We live in a world where mental health awareness is steadily on the rise. Part of this awareness is knowing when and when not to use mental health terminology.
Many of us have a habit of misusing terms for mental illness to explain situations or experiences. For example, experiencing a stressful situation and labelling it as ‘having a panic attack’. It is hard enough for someone to experience the debilitating terror and distress of a panic attack, but it gets worse when the term is heard casually in conversation or as a joke.
While there is usually no harm intended in the careless use of these terms, it can create misconceptions about what it is truly like to experience these mental illnesses. When we use mental health terminology without educating ourselves, we run the risk of trivialising conditions that can be life-changing or even life-endangering for people.
Furthermore, the misuse of mental health terms makes it harder for those with who are actually dealing with a clinical diagnosis, like a panic attack, to speak out about their experiences and be heard. Hearing their very real experiences being trivialised in conversation or used as a catchphrase can force people with mental illnesses into silence. Thus, it can perpetuate the already highly prevalent stigma surrounding mental illness.
So how do we become more sensitive in our use of mental health terminology, specifically terms like ‘panic attack’ or ‘panic disorder’?
The first step is to educate ourselves about it. So let’s take a minute to understand what panic attack and panic disorder mean, their diagnosis as well as a little bit about what leads to them and how they are usually treated.
Panic disorder is part of a larger group of mental health conditions called anxiety disorders. So before we jump into understanding panic attacks and panic disorder more specifically, let’s look at differentiating between normal fear or anxiety and an anxiety disorder.
Anxiety and fear are common emotional reactions that most of us experience. Anxiety is future-focused and makes one alert and prepared. Fear acts as a signal for danger and prepares the body to respond to it. This fear response is often termed the ‘fight/flight response’. Anxiety disorders are diagnosed when this response becomes disproportionate to the situation and has a harmful effect on a person’s day-to-day functioning.
Now that we have clarified this, we are in a good place to start looking at panic attacks and panic disorder more specifically.
What are panic attacks?
A panic attack involves a sudden surge of fear and discomfort that usually reaches its peak within 10 minutes. Panic attacks can be a one time-occurrence, but usually they happen repeatedly.
The experience of a panic attack can vary from person to person. However, there are some physical, cognitive and emotional symptoms that are common to panic attacks. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is a widely used classification system that helps mental health professionals diagnose mental illnesses. According to the DSM 5 four or more of the following symptoms need to be present in order to diagnose a panic attack:
1. Palpitations, pounding heart, or accelerated heart rate.
2 . Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6 . Chest pain or discomfort.
7. Nausea or abdominal distress.
8 . Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of external environment not being real) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy.”
13. Fear of dying.
It is important to note that panic attacks can occur as a part of panic disorder but they are not specific to it. They can occur as a part of other anxiety disorders as well as other mental illnesses like depression, substance-related disorders, psychotic disorders, PTSD as well as some medical conditions such as cardiac, respiratory and gastrointestinal conditions. Panic attacks can be an important indicator of the severity of these disorders. Thus, panic attacks are a specific type of fear response; they don’t qualify as a mental disorder.
Many people may seek medical support after having a panic attack because its symptoms may be confused for a heart attack. After medical tests however, there are no medical issues that are identified. However, it is necessary to rule out medical disorders before diagnosing a panic attack.
There are two types of panic attacks: Expected and Unexpected. Expected panic attacks are predictable, occurring in situations that the individual is afraid of, which may happen in the case of phobias. Unexpected panic attacks occur suddenly without warning in situations where there is no apparent reason for the attack. In the latter case, it may even happen when a person is relaxed or when they are asleep. Panic disorder is characterised by these unexpected panic attacks.
Panic attacks are different from other anxiety reactions as they tend to be more intense and episodic. They can last from anywhere between 5 to 20 minutes. In severe cases panic attacks may last up to one hour.
Due to the unpredictable nature of panic attacks they do tend to affect how an individual copes with everyday situations like traveling to work or going to crowded places. Sometimes panic attacks can lead to severe avoidance behaviours like not wanting to leave the house for fear of having a panic attack in public.
What is Panic Disorder?
