Panic disorder

Panic disorder is a condition characterized by sudden, unpredictable panic attacks that may cause feelings of impending death or doom, and heart attack-like symptoms.  During a panic attack your child might experience palpitations, an acute shortness of breath, and an intense urge to flee the situation, to do something to make it stop. The condition is very rare in childhood, but often manifests in adolescence, when a teenager might make repeated trips to doctors and the emergency room before the psychiatric disorder is diagnosed. Attacks can happen at any time and may be triggered by a variety of cues; a key feature of panic disorder is that fear of an attack can trigger a fresh one.  For this reason, many kids with panic disorder avoid the locations of previous episodes and other places where help would not be available or escape would be difficult—ie enclosed or crowded places.  Cars, tunnels, bridges, and subways can all be worrying to a child with panic disorder. Some kids with the disorder will avoid leaving the house alone; extreme cases may even become housebound.

Panic disorder is characterized by the episodic occurrence of unexpected panic attacks. These events are extremely stressful and frightening both for the person having the attack and those watching it happen. Should your child experience these events, she may describe heart attack-like symptoms, a sudden and overwhelming fear of death or losing control, a feeling that the world is unreal, and an intense desire to flee, as well as physical symptoms such as dizziness, nausea, sweating, and shortness of breath, among others.  After an attack, which usually peaks within 10 minutes, children may be left with an intense fear of another attack.  

Though the exact cause of panic disorder is not known, studies show that biological, genetic and social factors may contribute to its onset. One theory suggests that panic attacks are caused by an imbalance of serotonin, norephinephrine and dopamine—neurotransmitters (or “chemical messengers”) that help, among other things, to regulate feelings of anxiety and galvanize the fight-or-flight response.  Studies also show that the stress which accompanies major life changes, such as divorce or the death of a loved one, can affect one’s susceptibility to panic disorder. Though heredity offers no more reliable an explanation than chemical imbalance or trauma, studies that explore the genetics of panic disorder have yielded important results: The first-degree biological relatives of people with panic disorder are 4 to 7 times more likely to develop panic disorder, while children of parents with panic disorder are up to 8 times more likely to suffer from it as well.

A diagnosis of panic disorder often occurs only after medical explanations for signs and symptoms, as well as other psychiatric disorders—including OCD and PTSD—are exhausted. A professional will diagnose your child with panic disorder if attacks are recurrent, and unexpected, and if one attack is followed in the ensuing months by other signs including: a preoccupation with the possibility of further attacks; fear of the effects of an attack, including the feeling of having a heart attack or “going crazy;” and a considerable change from normal behavior following the attack or attacks.

Treatment for panic disorder is often very successful and usually consists of a pharmacological and psychotherapeutic component.

 

Psychotherapy:  Your child’s clinician will likely start cognitive behavioral therapy to begin reducing negative, avoidance-based behavior patterns. Another common form of treatment is exposure therapy, which counteracts anticipatory anxiety through gradual exposure to situations that are associated with attacks.

 

Pharmacological: Various classes of drugs may be prescribed to treat the effects of panic attacks, starting with antidepressants, which have proven effective. The next step might be a benzodiazepine(Xanax, among others). Though these drugs carry a risk of dependence, a clinician notes that it is rare in children if the course is correctly monitored.

People with panic disorder are also at risk for substance abuse, as well as depression.

Will my child grow out of it?
Many people will have a single panic attack at some point in their life and never have another. But if the attacks continue, developing into panic disorder, they are more likely to become more frequent, and the child’s movements and activities to become more restricted as a result. Panic disorder does not get worse before it gets better—it just gets worse.
Is it dangerous?
Panic attacks themselves are not dangerous or life threatening, though they might feel that way to a child, and fear of them can severely affect her quality of life. The attacks are simply the body’s natural fight or flight response triggered at an inappropriate time. Attacks differ from other panic reactions since there is no sudden rise of stress hormones.
Do drugs help?
Yes. Some antidepressants also have anti-anxiety properties, and can be used to eliminate the reoccurrence of attacks. Many cases can be treated with medication and support. Sedatives in the benzodiazepene family work very quickly to counter symptoms of a panic attack, though they are more habit-forming than other drugs. Often, just having a pill available helps a person deal with her anxiety.
What causes it?
Experts are unsure about the root causes of panic disorder—there may be a genetic component, but stress and life changes have also been implicated in the onset of the disorder.