Panic attack

The Manila Bulletin
August 6, 2006

"Each is liable to panic, which is exactly, the terror of ignorance surrendered to the imagination." -Ralph Waldo Emerson (1803-1882) US essayist and philosopher "Courage," Society and Solitude (1870)

By Dr. Jose Pujalte Jr.

THIS is not about the panic attack of civilians caught in an Army/CAFGU-NPA encounter, or of Filipino OFWs trapped in Beirut condominiums. While the reactions are essentially that of the flight or fight reflex, a genuine psychiatric panic attack has no external and identifiable cause. It’s not because of bullets whizzing by or because of bombs exploding in the horizon.

In a panic attack, a person is terrified for no reason.

Signs and Symptoms. How do you recognize a panic attack? It peaks within 10 minutes and can last from 30 minutes to an hour. Here’s a checklist:

* Tachycardia (or rapid heart rate)
* Chest pain
* Uncontrollable trembling
* Profuse sweating
* Rapid breathing or shortness of breath
* dizziness
* abdominal cramping
* nausea
* tightness in the throat
* a sense of impending doom

Causes. Why does a panic attack occur? What are the underlying causes? Apparently, it can run in families. Substance abuse – drugs or alcohol – is also a factor in the development of a panic attack. Brain (organic) abnormalities have been implicated. Finally, a major life stress like the death of a loved one or getting fired can trigger a panic attack.

Diagnosis. It is quite possible that a panic attack has an entirely physical origin like uncontrolled hypertension, an overactive thyroid (hyperthyroidism), or angina (chest pain usually associated with an impending heart attack). Therefore it makes sense to see your favorite family doctor first and get a thorough physical examination and some baseline lab tests and blood chems. If no physical causes can be isolated, then the next step is consulting mental health professionals (psychiatrists or psychologists). They are able to diagnose a panic disorder partly from interviews and assessment tools.

Treatment. Getting better is not just a matter of hanging around with supportive friends to wait for emotional stroking. Loving but misguided relatives are even worse. When a cousin or niece gets a panic attack it doesn’t mean she’s "KSP" (kulang sa pansin) "lacks attention" and is of course play acting. Professionals are needed for mainstays of treatment that include psychotherapy (counseling) and cognitive-behavioral therapy. The latter teaches recognition of, and appropriate response to, panic disorder. The key is consciously changing thought patterns and behaviors to prevent the panic attack. The doctor may also prescribe antidepressants and anti-anxiety pills.

Complications. Relief from panic disorder has been reported to be successful in 90 percent of cases. Compare that to an approach of denial and consequently being unproductive and miserable for it. Without treatment, the person’s condition worsens. Anticipatory anxiety is the helplessness of merely thinking about a panic attack. One needs only to read Albert Camus or Franz Kafka to get a glimpse of such dread and anguish. Untreated patients also resort to avoidance. Activities that are considered stressful and that may lead to a panic attack are naturally avoided by the person. More often than not, this makes work and home life unbearable. A person with panic disorder may also develop agoraphobia or the fear of public places. Again as a natural but extremely cramping adjustment, the person avoids crowds and open spaces where a panic attack means embarrassment.

True panic is indeed a lifesaving reflex against real danger. But it is useless and dysfunctional when no danger exists. Getting better begins by seeking professional help.