Panic Disorder

COEXISTING CONDITIONS
At the NIH conference on panic disorder, the panel recommended
that patients be carefully evaluated for other conditions that
may be present along with panic disorder. These may influence
the choice of treatment, the panel noted. The following are among the conditions frequently found to coexist with panic disorder:

Simple Phobias. People with panic disorder often develop
irrational fears of specific events or situations that they
associate with the possibility of having a panic attack. Fear of
heights and fear of crossing bridges are examples of simple
phobias. Generally, these fears can be resolved through repeated
exposure to the dreaded situations, while practicing specific
cognitive-behavioral techniques to become less sensitive to them.

Social Phobia. This is a persistent dread of situations
in which the person is exposed to possible scrutiny by others and
fears acting in a way that will be embarrassing or humiliating.
Social phobia can be treated effectively with
cognitive-behavioral therapy or medications, or both.

Depression. About half of panic disorder patients will
have an episode of clinical depression sometime during their
lives. Major depression is marked by persistent sadness or
feelings of emptiness, a sense of hopelessness, and other
symptoms.

When major depression occurs, it can be treated effectively with
one of several antidepressant drugs, or, depending on its
severity, by cognitive-behavioral therapies.

Symptoms of Depression

Persistent sadness or feelings of emptiness
A sense of hopelessness
Feelings of guilt
Problems sleeping
Loss of interest or pleasure in ordinary activities
Fatigue or decreased energy
Difficulty concentrating, remembering, and making decisions

Obsessive-Compulsive Disorder (OCD). In OCD, a person
becomes trapped in a pattern of repetitive thoughts and behaviors
that are senseless and distressing but extremely difficult to
overcome. Such rituals as counting, prolonged handwashing, and
repeatedly checking for danger may occupy much of the person’s
time and interfere with other activities. Today, OCD can be
treated effectively with medications or cognitive-behavioral
therapies.

Alcohol Abuse. About 30 percent of people with panic
disorder abuse alcohol. A person who has alcoholism in addition
to panic disorder needs specialized care for the alcoholism along
with treatment for the panic disorder. Often the alcoholism will
be treated first.

Drug Abuse. As in the case of alcoholism, drug abuse is
more common in people with panic disorder than in the population
at large. In fact, about 17 percent of people with panic
disorder abuse drugs. The drug problems often need to be
addressed prior to treatment for panic disorder.

Suicidal Tendencies. Recent studies in the general
population have suggested that suicide attempts are more common
among people who have panic attacks than among those who do not
have a mental disorder. Also, it appears that people who have
both panic disorder and depression are at elevated risk for
suicide. (However, anxiety disorder experts who have treated
many patients emphasize that it is extremely unlikely that anyone
would attempt to harm himself or herself during a panic attack.)

Anyone who is considering suicide needs immediate attention from
a mental health professional or from a school counselor,
physician, or member of the clergy. With appropriate help and
treatment, it is possible to overcome suicidal tendencies.

There are also certain physical conditions that are often
associated with panic disorder:

Irritable Bowel Syndrome. The person with this syndrome
experiences intermittent bouts of gastrointestinal cramps and
diarrhea or constipation, often occurring during a period of
stress. Because the symptoms are so pronounced, panic disorder
is often not diagnosed when it occurs in a person with irritable
bowel syndrome.

Mitral Valve Prolapse. This condition involves a defect
in the mitral valve, which separates the two chambers on the left
side of the heart. Each time the heart muscle contracts in
people with this condition, tissue in the mitral valve is pushed
for an instant into the wrong chamber. The person with the
disorder may experience chest pain, rapid heartbeat, breathing
difficulties, and headache. People with mitral valve prolapse
may be at higher than usual risk of having panic disorder, but
many experts are not convinced this apparent association is real.

Brain and Mental Health

References and Sources: Medline, Pubmed, National Institutes of Health

last update: February 2009