Panic disorder

Also called Panic attacks

Attacks of overwhelming physical fear, and then the fear of the next one. The second part is the disorder.

What it is

A panic attack is a surge of intense fear with a full physical alarm response: pounding heart, breathlessness, chest tightness, dizziness, tingling, and a conviction that you are dying or losing your mind. It peaks within about ten minutes.

It is not dangerous, which is a sentence people need to hear from somebody they trust rather than read on a leaflet.

Panic disorder is different from having a panic attack. It is when the fear of the next attack starts shaping behaviour: avoiding places, monitoring the body constantly, and living in anticipation. That anticipation is what turns a frightening event into a condition, and it is why agoraphobia so often follows.

Signs you might notice

Sudden attacks with a clear physical peak, often out of the blue.

Chest pain and palpitations that lead to A and E attendances with normal results.

Constant body scanning for early signs.

Places and situations quietly dropped from the routine.

Carrying water, tablets or a phone as a talisman, and feeling unable to leave without them.

How it can affect day-to-day life

A great many people have had a full cardiac workup before anybody says the word panic. That is not a waste, since chest pain must be taken seriously, but the way the reassurance is delivered matters enormously and is often perfunctory.

The safety behaviours are what maintain it: sitting near the door, having someone with you, carrying the diazepam you never take. Each one relieves anxiety and teaches the brain that the situation was genuinely dangerous.

Left alone, the world contracts.

Supporting someone well

Do not rescue. Staying with somebody through an attack is different from taking them home, and taking them home teaches avoidance.

Breathe out longer than in. Slow, low breathing for a few minutes shifts the physiology genuinely, and it beats a paper bag, which is outdated advice.

Name what is happening. "This is a panic attack. It will peak and pass. Nothing bad is going to happen." Calm, factual, repeated.

Afterwards, go back. Returning to the place where it happened, soon, prevents the association hardening.

Drop the safety behaviours deliberately, one at a time, as part of a plan.

Fiducia Life has a Calm Room and a feelings record, which together give somebody a rehearsed thing to do rather than a scramble, and evidence afterwards that the attacks are getting shorter.

Where to get help

In England, self-refer to NHS Talking Therapies. CBT for panic is highly effective and usually brief.

See a GP once to be checked, and then treat repeat A and E attendances as a sign the anxiety needs treating rather than more tests.

First-ever chest pain should always be assessed properly. After that, the plan should be about panic.