Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds. You sweat. You feel like you can’t breathe or think clearly. Do these attacks occur at unpredictable times with no apparent trigger, causing you to worry about the possibility of having another one at any time?

An untreated panic disorder can affect your quality of life and lead to difficulties at work or school. The good news is panic disorder is treatable. Learn more about the symptoms of panic disorder and how to find help.

What is panic disorder?

People with panic disorder have frequent and unexpected panic attacks. These attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control, even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

Panic attacks often include physical symptoms that might feel like a heart attack, such as trembling, tingling, or rapid heart rate. Panic attacks can occur at any time. Many people with panic disorder worry about the possibility of having another attack and may significantly change their life to avoid having another attack. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Panic disorder often begins in the late teens or early adulthood. Women are more likely than men to develop panic disorder.

What are the signs and symptoms of panic disorder?

It is common to experience a panic attack sometime in your life. However, it may become more and turn into a mental disorder. In this case, the core symptom of panic disorder is:

• Sudden and repeated panic attacks of overwhelming anxiety and fear
• A feeling of being out of control, or a fear of death or impending doom during a panic attack
• An intense worry about when the next panic attack will happen
• A fear or avoidance of places where panic attacks have occurred in the past

During panic attacks several of these symptoms can occur in combination:

• Palpitations, pounding heart or rapid heart rate
• Sweating
• Trembling or shaking
• Feeling of shortness of breath or smothering sensations
• Chest pain
• Feeling dizzy, light-headed, or faint
• Feeling of choking
• Numbness or tingling
• Chills or hot flashes
• Nausea or abdominal pains
• Feeling detached
• Fear of losing control
• Fear of dying

Because symptoms can be so severe, many people who experience a panic attack may believe they’re having a heart attack or other life-threatening illness. They may go to a hospital emergency room. Panic attacks may occur with other mental disorders such as depression or PTSD.

What causes panic disorder?

Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain and certain biological processes may play a crucial role in fear and anxiety. Some researchers think panic attacks are like “false alarms” where our body’s typical survival instincts are active either too often, too strongly, or some combination of the two.

For example, someone with panic disorder might feel their heart pounding and assume they’re having a heart attack. This may lead to a vicious cycle, causing a person to experience panic attacks seemingly out of the blue, the central feature of panic disorder. Researchers are studying how the brain and body interact in people with panic disorder to create more specialized treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is panic disorder treated?

If you’re experiencing symptoms of panic disorder, talk to your Health Guardian, or a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker, or suggest herbal teas to help reduce anxiety and relax. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Panic disorder is generally treated with psychotherapy (sometimes called “talk therapy”), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat panic disorder. CBT teaches you different ways of thinking, behaving, and reacting to the feelings that happen during or before a panic attack. The attacks can become less frequent once you learn to react differently to the physical sensations of anxiety and fear during a panic attack.

Exposure therapy is a common CBT method that focuses on confronting the fears and beliefs associated with panic disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises, and herbal infusions.

How can I support myself and others with panic disorder? 

Educate Yourself

A good way to help yourself or a loved one who may be struggling with panic attacks or panic disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing panic disorder symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think that a friend or family member may be struggling with panic disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as at school, at work, or with friends and family—it’s time to seek professional help. Talk to a health care provider about your mental health.

Collaboration is a skill in great demand. New couples learn to consider the needs of others, sometimes for the first time in their lives. Sports teams learn special words that aid in quick communication, but not necessarily collaboration. Collaboration requires two-way communication, a discussion of shared meanings, with more listening then talking, shared inspirational visions, and shared decisions. Notice just how much sharing is going on between all participants. In the eight elements of teamwork required in high-performance teams, a collaborative environment is essential.

In the collaborative medicine approach, collaboration is also important. One of the roadblocks preventing effective collaboration between team members is anxiety. We all experience fear, anxiety, or discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions at some point. This anxiety normally can be addressed, and members move on as they learn they can trust each other. But in some cases, this is more difficult.

This anxiety only becomes a disorder when we try to avoid the situation or endure it with great effort. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public, and trying to collaborate with strangers we’re intimidated by. We might feel we’ll be unfairly judged. When the fear or anxiety causes problems with daily functioning and lasts at least six months it’s thought of as a social anxiety disorder and might need to be addressed by special treatment.

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. In a collaborative medicine environment, it can even impact our medical treatment. The good news is social anxiety disorder is treatable. We all should learn more about the symptoms of social anxiety disorder and how to find help.

