Panic Disorder

Distinction between Attack and Disorder

Having an isolated panic attack does not constitute a disorder.

Panic disorder is diagnosed when, after suffering one or more attacks, the person experiences for at least one month a persistent worry about having another attack or its consequences (e.g. "I'm going to have a heart attack", "I'm going to lose control").

This leads to a maladaptive change in behavior, such as avoiding exercise or going out of the house, in an attempt to prevent further attacks.

Anatomy of a Panic Attack

A panic attack is defined as a sudden wave of intense fear or discomfort that peaks within minutes.

To be diagnosed, at least four physical or cognitive symptoms must be present, such as: palpitations or tachycardia, sweating, tremors, a feeling of suffocation or shortness of breath, chest pain, nausea, dizziness, chills or heat, paresthesias (tingling), derealization (feeling of unreality) or depersonalization.

Cognitively, the most frightening symptoms are fear of dying, fear of going insane or fear of losing control of one's actions.

It is this catastrophic interpretation that turns a physical reaction into pure terror.

The Cognitive Model of Panic (Vicious Cycle)

The cognitive model explains panic as a misinterpretation. The cycle begins with a trigger (internal or external) or a normal physical sensation (e.g. slight tachycardia from climbing stairs).

The person perceives this as a threat. This perception activates the anxiety response, which intensifies the physical symptoms.

The critical point is the catastrophic misinterpretation: "My heart is beating fast, therefore, I am having a heart attack".

This interpretation triggers terror, which in turn releases more adrenaline, further accelerating the heart and apparently confirming the heart attack hypothesis.

The patient enters a positive feedback loop where fear of symptoms begets more symptoms.

Summary

This disorder is diagnosed when, after panic attacks, the fear of repeating them or their consequences persists. This generates maladaptive and avoidance behavioral changes in an attempt to prevent future attacks.

The attack is a sudden wave of intense fear with physical symptoms such as tachycardia or suffocation. Cognitively, what defines panic is the catastrophic interpretation of dying, going mad or losing control.

The cognitive model explains panic as a vicious cycle of misinterpretation. A normal physical sensation is perceived as a serious threat, triggering fear and amplifying symptoms that confirm the danger.