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Anxiety and Panic

Panic attacks are intense periods of fear or feelings of doom developing over a very short time frame — up to 10 minutes — and associated with at least four of the following:

  • Overwhelming fear (of losing control or going crazy)
  • Palpitations
  • Sweating
  • Trembling
  • Shortness of breath
  • Sense of choking
  • Chest pain
  • Nausea
  • Dizziness
  • A feeling of being detached from the world (de-realization)
  • Fear of dying
  • Numbness or tingling in the limbs or entire body
  • Chills or hot flushes

Panic attacks and panic disorder are not the same thing. Panic disorder involves recurrent panic attacks along with constant fears about having future attacks and, often, avoiding situations that may trigger or remind someone of previous or unexpected attacks. Not all panic attacks are caused by panic disorder. Sometimes, they’re related to conditions like:

Doctors will often look for other medical conditions that might trigger or be related to panic attacks or similar episodes. They might include:

Generalized anxiety disorder is excessive and unrealistic worry over a period of at least 6 months. It is associated with at least three of the following symptoms:

  • Restlessness
  • Fatigue
  • Difficulty concentrating
  • Irritability or anger
  • Muscle tension, aches, or soreness
  • Sleep disturbances

Phobic disorders are intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack. Social phobia and agoraphobia are examples of phobic disorders.

Posttraumatic stress disorder or PTSD — was considered to be a type of anxiety disorder in earlier versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. But in 2013, PTSD was reclassified as its own condition.

It describes a range of emotional reactions caused by exposure to either death or near-death circumstances (such as fires, floods, earthquakes, shootings, assault, automobile accidents, or wars) or to events that threaten one’s own or another person’s physical well-being. The traumatic event is re-experienced with fear of feelings of helplessness or horror and may appear in thoughts and dreams. Common behaviors include the following:

  • Avoiding activities, places, or people associated with the event
  • Persistently re-experiencing the traumatic event, such as:
    • Unwanted memories
    • Nightmares or flashbacks
    • Emotional or physical distress when experiencing reminders of the trauma
  • Changes in arousal or reactivity, including:
    • Trouble concentrating
    • Trouble sleeping
    • Being hypervigilant (you closely watch your surroundings) or being easily startled
    • Irritability or aggression
    • Risky behavior
  • Negative changes in feelings and thoughts, such as:
    • Feeling a general sense of doom and gloom with diminished emotions (such as loving feelings or aspirations for the future)
    • Feeling isolated or negative about the world
    • Less interest in activities
    • Exaggerated feelings of blame for self or others about the trauma
    • Negative thoughts and feelings about the world

Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness should not be automatically attributed to anxiety and require evaluation by a doctor.

What Should I Ask My Doctor?

If you have anxiety or were recently diagnosed with an anxiety disorder, consider asking your doctor these questions at your next visit.

  1. How did I get anxiety? Is there a chance I passed this on to my kids?
  2. Are there any underlying medical problems that could be causing my anxiety symptoms?
  3. What are my treatment options for anxiety? Will I need to take an anxiety drug? Will I take it every day or as needed? How long will I need to take it?
  4. What side effects can I expect from medications? Is there a way to minimize or prevent side effects?
  5. What should I do if I miss a dose of medication?
  6. Should I begin therapy sessions? Which type and for how long?
  7. How long before I can expect to feel better?
  8. Once treated, how likely is it that my anxiety symptoms will return?
  9. What lifestyle changes can I make to help me feel better?
  10. How will alcohol or other drugs interact with my medication or affect my anxiety?

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