There are many criteria one must meet to be diagnosed with panic disorder, and the major ones are having suffered an attack, worrying about having another attack for more than a month thereafter, and tailoring your way of life to avoid the possibility of having another attack. For example, if you had a panic attack on a bus, you would avoid taking the bus thereafter.
What is a panic attack? For those of you lucky enough not to know from personal experience, it is a state where the body releases a huge quantity of the neuromediator noradrenaline. Noradrenaline is normally released in the fight-or-flight context, where the person perceives a dangerous stimulus in his/ her environment and experiences the innate urge to escape. Panic attacks, when they are an element of panic disorder, are experienced in the absence of actual threats.
They are, in effect, unwarranted. The entire attack is built up, takes place, and subsides in all of two minutes, but they are the worst two minutes of anyone’s life. Panic attacks are experienced as feelings of nausea, sweating, dilated pupils, the feeling that you are losing your mind, that other people will know and laugh at you (people do realize the irrational nature of this condition). These can be accompanied by trembling, and complete and utter terror. Again, this occurs in the absence of actual threats.
The best way to deal with panic attacks is cognitive-behavior therapy (CBT). This type of therapy is directed toward identifying and dealing with irrational thoughts. A typical thought is, “I am going to have an attack” and building your life around this. You are afraid of having another attack, so you refuse to get on the bus. Soon, your fear of this particular means of transportation comes to include others, like trams, cars, planes, and ships. If left untreated, the panic disorder can be utterly debilitating. Very rarely is panic disorder seen on its own. It is usually combined with agoraphobia.
Agoraphobia is a fear of all public places where a lot of people congregate. Paradoxically, it is also a fear of wide open spaces. The name comes from “agora” – the main city square where everybody gathered in ancient Greece. It involves a fear of crowds, public transport, supermarkets, restaurants, clubs, concerts, and all other situations where you could get stuck in a crowd and be unable to get help if something happens to you. Some people refuse to go to places where access to the nearest emergency room could be obstructed in any way.
The causes of panic disorder are many. Usually they stem from several factors – personality traits (neurotic people are more prone to develop PD), upbringing (parents who thwarted assertiveness and kept warning you about how dangerous the world is) and stress, accumulated over the years. The treatment of panic attacks involves focusing on the particular causes and effects. You should not avoid situations that make you feel afraid because that augments the fear.