Panic Disorder is an anxiety disorder involving recurrent and unexpected panic attacks along with a persistent fear of having another attack. The DSM 5 also specifies that the panic attack symptoms are present for 1 month or more. Additionally, it involves certain changes in the person’s behaviour and day to day functioning (e.g. avoiding unfamiliar situations).
As mentioned panic attacks can occur in the context of other disorders so it is important to rule out other mental health disorders as well as medical conditions that could explain the symptoms.
How common is a panic attack or panic disorder?
Panic attacks are a lot more common than panic disorder. Panic Disorder occurs in 2-3% of the population. It appears to be more common among young adults between the ages of 20-24. Additionally, females seem to be more prone to panic attacks and panic disorder than males.
What can contribute to a panic attack and panic disorder?
No one is born with a panic disorder nor is it an entirely learnt fear response. The Biopsychosocial Theory in Psychology believes that most mental disorders are a result of a combination of biological, psychological and social or cultural factors.
Biological: Research studying families and twins has shown that individuals can have a genetic predisposition to a panic attack. Disturbances in neurotransmitter systems in the brain, such as the GABA neurotransmitter, may also contribute to panic attacks.
Psychosocial: Certain temperaments, personality characteristics and early life experiences can predispose individuals to panic attacks and panic disorder.
A heightened awareness of physical sensations and a tendency to interpret them as signs of danger can contribute to panic attacks. Additionally, avoidance and safety behaviours can further sustain panic attacks. These cognitive and behavioural factors help maintain panic attacks that consequently become an important target for treatment.
How are panic attacks and panic disorder treated?
There are a number of psychological and pharmaceutical approaches that help treat panic attack and panic disorder.
Psychotherapeutic approaches such as Exposure Therapy and Cognitive Behaviour Therapy are used to help people work through the unhelpful thinking and behaviour patterns that maintain panic attacks. Other in-depth approaches to therapy, such as the Psychodynamic approach, helps people explore the early experiences and unconscious conflicts that may have contributed to the panic attacks.
Additionally, certain relaxation exercises, such as deep breathing, are helpful in managing the symptoms of panic attacks. However, not all relaxation exercises work for panic attacks and it is important to be careful in selecting them. Two categories of medication, antidepressants and benzodiazepines are commonly used to treat the symptoms of these two conditions.
How do we become more sensitive when using mental health terminology?
Here are some ways we can start being more mindful in our use of mental health terms:
Find new adjectives for labelling your experiences instead of relying on terms like ‘panic attack’ or ‘depression’.
Educate yourself about panic attacks and panic disorder as well as other mental illnesses before you use these terms. Read up, speak to mental health professionals and speak to people who have been diagnosed with panic disorder or who deal with panic attacks.
Become more aware of how you are using ‘panic attack’ or ‘panic disorder’ in conversation. By becoming more aware you will be more careful before using these terms.
Conclusion:
It is important to remember that mental illnesses are complex experiences and it is important to honour this complexity and use terminology with care and sensitivity.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi-org.ezproxy.frederick.edu/10.1176/appi.books.9780890425596
Bonevski, Dimitar & Naumovska, Andromahi. (2020). Panic Attacks and Panic Disorder. 10.5772/intechopen.86898.
Good Therapy. (2019, December 11). Panic and Panic Attacks. https://www.goodtherapy.org/learn-about-therapy/issues/panic
Good Therapy. (2022, January 7). Coping with Panic Attacks: Strategies to Share. https://www.goodtherapy.org/blog/Coping-with-Panic-Attacks-Strategies-to-Share
Hoffman S.G., Hay, A. & Barthel.A. Panic Attacks and Panic Disorder: Symptoms, Treatment, Causes, and Coping Strategies. Anxiety.org. https://www.anxiety.org/panic-disorder-panic-attacks
National Institute of Mental Health. Panic Disorder: When Fear Overwhelms. https://www.nimh.nih.gov/sites/default/files/documents/health/publications/panic-disorder-when-fear-overwhelms/22-MH-8077_PanicDisorder.pdf
Philip R. Muskin. (2021, June). What are Anxiety Disorders. American Psychiatric Association. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
Written By - Riea Enok (Psychotherapist at The Mood Space)
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