Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012

What is panic?
Panic disorder

In 1837, just a few months after returning from his epic five-year voyage around the globe on the Beagle, the 28-year-old Charles Darwin began to experience a number of puzzling and distressing symptoms, including palpitations, breathlessness, trembling, nausea, faintness, and sudden fear:

I have awakened in the night being slightly unwell and felt so much afraid though my reason was laughing and told me there was nothing and tried to seize hold of objects to be frightened of.

The attacks persisted until the end of Darwin’s life, 45 years later, and the scientist-adventurer rapidly became a recluse, unwilling even to leave his home unless in the company of his wife: ’I have long found it impossible to visit anywhere; the novelty and excitement would annihilate me.’

Darwin’s doctors diagnosed a variety of illnesses, among them ’dyspepsia with an aggravated character’, ’catarrhal dyspepsia’, and ’suppressed gout’. Today, discussion in clinical journals concludes that what he may actually have been suffering from was panic disorder.

What is panic?

For most of us, the word ’panic’ describes a sudden feeling of intense anxiety. It’s what we experience when we can’t find our passport at the airport, or suspect that we’ve deleted a crucial file on our computer.

Unpleasant though it is, this kind of experience is a distinctly ’watered-down’ version of the real thing. Genuine panic means being hit by a wave of overwhelming, visceral fear, accompanied by a variety of unpleasant physical sensations, among them shortness of breath, sweating, chest pains, trembling, dizziness, numbness, tingling in the limbs, nausea, and chills and hot flushes. Heart rate may rise by more than 20 beats per minute.

Panic brings with it a range of terrifying thoughts — for example, that we’re about to lose control or faint, that we’re going mad, or that we’re dying. Attacks develop very quickly, often peaking in as little as four or five minutes, and generally last around ten to twenty minutes.

Panic is a common feature of all anxiety disorders, and other psychological problems too (depression, for instance). In fact, one study found that fully 83% of patients with a psychological disorder reported at least one panic attack. But it takes centre stage in panic disorder, which the Diagnostic and Statistical Manual of Mental Disorders defines as follows:

• Recurrent, unexpected panic attacks, involving four or more of a range of sensations, including palpitations, pounding heart, sweating, trembling, breathlessness, chest pain, dizziness, and fear of dying, losing control, or going crazy.

• After an attack, one month or more of:

worry about the possibility of another attack, or about the meaning of the attack (for example, that it signifies a serious physical or mental illness);

change in behaviour because of the attack (for instance, avoiding situations associated with the panic).

If you look back to the first item in this list of criteria, you’ll notice the word ’unexpected’. This unexpectedness is critical in panic disorder. Someone with a height phobia might have a panic attack if asked to travel in an elevator, but the trigger for that panic will be obvious to them. In panic disorder, at least two attacks need to come out of the blue, with no obvious immediate trigger. Over time, however, the person often realizes that there are particular situations, for example supermarkets or bus journeys, in which they are more likely to panic.

Many people with panic disorder also suffer from agoraphobia. This makes sense because agoraphobia isn’t in fact a fear of open spaces, but rather the fear of experiencing a panic attack in a situation in which escape is impossible and help unavailable. Because of this, agoraphobia isn’t regarded these days as a distinct category of illness, but instead as secondary to panic disorder. Common situations feared by people with agoraphobia include being in a crowd or on public transport, crossing a bridge or travelling in a lift, or simply being alone — either in the home or outside it.