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class or on a team, or even having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, also may cause anxiety or fear due to concerns about being humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so intense that they feel it is beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things. Other people may be able to accomplish these activities but experience a great deal of fear or anxiety when they do. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment.

Some people with this disorder do not have anxiety related to social interactions but have it during performances instead. They feel symptoms of anxiety in situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage.

Social anxiety disorder usually starts during late childhood and may resemble extreme shyness or avoidance of situations or social interactions. It occurs more frequently in females than in males, and this gender difference is more pronounced in adolescents and young adults. Without treatment, social anxiety disorder can last for many years, or even a lifetime.

What are the signs and symptoms of social anxiety disorder?

 When having to perform in front of or be around others, people with social anxiety disorder may:

• Blush, sweat, or tremble.
• Have a rapid heart rate.
• Feel their “mind going blank,” or feel sick to their stomach.
• Have a rigid body posture or speak with an overly soft voice.
• Find it difficult to make eye contact, be around people they don’t know, or talk to people in social situations, even when they want to.
• Feel self-consciousness or fear that people will judge them negatively.
• Avoid places where there are other people.

What causes social anxiety disorder?

Risk for social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety and that genetics influences how these areas function. By studying how the brain and body interact in people with social anxiety disorder, researchers may be able to create more targeted treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in this disorder.

How can I support myself and others with social anxiety disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think that a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support. Relationships of trust are critical here, and if you’re experiencing a social anxiety disorder, this may prove to be difficult.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as avoiding social situations at school, at work, or with friends and family—it’s time to seek professional help. Talk to your Health Guardian, or another health care provider about your mental health.

The information in this article should help reduce common stress and anxiety sometimes experienced by the Health Guardian, and help you discover what can be done to cope.

Is it stress or anxiety?

Life can be stressful—you may feel stressed about performance at school, traumatic events such as a pandemic, a natural disaster, or an act of violence, or a life change. Everyone feels stress from time to time.

What is stress? Stress is the physical or mental response to an external cause, such as having a lot of homework, caring for a loved one with COVID, or having an illness yourself. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time.

What is anxiety? Anxiety is your body's reaction to stress and can occur even if there is no current threat.

If that anxiety doesn’t go away and begins to interfere with your life, it could affect your health. You could experience problems with sleeping, or with your immune, digestive, cardiovascular, and reproductive systems. You also may be at higher risk for developing a mental illness such as an anxiety disorder or depression.

The Health Guardian needs to be familiar with the differences between common stress and anxiety, and know when stress becomes an issue needing professional help to address.

So, how do you know when to seek help? 

Stress vs. Anxiety 

It’s important to manage your stress.

Everyone experiences stress, and sometimes that stress can feel overwhelming. You may be at risk for an anxiety disorder if it feels like you can’t manage the stress and if the symptoms of your stress:

• Interfere with your everyday life.
• Cause you to avoid doing things.
• Seem to be always present.

Coping With Stress and Anxiety

Learning what causes or triggers your stress and what coping techniques work for you can help reduce your anxiety and improve your daily life. It may take trial and error to discover what works best for you. Here are some activities you can try when you start to feel overwhelmed:

• Keep a journal.
• Download an app that provides relaxation exercises (such as deep breathing or visualization) or tips for practicing mindfulness, which is a psychological process of actively paying attention to the present moment.
• Exercise, and make sure you are eating healthy, regular meals.
• Stick to a sleep routine, and make sure you are getting enough sleep.
• Avoid drinking excess caffeine such as soft drinks or coffee.
• Identify and challenge your negative and unhelpful thoughts.
• Reach out to your friends or family members who help you cope in a positive way.

Recognize When You Need More Help

If someone you know is struggling to cope, or the symptoms of the stress or anxiety won’t go away, it may be time to talk to a professional. Psychotherapy (also called “talk therapy”) and medication are the two main treatments for anxiety, and many people benefit from a combination of the two.

Stress management is one of the eight practices of Mental Health and is a concern of every Health Guardian. Pathology prevention activities, addressing fatigue, short-term and long-term illness, trauma, and secondary stressors such as lifestyle and environment, include at least some element of stress reduction. As Health Guardians, we become familiar with these activities, and share with each other our successes and failures. 

For this article we have invited a special guest, Dr. Linda, to discuss anxiety, the impact it has on our health, and to better understand the difference between common anxiety and anxiety disorders. We have all experienced some form of anxiety at one time or another.

