Panic disorder patients aren't fainthearted

Panic disorder patients experience sudden and extreme fear in safe circumstances, which come with symptoms such as an increase in heartbeat, blood pressure and respiration, along with feelings of suffocation, chest pain, and dizziness. / Korea Times files

By Yoon Ja-young

There is increasing awareness of panic disorder these days, following confessions by a number of celebrities that they have suffered from symptoms.

However, some people still think that patients suffer from the condition because they are feeble-minded.

However, Prof. Yu Bum-hee at Samsung Medical Center in southern Seoul says that patients shouldn’t be blamed because the attacks are caused by problems in the brain circuitry.

In a lecture on panic attacks, the psychiatrist said that one must first learn about anxiety disorder in order to understand panic disorder.

Everybody gets anxious when stressed, and this anxiety is accompanied by physical symptoms. “Anybody can experience normal anxiety. It even helps our daily lives because it protects us by making us more alert and prepares us when facing danger,” said Prof. Yu.

In pathological anxiety, however, the state becomes overwhelming and sometimes those affected get anxious even when they aren’t in danger at all.

“It’s normal to feel anxious when you are standing on a cliff. You become cautious. But what if you have the same feeling while sitting on a couch watching TV at home? It will seriously affect your daily life,” he said.

Edvard Munch created “The Scream” inspired by a panic attack he suffered. / Korea Times files

Anxiety can cause psychological symptoms such as fear, worry, uneasiness, irritation, fright and sleep disorders.

It will also incur diverse physical symptoms — tense muscles, pain, tremors, perspiration, a fast heart beat, stifling, breathlessness, parched mouth, diarrhea, frequent urination, loss of sexual desire, dizziness and numbness. Most anxiety disorder patients head to emergency rooms for diverse examinations.

“When these symptoms occur, many people go to hospitals, wondering whether they have heart or nervous problems. However, physical checkups won’t reveal any problems. Some of them would thus wander from hospital to hospital,” he said. “They have such physical symptoms because of anxiety, but they mistake them for a physical problem.”

For instance, digestive problems are common in generalized anxiety disorder patients. “Thus they often go to internal medicine clinics. As they turn out to have no internal problems, doctors prescribe tranquilizers. Then they get better. They get better not with digestive pills but with tranquilizers.”

Anxiety disorder is common. According to Prof. Yu, one in 14 adults suffers from it, while one in 25 suffers from depression.

There are various kinds of pathological anxiety, and panic disorder is one of them — people are normal in ordinary times, but suddenly get extremely anxious for a while.

Sudden fear in safe circumstances

“Panic refers to a sudden feeling of fear in circumstances when your life is threatened, such as facing down a robber with a gun. In panic disorder, you experience fear in non-fearful circumstances, due to problems in the activation of the fear circuit in the brain or the alert system in our body,” the doctor said.

In panic disorders, the autonomic nervous system has problems — the sympathetic nerves, which enable the body to cope with danger, are highly activated, while the parasympathetic nerves, which balance this out so that we can return to a normal state, lose their function.

Consequently, patients experience symptoms of extreme excitement, such as an increase in heartbeats and blood pressure, increasing breath, feelings of suffocation, chest pains, dizziness, tension, tremors, etc.

Such unexpected panic attacks occur repeatedly. “The extreme fear and pain reach maximum levels within a few minutes, and people get better in an hour or two. Most commonly, they rush to the emergency room thinking they are having a heart attack or a stroke, but after a couple of hours the symptoms disappear.”

“After this process is repeated a few times, even the family comes to disregard it. However, it is so torturous for the patients each time,” Prof. Yu said.

It occurs to around 15 to 50 people out of every 1,000. It is most common in those aged between 20 and 40, and is two or three times more common in women than men. Those with a family history have 10 times the incidence rate.

Don’t blame patients

Simply put, panic disorder is caused by problems in the brain, so you shouldn’t condemn patients as weak-minded, the doctor said.

“There is a fear circuit in your brain, which senses the fear. When you experience panic attacks, this circuit is activated much more intensely than other times when people feel fearful. It leads to abnormal physical responses,” the professor explained.

There also is an alert system called locus ceruleus in our body, and this system is too easily activated in panic disorder patients. Problems in the alert system of the brain, which determines how much we should breathe by detecting levels of oxygen and carbon-dioxide, can also cause panic attacks — because it wrongly judges that the brain lacks oxygen and the patient hyperventilates.

As too much oxygen enters our body, the concentration of oxygen rises, causing irregularities in the nerves. “Many come to emergency rooms because they are hyperventilating. Breathing into a paper bag is one form of treatment,” said the doctor.

As a result of panic disorders, patients avoid going out, which leads to other problems such as depression, agoraphobia, and further anxiety. “They try to avoid driving, public transportation, waiting in line, crowded areas, long distance travel and saunas,” he explained.

Treatment

As the doctor pointed out, patients often wander from hospital to hospital, not knowing what is causing the symptoms.

“It’s been only around 30 years since this disease was officially recognized. Some doctors at other departments may not know about it. Recently, however, thanks to increasing media coverage, more doctors are aware and they send patients to psychiatrists,” he said.

Around 60 percent of patients are cured, but this falls to 40 percent for patients with agoraphobia, according to the doctor.

There are pharmaceutical treatments and psychological treatments. “Generally you get better in two or three weeks, or one or two months after taking medicine. However, it often reoccurs when you stop taking medication. It generally needs over a year’s treatment,” the doctor said.

Prof. Yu warned against alcohol and caffeine as they worsen the symptoms. Medicines stimulating central nerves, such as some medication for coughs, are also banned.

“Panic disorder can affect anybody in this stressful and overworked society. If left untreated, it can cause chronic problems, but it is a disease that can be treated. It is a neural problem and has nothing to do with feeble-mindedness. You need long-term treatment by a psychiatrist to get fully cured,” he said.