Panic Disorder in Adolescents
Panic disorder (PD) is a life-changing condition that affects millions of people around the world. Patients often live in fear of the disorder, allowing for it to take control of their daily lives. PD is a serious disorder with features of repeated panic attacks (PA’s). These attacks appear out of nowhere, and considerably affect the lifestyle of patients and their families. Research has been conducted over the disorder; among the studied aspects are its incidence and prevalence rates, the risk factors involved, family factors and management, and treatment options. PD is becoming more common and severe in adolescents around the world and researchers are doing the best they can to find a cause and subsequent treatment plan.
Panic Disorder Overview
Panic disorder is a mental disorder that results in anxiety without any specific reason and is related to physical (Zaubler & Katon, 1996) and emotional health issues (Andrade, Eaton, & Chilcoat, 1996; Kessler, Stein, & Burglund, 1998; Roy-Byrne & Katon, 2000). According to the American Psychiatric Association (2000), it is a psychiatric condition defined by repeated and unexpected panic attacks, significant behavioral changes to avoid new panic attacks, fear of these panic attacks and their negative outcomes. Patients with PD have to constantly be aware of their surroundings in order to prevent panic attacks, therefore greatly affecting their quality of life. Panic disorder impacts a patient’s life in multiple ways and it oftentimes gives them a negative view on social, familial, and working lives (Kessler, Berglund et al., 2005). Patients see social events, family gatherings, and their work lives as likely places they will have a panic attack. They have to take precautions everywhere they go to refrain from having an attack.
Studies conducted over PD show that is it often comorbid with agoraphobia and anxiety. If a patient suffers with panic disorder and either agoraphobia or anxiety, it often results in them avoiding restaurants, crowds, elevators, and small rooms, in order to avert an attack (Kearney et al., 1997). When suffering from panic disorder, patients do their best to steer clear of these factors that are likely to cause an attack; however, these factors tend to show up almost everywhere, affecting millions of patient’s lives.
Incidence and Prevalence Rates of Panic Disorder
The disorder is much more common than most people think. In fact, about 2.4 million, or 1 in 113 Americans, have been diagnosed with panic disorder (NIMH). According to the American Psychiatric Association (1994), panic disorder can occur in adulthood, but adolescence tends to be the first point of onset. Robert Weis (2013) found that about 20% of children and teens will develop an anxiety disorder before becoming adults. However, a lot of these patients do not receive the treatment needed. According to Evolve Treatment Centers (2018), about 8% of teens have an anxiety disorder, but less than one in five receive treatment. Even more teenagers have an anxiety disorder and are not receiving treatment due to the fact that they have not been diagnosed.
PD can be present in men and women, but women are twice as likely to develop the disorder (Batelaan et al., 2006). Weis (2013) discovered that the gender ratio of anxiety disorders seems to increase with age, being 1:2 or 1:3, boy to girl, by adolescence. In a recent study, lifetime prevalence rates for PA’s without agoraphobia were 22.7%, 0.8% for PA’s with agoraphobia without PD, 3.7% for PD without agoraphobia, and 1.1% for PD with agoraphobia (Kessler, Chiu, Jin, Ruscio, Shear, & Walters, 2006). When a person is diagnosed with panic disorder, it changes their whole life. They have a much greater risk of attempting suicide than those who do not have the disorder (Evolve, 2018), forcing them to take much caution leading their daily lives.
Symptoms of Panic Disorder
There are many symptoms of panic disorder and its attacks. The DSM-5 describes the symptoms of PA’s being: excessive sweating, shaking, shortness of breath, chest pain, nausea, and dizziness. These symptoms tend to last about ten minutes, come considerably abrupt, are related to at least one month of anxiety about PA’s, and result in the patient striving to prevent attacks (DSM-5).
Not all of the symptoms are experienced each time a PA occurs. Oftentimes, only a few symptoms will be experienced by the patient. However, each time a PA occurs the victim is taken by surprise and is left feeling scared and extremely tired. Each time a PA is experienced the patient has anxiety about another attack for at least a month, however normally longer, and tries to avoid doing whatever it was they were doing the last time a PA occured. Those with PD tend to focus on different ideas than those without the disorder. Studies show that those who are anxious, along with panic disorder, tend to focus on more alarming stimuli (Lang & Sarmiento, 2004; Reincke et al., 2011) than those without PD. Patients often become frustrated when there are no answers for what causes PD or its attacks.
