Panic disorder

Panic disorder is one of the six anxiety disorders proposed by the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders,4th edition, Text Revision. The other five include Phobia, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Post-Traumatic Stress Disorder and Acute Stress Disorder. The panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror ,often associated with feelings of impending doom.  

Symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present during these attacks. Panic Disorders can occur in the context of any Anxiety Disorder as well as other mental disorders The essential feature of Panic Disorder is the presence of recurrent, unexpected panic. The individual shows persistent concern about having another attack for at least one month. The person with disorder worries about the consequences of the attacks, or a significant behavioral change related to the attacks. These attacks are not due to the direct psychological effects of a substance or drug or a general medical condition.  

There are three characteristics types of Panic Attacks. i) Un-cued ii) Cued, iii) Situation-ally predisposed. Uncued or Unexpected Panic Attacks are those for which the individual does not associate onset with an internal or external situational trigger. Situationally bound or Cued Panic Attacks are defined as those that almost invariably occur immediately on exposure to, or in anticipation of, the situational cue or trigger e.g a person with Social Phobia having a Panic Attack upon entering into party or a gathering of friends. Situation-ally predisposed attacks are similar to Cued Panic Attacks but are not invariably associated with the cue and do not necessarily occur immediately after the exposure e.g attacks are more likely to occur during driving but there are times when the individual drives and does not have an attack or times when attack occurs after driving for half an hour. The frequency and severity of the panic attack may vary widely.  

For instance, some people have moderately frequent attacks (e.g once a week) that occur regularly for months at a time. Others report short bursts of more frequent attacks that is daily for a week separated by weeks or months without any attacks or with less frequent attacks over many years. There are various therapies to control these Panic Attacks. One of which is developed by David H. Barlow, an American Clinical Psychologist at Boston University. He referred to this well-validated therapy as PCT (Panic Control Therapy),which include relaxation training, Cognitive and Behavioral interventions and exposure to the internal cues that trigger panic as it’s principle components. 


Islamabad, November 25. 


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