection for our system in the event of true danger; the body can react quickly to a true danger by what is commonly known as the "fight or flight" response.

Some people, however, suffer severe attacks of debilitating fear (panic attacks) from either minimal provocation or no obvious provocation: such episodes are the bases for the diagnosis of Panic Disorder. At other times, a person might experience a panic attack which is obviously cued by a particular trigger (like seeing a snake, or having to speak in front of a large group of people); that type of panic attack is considered part of a different diagnostic group, Specific Phobia or Social Phobia.

The Diagnostic and Statistical Manual (Fourth Edition) lists a number of criteria for Panic Disorder: "…a discrete period of intense fear or discomfort, in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes: 1) palpitations (feeling as if one's heart beats irregularly), pounding heart, or accelerated heart rate, 2) sweating, 3) trembling or shaking, 4) sensations of shortness of breath or smothering, 5) feeling of choking, 6) chest pain or discomfort, 7) nausea or abdominal distress, 8) feeling dizzy, unsteady, lightheaded, or faint, 9) feelings of unreality or being detached from oneself, 10) fear of losing control or going crazy, 11) fear of dying, 12) numbness or tingling sensations, and 13) chills or hot flushes."

Panic disorder may or may not be accompanied by agoraphobia; the original Latin word means "fear of the marketplace", but in common use describes "...anxiety about being in places or situations from which escape might be difficult, or help may not be available..." Agoraphobic fears typically involve situations such as being outside the home alone, being in a crowd or standing in a line, or being on a bridge.

It has been estimated that between 1.5 - 3.5% of people will suffer Panic Disorder at some time in their lifetime. Up to 65% of people with Panic Disorder either have already experienced or will experience a Major Depressive Disorder (see prior Missionary Medical Moments: Depression). Panic disorder typically is first seen between late adolescence and the mid-30s.

Panic attacks may occur frequently or infrequently, but the usual course is that after an initial attack, the person begins to avoid any situation which might lead to another attack, so even if there are few attacks, there may be great limitation of life activity. Sufferers often avoid going outdoors, are limited in how far or where they travel, and experience demoralization and discouragement in their inability to "conquer" their fears. Associated anxiety and apprehension about medical illness, medication effects, and the outcome of even routine activities and experiences are common. While a single panic attack may last only minutes, episodes of repeated panic attacks and the associated anticipatory anxiety of further attacks can last for months or even years.

Even with treatment, there is a 50% risk of some ongoing symptoms or recurrence. Recent research has shown that there are particular areas of the brain which appear to exhibit abnormal biochemical responses in panic attacks, suggesting that panic attacks are more of a physical disorder than a strictly psychological one.

Since the symptoms of Panic Disorder can be similar to some general medical illnesses (such as thyroid disease, heart abnormalities, lung diseases, and certain types of seizures), a medical evaluation is necessary to rule out those causes. Treatment for Panic Disorder can be accomplished with either medications or specific types of behavioral and cognitive counseling therapy; often, both may be used.

Medications which have been found effective in the treatment and prevention of panic attacks include some types of tranquilizers; alprazolam (U.S. trade name Xanax, available generically worldwide) has been particularly effective in treating acute attacks, while many of the class of medications known as antidepressants are successful in decreasing the likelihood of further attacks. The newer antidepressants known as SSRIs [selective serotonin reuptake inhibitors; fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), others] as well as an older group of antidepressants known as MAO Inhibitors [tranylcypramine (Parnate) and phenelzine (Nardil), others] are particularly effective in the long term management of Panic Disorder.

The author of Proverbs accurately notes, "…anxiety in the heart of a man weighs it down, but a good word makes it glad." (Pr 12:25). Often, missionaries and pastors with panic attacks suffer needlessly by trying to conceal their symptoms rather than seeking counsel and assurance from others. And as with all other types of problems, God directs us to go to Him and trust Him to provide peace even in the midst of discomfort: "…when my anxious thoughts multiply within me, Thy consolations delight my soul." (Ps 94:19).

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