Symptoms including a racing heart, shallow breaths, and excessive perspiration are common in severe anxiety and panic disorder. These attacks can cause extreme anxiety in some people, leading to terror. Panic attacks can be curbed with counseling and anti-anxiety drugs. Severe anxiety and panic disorder denote abnormal psychological problems diagnosed and treated differently across cultures and genders (Comer & Comer, 2021). It is characterized by strong episodes of panic that appear in both physical and mental symptoms. Severe anxiety and panic disorder are more prevalent in Western cultures, and women are more likely to suffer from them than males.
Description of the Symptoms and Theories
Regression is described in the psychodynamic theory of severe anxiety and panic disorder. Fear and terror take hold, and the person is left feeling depleted and unable to cope. A patient’s internal conflicts, encompassing angry hallucinations and thoughts of loss, are more distressing than the actual panic attacks themselves. Panic symptoms might be interpreted in a psychodynamic context to indicate specific, deep-seated conflicts in the unconscious mind. Severe anxiety and panic disorder is primarily brought on by worries about being separated from others and feelings of resentment (Aydın et al., 2019). Individuals prone to severe anxiety and panic disorder have difficulty dealing with emotions of failure and a sense of need for their caregivers from an early age.
The behavioral theory highlights that severe anxiety and panic disorder develops by identifying the parents’ actions model. Fear and dissatisfaction can lead to stress that becomes a chronic response when confronted with new and terrifying stimuli, like a car accident. The fear of the unknown or actual stressful experiences, such as the danger of loss or abandonment, can evolve into a frightening dependence in severe anxiety and panic disorder. When a child perceives a parent as abandoning or rejecting them, they become enraged and lash out at the parent. Because of the anxiety that this rage would damage the connection with caregivers, the patient becomes more reliant on the caregiver (Aydın et al., 2019). It is common to have dreams or experiences of attachment difficulties in adulthood, which significant life situations can prompt.
Severe anxiety and panic disorder makes patients experience acute terror and dread periods. Because of this dread, they exhibit numerous physical symptoms such as tremors, shortness of breath, coughing, chest pain, dizziness, and faintness. They also experience chills or hot flushes and paresthesia (Aydın et al., 2019). Additionally, it generates various mental symptoms, including emotions of depersonalization, the dread of losing control or becoming insane, and the fear of death. Severe anxiety and panic disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as having at least four symptoms and behavioral change. Additionally, patients have an unexpected intense fear and, at minimum, one month of significant trepidation that one will develop another frightful experience.
Even if intense fear is predicted, a person can still have severe anxiety and panic disorder. Because of anticipated and unanticipated panic attacks, people with agoraphobia are afraid of situations that could trigger fright. Diagnosing panic disorder is difficult due to its wide range of symptoms and manifestations. Classification of the condition is challenging because there are more than 13 symptoms and 700 combinations (Aydın et al., 2019). Everyone will encounter a few or all of these symptoms at some point. Although severe anxiety and panic disorder are not ubiquitous in the diagnostic stage, the criteria should be met to make a precise diagnosis.
Severe anxiety affects 23% of people at some point in their lives, while only 5% have an actual panic disorder. Approximately 20% of the general population will experience severe anxiety devoid of having a panic disorder (Niles et al., 2021). The theoretical danger of having a panic disorder is more significant than the practical reality, and the likelihood changes depending on the society in which the person lives. The projected lifetime risk accounts for 17% and 69% of the expected prevalence. In countries where sectarian violence is a problem, the ratios are the highest (Nigeria, Israel, and South Africa). The most recent cohorts show the greatest increase in the general tendency toward projected risk in all countries. In addition to the typical age of beginning panic disorder being relatively early, children who have the condition tend to develop other psychiatric problems; this makes the disorder often underdiagnosed and misunderstood. The National Comorbidity Survey Replication (NCS-R) found that 3% of adults in the United States aged 18 or older have panic disorder. Panic disorder affects about 5% of the adult population in the United States.
Anxiety disorders, such as panic attacks, result from hereditary and environmental variables. Attributable to this, the illness is not universally recognized across cultures. For the most part, genes do not cross racial barriers in most societies. Anxiety and panic disorders are more common in people who have a family history of the problem, and a gene has been linked to an increased risk of 6–17%. More than 17 times as many first-degree relatives of those with panic disorder suffer from severe anxiety and panic disorder before 20 years, and six times as many as non-relatives after 20 years (Lai, 2019). Psychologists have linked more than a thousand polymorphisms and 350 potential genes to panic disorder. This serves as further evidence that the disorder is not a universal condition but rather one that can manifest itself in various ways in a wide range of people.
Irrespective of culture, the prevalence of panic disorder is skewed heavily toward one gender. Females are twice likely than males to suffer from panic disorder, manifesting earlier in life. A higher frequency of traumatic experiences such as sexual assault or domestic violence, as well as hormonal changes and early life stress, contribute to the earlier onset of severe anxiety and panic disorder in women. The slightly elevated COMT polymorphism, Val158Met, allele in women also predisposes them to panic disorder (Niles et al., 2021). In addition to a person’s fearfulness and cardiovascular and hyperventilation subtypes, personality traits and inhibitions, cultural variety, age at onset, and false suffocation alarms influence a person’s likelihood of developing panic disorder. Anxiety is more common in women in their forties or fifties who have been bereaved or divorced and those who are poor. However, there is no disparity in the prevalence of panic disorder between rural and urban populations. Panic disorder cannot be linked to urbanization; however, the race of those afflicted plays a role. Of the panic disorder patients studied, 91% were Caucasian, 7% were African-American, and 2% claimed to be biracial.
