This article is the fifth in a series about anxiety.
Q: What are some other anxiety disorders?
A: According to the American Psychiatric Association, 2 percent to 3 percent of the adult population in any given year in the United States have panic disorders. Women are more apt than men to have anxiety disorders.
The following information is from the University of Maryland Medical Center. Predisposing factors for panic disorders are that panic disorders first appear either in late adolescence or in adults in their mid-30s. Women have twice the risk as men have for panic disorders. Panic attacks are common after menopause. With pregnancies, the effects of panic attacks appear mixed. Sometimes panic disorders improve during pregnancies, and other times, panic disorders worsen during pregnancies.
By definition, panic disorder is a period of intense anxiety or terror called a panic attack. Panic attacks usually last 15 to 30 minutes. Panic attacks can occur in other anxiety disorders. There always is a trigger for a panic attack.
A diagnosis of panic disorder necessitates the following two conditions:
• Someone experiences at least two recurrent, unexpected panic attacks.
• For at least one month following the attacks, the person fears another one will occur.
Symptoms of panic attacks include four or more of the following symptoms during which the person feels intensely:
• Rapid heart beat.
• Shortness of breath.
• Choking or a feeling of being smothered.
• Feelings of unreality.
• Hot flashes or chills.
• Chest pain.
• Fear of dying.
• Fear of going insane.
Women seem to be more likely than men to have shortness of breath, nausea and feelings of being smothered. Men seem more apt than women to experience sweating and abdominal pain.
Limited-symptom panic attacks have only one or two symptoms, such as heart pounding and dizziness. The limited-symptom attacks follow large panic attacks or are precursors to full-scale panic attacks. The patterns of occurrence vary widely with panic attacks. Some people have frequent panic attacks, such as every week, patterns that can last for months. Other people might have daily clusters of panic attacks and then weeks or months of remission.
Triggers for panic attacks vary. Attacks can occur spontaneously or as a response to a particular situation. Re-experiencing or remembering even harmless circumstances that accompanied a previous attack might trigger subsequent panic attacks. As many as 50 percent of people with panic disorders have close relatives with panic disorders. Panic disorders are associated with increased risks for suicidal thoughts. If someone has both an anxiety disorder and a mood disorder, such as depression, the risk for suicide is greater. Both anxiety and depression contribute to a poorer outcome in the treatment of heart patients, including heart surgery.
Another category of anxiety disorder is called Post-Traumatic Stress Disorder. It is a severe, persistent emotional response to a traumatic event that severely interferes in one's life. PTSD is classified as an anxiety disorder because of the symptoms.
Not every traumatic event results in PTSD. There are two criteria necessary for a diagnosis of PTSD:
• The person must have directly experienced, witnessed or learned of a life-threatening or serious, injurious event.
• The person's response is intense fear, helplessness, or horror.
• Children may have agitated or disorganized behavior.
PTSD is triggered by violent or traumatic events usually outside the normal realm of human experience. War, murder or rape are examples. The most likely triggers are deliberate, destructive acts and those that are prolonged or physically challenging. More events beyond those already mentioned include witnessing sexual attacks, accidents, natural disasters or the unexpected deaths of loved ones.
PTSD also can occur in those people with serious illnesses who receive aggressive treatments and in those persons who have close family members or friends with such circumstances. Symptoms of PTSD can begin immediately after an event or develop up to a year afterward. There are three basic groups of symptoms with PTSD: First is the group of symptoms called re-experiencing. Persons re-experience the trauma in at least one of the following ways: recurrent images, thoughts, flashbacks, dreams or feelings of distress with situations that remind them of the traumatic event. Children might act out the traumatic events repeatedly in play.
Avoidance is the next category of symptoms. People usually avoid reminders of the events, such as thoughts, persons or any other factor that triggers recollection. Persons who avoid reminders tend toward emotional numbness, a sense of being in a daze or losing touch with their identity or external reality. They might not remember important aspects of the traumatic event.
The third group of symptoms is called increased arousal. Symptoms include a heightened awareness of danger that include sleeplessness, irritability, being startled easily or becoming overly vigilant to unknown dangers. To qualify for a diagnosis of PTSD, persons must have at least one symptom of re-experiencing, three avoidance symptoms and two arousal symptoms.
Acute Stress Disorder is a syndrome in which symptoms of PTSD appear from two days to four weeks after the event. Most persons with Acute Stress Disorder progress to PTSD. The long-term impact of PTSD is uncertain.
• Next week's article will continue discussing anxiety disorders.
Judy Caprez is professor emeritus at Fort Hays State University.