Risk Factors of Panic Disorder
Despite all the studies conducted, researchers have yet to find a cause for panic disorder. However, it appears that biological, psychological, and environmental factors can trigger the disorder (Klauke, Deckert, Rief, Pauli, & Domschke, 2010). Genetics seem to be the the strongest risk factor of PD. Evolve (2018) found that many patients tend to have a family history of anxiety or panic attacks. Some environmental risk factors include: having overprotective parents, having a passive personality, already having an anxiety disorder, experiencing traumatic events, or having high levels of stress (Evolve, 2018). Lack of sleep also seems to be a potential cause of the disorder. Lack of sleep and PD are associated with each other, even in the absence of comorbid mood disorders (Arriaga et al., 1996; Ramsawh, Stein, Belik, Jacobi, & Sareen, 2009).
Family Factors and Management of Panic Disorder
Managing panic disorder is very difficult, and often inflicts a lot of stress on the patient and their family. Since it has been found that genetics seem to be the strongest risk factor, many families with relatives diagnosed with PD often blame themselves. However, most of the risk factors from within the family are completely inescapable for the victim. It has been found that parent’s death, separating from a caregiver, illness in childhood, parent’s use of substances, physical abuse, and sexual assault can all trigger panic disorder (Bandelow et al., 2002). Another stressor on the patient and their family is that those with this disorder require more medical and mental resources compared to those without it (Barlow, 2002; Bystritsky et al., 2010; Schmidt, Norr, & Korte, 2014; Zaubler, & Katon, 1998), which ends up costing them a lot of time and money.
Patients and their families with this disorder often have loads of anxiety. In researching anxiety Barlow found that anxiety is best described as an intense feeling of dread or alarm at the unpredictable and uncontrollable future, especially thoughts of worst cases, allowing these thoughts to affect the patient’s present mindset (2002; Barlow, Allen, & Choate, 2004). PD is linked to many other functions and behaviors. It is associated with damaged social, comparative, and occupational functions, substance use (Altamura, Santini, Savadori, & Mundo, 2005), and suicidal thoughts and ideas (Weissman, Kleman, Markowitz, & Ouellette, 1989). Once diagnosed, PD does not commonly go away, despite treatment. Weis (2013) reported that usually, 25-30% of patients diagnosed with an anxiety disorder still meet criteria for the disorder ten years later. All of these factors often cause the family involved to feel anxiety and stress about how to care for this disorder.
Evidence-Based Treatment for Panic Disorder
There have been many studies done to find the most effective treatments for panic disorder. Some believe that biological reasons are the cause of the disorder and choose medication for treatment. Studies are showing that certain medications are adequate in diminishing anxiety and symptoms of panic disorder (Dannon et al., 2004). However, only some medications have proven to be effective. Smits, O’Cleirigh, and Otto (2006) found that a combination of CBT and medication has been found effective in most cases and four classes of drugs were better than the placebo, these drugs are: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI), and high-potency benzodiazepines (BDZ) (Marchesi). Eye Movement Desensitization and Reprocessing (EMDR) has also been found to reduce symptoms of PD. It is useful because panic attacks can be life threatening and panic memories can cause symptoms similar to PTSD (Horst, Den Oudsten, Zijlstra, de Jongh, Lobbestael, & De Vries).
Most patients use the same type of care. It has been found by Leon, Olfson, and Portera (1997) that 70-80% of PD patients use primary care to access mental health services. One-third of patients reach remission, however, one of out five normally relapse (Rosenbaum et al., 1996, Katschnig & Amering, 1998), requiring them to participate in more long-term treatments (Davidson, 1998, Doyle & Pollack, 2004). Results have also shown that those who received immediate Panic Control Treatment for Adolescents showed decreases in severe symptoms of PD (Pincus, May, Whitton, Mattis, & Barlow, 2010). When a patient is diagnosed with PD they are prescribed a treatment based on their symptoms and frequency of panic attacks.
Panic disorder is a serious condition that affects a large percentage of the world’s population. This disorder controls its patients life and forces them to miss out on opportunities in life, due to their fear of panic attacks. Researchers are continuing to conduct research over the disorder and hope to find a definite cause and treatment plan soon.