PathologyPrevention™ - Dr. Linda has been a guest with us before, so without any further introduction, we’ll turn this topic over to her.

Dr. Linda - Thank you PathologyPrevention™ for this opportunity to discuss what I feel is one of the most important aspects of personal health management, and the control of pathology prevention efforts, which is like washing our hands before we eat. Stress is one of the principle contributing factors to the failure of our immune system, and cause of chronic diseases in the United States. This stress can impact both our physical and mental health, leading to anxiety and all its forms.

Now I know that you folks at PathologyPrevention™ look at mental health using eight or nine separate theories of psychology and encourage considering the combined view of these theories in understanding our mental health. Anxiety, and many other mental health issues are commonly understood using multiple lens, or combined disciplines, such as your psychology theories. 

When I talk about Anxiety, I’m referring to an intense, excessive, and persistent worry and fear about everyday situations. Fast heart rate, rapid breathing, sweating, and feeling tired may occur in these scenarios. When you feel anxious, your body goes on high alert, looking for possible danger and activating your fight or flight responses. As a result, some common symptoms of anxiety include nervousness, restlessness, being tense, or having feelings of danger, panic, or dread. I’m sure most of us have felt this at one time or another.

Anxiety can be normal in stressful situations such as public speaking or taking a test. Anxiety is only an indicator of underlying disease when feelings become excessive, all-consuming, and interfere with daily living. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. But anxiety and anxiety disorders are treatable, and several effective treatments are available. Treatment helps most people lead normal productive lives.

PathologyPrevention™ - Dr Linda, are you saying that all of us should consider some form of treatment, right now, even if we aren’t currently experiencing anxiety disorders?

Dr. Linda - Well, I haven’t thought of it like that before, let’s look at your idea as we continue, and see if it makes since. I’ll point out what each of us can do as a form of pathology prevention when it comes up. As I was just going to say, anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay greater attention.

Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. These disorders refer to anticipation of a future concern and is more associated with muscle tension and avoidance behavior. In contrast, fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

Managing anxiety is an activity that we should all participate in during normal pathology prevention activities. I believe this is what you were suggesting earlier. To help reduce common anxiety, we can practice aerobic exercise, relaxation techniques, drink herbal teas and vegetable juices, get massages and even apply grounding practices, or participate in meaningful discussions with family, friends, pastors, or coaches, which have been shown to help address anxiety.

However, anxiety disorder, which is beyond common anxiety, can cause people to try to avoid situations, even trigger or worsen their symptoms. This is referred to as a negative feedback loop, becoming worse and worse as more effort is attempted to resolve it, and eventually becomes the disorder. Job performance, schoolwork and personal relationships can be affected.

In general, for a person to be diagnosed with an anxiety disorder, meaning the above health management efforts will be in vain, the fear or anxiety must:

• Become out of proportion to the situation or age-inappropriate
• Hinder ability to function normally or
• Health management efforts cause deepening anxiety instead of improving it

There are several types of anxiety disorders, including generalized anxiety disorder, which I’m talking about here, and others such as panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder should be addressed in future interviews.

The causes of anxiety disorder are currently unknown but likely involve a combination of factors including genetic, environmental, psychological, trauma, and developmental. This suggests that anxiety disorder can run in families, a combination of genes and environmental stresses can produce the disorder. In fact, all the psychology theories described by PathologyPrevention™ may jointly contribute to the normal feelings of anxiety and contribute to the growth of a mental health disorder.

The generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.

The first step when considering any mental health issue is to make sure there is no physical problem causing the symptoms. If an anxiety disorder is determined, a mental health professional, or even your Health Guardian can work with you on finding the best treatments. Unfortunately, many people with anxiety disorder don’t seek help. They don’t realize that they have an illness for which there are effective treatments, and this is not something to be embarrassed about or ashamed of.

Supervised stress management techniques and meditation can help people with anxiety disorder, calm themselves, and may enhance the effects of additional therapy. Research suggests that aerobic exercise can help some people manage their anxiety, and even reverse the negative feedback loop.

There are a few things people can do to help cope with symptoms of anxiety disorder and make treatment more effective. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand the condition better can also be helpful. People who are anxious should avoid caffeine, which can worsen symptoms, and should check with their health care professional about any medications that could affect their condition.

PathologyPrevention™ - We at PathologyPrevention™, would like to thank you Dr. Linda, for your time today, and look forward to future discussions about other Mental Health topics.