PANIC DISORDER AND ITS CAUSES
CONCEPTS
Before introducing the subject of panic disorder, anxiety, fear, panic It would be healthier to start by defining the concepts of attack and agoraphobia.
The words anxiety and fear are often used interchangeably in daily language. Anxiety and fear are not the same thing. Anxiety is an emotion that occurs when a person feels under emotional or intellectual pressure. When the emotion of fear is felt, there is an element that threatens the person's physical existence. In the feeling of anxiety, there is no threat to the physical existence of the person. While fear is short-lived, anxiety lasts longer. The person produces anxiety as a result of his own negative thoughts.
While fear is an emotion felt in the face of a real danger and serves the person's survival, anxiety is the perception of threat felt by the person against events, situations, and people that do not pose a real threat. While there is an object to which the emotion is directed in fear, it may not be in anxiety. In fear, the threat is outside. The person knows what the danger is and can exhibit a behavior such as "flight" or "fight". When the situation in which he feels fear disappears, he feels relieved, it is instantaneous. Anxiety, on the other hand, is a more general condition, more severe and longer-lasting than fear.
Anxiety is a natural emotion, but when experienced at an optimal level, it keeps us alert. Anxiety appears as a problem when it is widespread, frequent, severe and uncontrollable enough to disrupt a person's daily functioning.
When we talk about the concept of panic attack, panic attacks are one of the most common situations today. Panic attack is not a disease but just a symptom. Natural panic; Panic disorder is a condition in which a person experiences recurrent, sudden panic attacks with intense anxiety, regardless of a physical threat. The person may begin to experience anxiety about having an attack again.
An individual with panic disorder may also show symptoms of agoraphobia. Agoraphobia is caused by traveling in open spaces, public places, public transportation, buses, trains and planes. It is the person's avoidance of such situations. The individual may avoid this situation (not going to crowded areas, not entering closed environments, not using public transportation, etc.), taking precautions, developing security-providing behaviors, feeling great discomfort and trying to endure it, or may need an accompanying person (security person).
Actually, you see; Panic attack is a state of being "as if". In fact, it is the state of perceiving unreal situations and events as real and constantly alerting the body and mind towards this.
It is a broken alarm system. It is a person's misinterpretation or misperception of a sensation felt in his or her body.
According to DSM V, the diagnostic criteria for Panic Disorder are as follows:
A.Recurrent unexpected panic attacks. A panic attack is a sudden state of intense fear or intense inner distress that culminates within minutes and is accompanied by four (or more) of the following symptoms: Note: Such a state occurs during a period in which the person is either calm or anxious. In this case, it may suddenly suppress.
1. Palpitations, pounding heartbeat or increased heart rate.
2. Sweating.
3. Tremors or shaking.
4. Sensation of shortness of breath or suffocation.
5. Sensation of breathlessness.
6. Chest pain or chest tightness.
7. Nausea or abdominal pain.
8. Dizziness, inability to stand, light-headedness, or a feeling of fainting.
9. Sensation of shivering, chills, chills or flushing.
10. Numbness (numbness or tingling sensations).
11. Unreality (“derealization”, the feeling of being unreal) or self-alienation (“depersonalization”, the feeling of detachment from oneself).
12. Fear of losing control or “going crazy”.
13. Fear of death.
Note: Culture-specific symptoms (e.g. tinnitus, neck pain, headache, uncontrolled screaming or crying) may be observed. These symptoms should not be counted as one of the four required symptoms.
B. At least one of the attacks is followed by one or both of the following for a month (or longer) :
1. Persistent worry or worry about having more panic attacks or their possible consequences (e.g., losing control, having a heart attack, “going crazy”).
2. Showing behavioral changes related to attacks that are associated with adjustment disorder (e.g., behaviors designed to avoid having a panic attack, such as avoiding sports or familiar or unfamiliar situations).
C. This The disorder is not attributable to the physiological effects of a substance (e.g., a substance of abuse, a medication) or another health condition (e.g., hyperthyroidism, cardiopulmonary diseases).
D.
strong> This disorder is not better explained by another mental disorder (e.g., panic attacks in response to feared social situations only, as in social anxiety disorder; in response to a limited set of phobic objects or situations, as in specific phobia; obsession-compulsive It does not occur as a reaction to obsessions, as in post-traumatic stress disorder; as a reaction to reminders of traumatic events, as in post-traumatic stress disorder; or as a reaction to separation from attached people, as in separation anxiety disorder).To summarize the symptoms during a panic attack. ;
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Heart palpitations,
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Sweating,
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Chest pain or chest discomfort,
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Trembling or shaking,
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Shortness of breath,
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Feeling like you are drowning,
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Colds or hot flushes,
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Feeling of losing reality,
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Nausea,
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Dizziness,
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Fear of losing control,
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Fear of death
CAUSES OF PANIC DISORDER
Suppressed emotions Unexpressed emotions, thoughts and experiences can cause panic attacks. They may worry about becoming angry and experiencing conflict. Especially people with repressed negative emotions may experience discomfort due to the anger they cannot express. A person who cannot express his negative emotion appropriately may experience physical symptoms. They may experience panic attacks.
One of the common conditions observed in people with panic disorder in adulthood is that they experienced separation anxiety in childhood. It has been observed that people who experienced separation in their early lives are prone to panic disorder. “Any family environment that makes people believe that the world is full of dangers and uncertainties, that instills the idea that they can be harmed by anything at any time, that makes them think that they may be inadequate to protect themselves, and that they cannot overcome anything on their own, increases the possibility of the person developing panic disorder later on.” (Köroğlu, 2017) . Overprotective, anxious parents send implicit messages to their children that the world is a dangerous place. Children growing up with a protective approach cannot develop an independent, autonomous personality and may have difficulty coping with problems alone and need others. They have difficulty taking responsibility for their own lives. The need for others makes a person dependent on others. He may worry about losing the person he is addicted to and experience panic. In life events such as military service, change of city or school, marriage, starting a new job, divorce, separation, loss of a loved one, the person may be forced, triggered and experience panic.
"Child individuals" in the adult body who have not experienced separation from their parents. They may complain about their parents' intrusive attitudes, but despite this, they may have difficulty taking responsibility for their own life, draw healthy boundaries and separate from their family. They may experience panic disorder due to these situations.
It is often observed that people with panic disorder are in fear of death. The basis of the fear of death actually stems from the feeling of having lost or will lose the person you love. Additionally, people with a fear of death worry about getting sick and are extremely sensitive to their physical sensations.
They are distrustful of the outside world and may generally have low self-confidence. They are concerned about their competence and need approval for their actions. Striving to be loved and approved by others They ignore their own wishes and prioritize responding to the needs of others. They have difficulty drawing healthy boundaries. The underlying emotion of this situation is anxiety. They experience deep-seated anxiety about losing others and not being loved.
PANIC DISORDER AND THE THERAPY PROCESS
For some clients, only therapy may be more beneficial, and for some clients, it may be more beneficial to manage the process with both medication support and therapy. First, after the interventions regarding the attacks, the life events that caused the person to show this symptom are evaluated and the underlying cause is started to be worked on through therapy.
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