Are there people who seem particularly prone to having panic attacks?
Men or women can have a panic attack at any age. However, women seem to have them twice as often as men, and there is not a good understanding of why. Sometimes it is described that hormonal changes for women may trigger or make it subside. These are not very well established patterns though; these are relatively loose observations.
Do people who have panic attacks have other similarities?
It is believed to be a combination of genetic factors so it runs in families and there may be some environmental factors. In research settings, it is possible to trigger panic attacks by having volunteer subjects breathe higher levels of carbon dioxide or by giving them infusions of certain chemicals. Those may act as triggers in an experimental setting, but in real life it is not known what might bring panic disorder on anymore than it is for cancer or Parkinson's or rheumatoid arthritis.
How do you diagnose a panic attack?
Patients rarely initially come to me because most often their symptoms are physical symptoms -- pounding heart or breathing difficulty or GI symptoms. Very often patients think they are having a heart attack or a stroke. Very often their first visit to a doctor is at the ER because very often they don't perceive it as an emotional condition.
And mostly they are right: These are physical symptoms. Anybody whose heart is pounding or who can't breathe -- well, obviously they are going to feel anxious. And there is a sense of impending doom that goes along with these attacks. ... Typically only after having tests that show that their hearts are fine and that they are not having a stroke are they sent to a psychiatrist for treatment.
What do you tell patients whom you have diagnosed as having had a panic attack?
The first thing I tell them is that while this is a very disturbing or scary event, it is almost never a dangerous event. So I help them to understand that this is not something that is going to kill them or cause a heart attack. But it is a tremendously scary event. Once they believe this, some people say, `I'm still having these attacks, but I am not getting as worked up over them.'
What else?
The other thing I try to explain is that this is a dysfunction in the brain -- almost like a seizure.
