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Unformatted text preview: palpitations
of the heart, tingling in the hands or feet, shortness of breath, sweating, hot and cold
flashes, trembling, chest pains, choking sensations, faintness, dizziness, and a feeling of
unreality. Small wonder that during a panic attack many people fear they will die, go
crazy, or lose control. I was inside a very busy shopping precinct and all of a sudden it happened: in a matter
of seconds I was like a mad woman. It was like a nightmare, only I was awake; everything
went black and sweat poured out of me—my body, my hands and even my hair got wet
through. All the blood seemed to drain out of me; I went as white as a ghost. I felt as if I
were going to collapse; it was as if I had no control over my limbs; my back and legs were
very weak and I felt as though it were impossible to move. It was as if I had been taken
over by some stronger force. I saw all the people looking at me—just faces, no bodies,
all merged into one. My heart started pounding in my head and in my ears; I thought my
heart was going to stop. I could see black and yellow lights. I could hear the voices of the
people but from a long way off. I could not think of anything except the way I was feeling
and that now I had to get out and run quickly or I would die. I must escape and get into
the fresh air.
(Hawkrigg, 1975) More than one-quarter of all people have one or more panic attacks at some point
in their lives (Kessler et al., 2006). Some people, however, have panic attacks repeatedly
and unexpectedly and without apparent reason. They may be suffering from panic
disorder. In addition to the panic attacks, people who are diagnosed with panic disorder experience dysfunctional changes in their thinking or behavior as a result of the attacks (see Table 4-8). They may, for example, worry persistently about having additional
attacks, have concerns about what such attacks mean (“Am I losing my mind?”), or plan
their lives around the possibility of future attacks.
Panic disorder is often accompanied by agoraphobia, one of the three categories
of phobia mentioned earlier. People with agoraphobia are afraid to leave the house and
travel to public places or other locations where escape might be difficult or help unavailable should panic symptoms develop. In severe cases, people become virtual prisoners in
their own homes. Their social life dwindles, and they cannot hold a job.
Until recently, clinicians failed to recognize the close link between agoraphobia and
panic attacks. They now realize that panic attacks, or at least some panic-like symptoms,
typically set the stage for agoraphobia: After experiencing one or more unpredictable
attacks, certain individuals become fearful of having new attacks in public places where
help or escape might be difficult.
Not everyone with panic disorder develops agoraphobia, but many such persons do.
Thus DSM-IV-TR distinguishes panic disorder without agoraphobia from panic disorder with
agoraphobia. Around 2.8 percent of all people in the United States suffer from one or
the other of these patterns in a given year; close to 5 percent develop one of the patterns...
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