Treatments can help people suffering from anxiety and panic disorders feel better and be more productive in their everyday lives. Psychotherapy and medication are the most common methods of treatment (Teismann et al., 2018a). Depending on the patient’s preference, history, the severity of the condition, and access to psychotherapists, one or both treatment modalities may be recommended.
One of the most common treatments for severe anxiety and panic disorder involves psychotherapy or talk therapy. People with fright episodes and panic disorder can benefit from psychotherapy. Cognitive-behavioral therapy (CBT) denotes a psychotherapy approach that can help patients realize that their anxiety and panic disorder is not life-threatening (Teismann et al., 2018b). This treatment method is designed to assist patients in gradually re-enacting the symptoms of a panic attack while remaining safe. Panic attacks begin to subside when the body no longer perceives them as a danger. People can overcome their phobias and anxieties if treatment is successful. It may take some time and effort to see results from treatment. Within a few weeks, one may notice a decrease in the severity of panic attacks, and within a few months, the condition may be entirely resolved.
If panic attacks or anxiety are a problem, medication may help. The symptoms of panic attacks can be efficiently treated with various drugs, including serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines. SSRI antidepressants are generally safe and have a low risk of adverse effects. Panic disorder can be treated with SSRIs such as paroxetine, sertraline, and fluoxetine approved by the FDA. Venlafaxine, an SNRI, has been licensed by the FDA to treat panic disorder (Quagliato et al., 2018). These drugs fall within the umbrella of the antidepressant drug class. Benzodiazepines should only be taken for brief periods due to the potential for habit formation and the development of physical or mental dependence. These sedatives have a depressive effect on the central nervous system. Alprazolam and clonazepam are two of the benzodiazepines endorsed by the FDA to manage panic disorder.
Primary care patients frequently have panic disorder, which can be debilitating. A chest ache or shortness of breath could signify something more serious, making diagnosis challenging. If severe anxiety and panic disorder is diagnosed and treated correctly, the patient’s quality of life is restored. According to recent meta-analyses, the severity and frequency of panic attacks can be reduced using both SSRIs and tricyclic antidepressants (TCAs) (Strauss et al., 2019). Physicians and patients work together to choose the best course of action. Patients with panic disorder who use antidepressant drugs report fewer and less severe attacks, in addition to a better overall quality of life.
Patients with panic disorder treated with professional cognitive therapy, behavioral interventions, and integrated CBTs are better off than those receiving general emotional support psychotherapy. About 30% of people with panic disorder are distressed, and 20% have tried to kill themselves (Teismann et al., 2018b). The use of alcohol as self-medication for panic disorder is not recommended because it interrupts treatment. Pregnant women should not use some medications, such as antidepressants, due to the risk of congenital disabilities and other complications.
The abnormal psychological problem, severe anxiety, and panic disorder is diagnosed and treated in different ways in diverse cultures and genders. It is more prevalent in Western cultures, and there is a higher incidence among females than males internationally. Patients with anxiety or panic disorders suffer from various physical symptoms, such as shaking, shortness of breath, and coughing as well as chest pain and dizziness. The most common treatment options for this disorder include counseling and medication. Patients who suffer from severe anxiety or panic disorder should see their doctor regularly to monitor and treat their condition if it worsens.
Aydın, O., Balıkçı, K., Çökmüş, F. P., & Ünal Aydın, P. (2019). The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: Effects on symptoms and comparison with healthy control. Nordic Journal of Psychiatry, 73(4-5), 293-301.
Comer, R. J., & Comer, J. S. (2021). Abnormal psychology (11th ed.). Worth Publishers.
Lai, C. H. (2019). Fear network model in panic disorder: The past and the future. Psychiatry Investigation, 16(1), 16-24.
Niles, A. N., Axelsson, E., Andersson, E., Hedman-Lagerlöf, E., Carlbring, P., Andersson, G., Johansson, R., Widén, S., Driessen, J., Santoft, F., & Ljótsson, B. (2021). Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic. Behavior Research and Therapy, 136, 1-10.
Quagliato, L. A., Freire, R. C., & Nardi, A. E. (2018). Risks and benefits of medications for panic disorder: A comparison of SSRIs and benzodiazepines. Expert Opinion on Drug Safety, 17(3), 315-324.
Strauss, A. Y., Kivity, Y., & Huppert, J. D. (2019). Emotion regulation strategies in cognitive behavioral therapy for panic disorder. Behavior Therapy, 50(3), 659-671.
Teismann, T., Brailovskaia, J., Totzeck, C., Wannemüller, A., & Margraf, J. (2018a). Predictors of remission from panic disorder, agoraphobia and specific phobia in outpatients receiving exposure therapy: The importance of positive mental health. Behaviour Research and Therapy, 108, 40-44. Web.
Teismann, T., Lukaschek, K., Hiller, T. S., Breitbart, J., Brettschneider, C., Schumacher, U., Margraf, J., & Gensichen, J. (2018b). Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia. BMC Psychiatry, 18(305), 1-5.