Panic Disorder

Panic disorder is an anxiety disorder characterised by recurrent, unexpected panic attacks, sudden surges of intense fear accompanied by pronounced physical symptoms that can feel indistinguishable from a heart attack or other medical emergency. Unlike a single panic attack, which many people experience at some point without it indicating a disorder, panic disorder is diagnosed when attacks recur unpredictably and are followed by persistent worry about future attacks or significant changes in behaviour to avoid them. It is a highly treatable condition, but in Nigeria it is frequently misattributed to physical illness, spiritual causes, or "heart problems," leading many people to undergo repeated cardiac or medical investigations before the underlying anxiety disorder is recognised and treated.

A panic attack typically peaks within minutes and includes at least four of the following: • Rapid or pounding heartbeat • Chest pain or tightness • Shortness of breath or a smothering sensation • Trembling or shaking • Sweating • Dizziness, light-headedness, or feeling faint • A choking sensation • Nausea or abdominal distress • Numbness or tingling, particularly in the hands or around the mouth • Chills or hot flushes • Feelings of unreality or detachment from oneself • Intense fear of dying, losing control, or "going crazy" Between attacks, many people develop persistent anticipatory anxiety about when the next attack will occur, and may begin avoiding places or situations associated with previous attacks.

The precise cause of panic disorder is not fully understood, but it is believed to result from an interaction of: • Genetic predisposition: panic disorder runs in families • Neurobiological factors: dysregulation in brain circuits and neurotransmitters (including serotonin, norepinephrine, and GABA) that control the body's fear and threat response • Major life stress or trauma: panic disorder often first develops following a significant stressful life event, though attacks can then continue in the absence of an obvious trigger • Learned fear response: after an initial panic attack, hyper-awareness of bodily sensations can itself trigger further attacks, creating a self-reinforcing cycle

• Family history of panic disorder or other anxiety disorders • History of significant life stress, trauma, or major transitions • Other co-existing mental health conditions, particularly depression and other anxiety disorders • Smoking and high caffeine intake, both of which can trigger or worsen panic symptoms • Female sex: panic disorder is roughly twice as common in women as men

• Development of agoraphobia: fear and avoidance of places or situations where escape might be difficult if a panic attack occurred, which can severely restrict daily life in advanced cases • Depression, which commonly co-occurs with or develops after panic disorder • Substance misuse, particularly alcohol, used as a coping mechanism • Repeated, unnecessary medical investigations and healthcare costs from symptoms being repeatedly misattributed to physical illness • Significant impairment in work, education, relationships, and social functioning if untreated

Panic disorder is not always preventable, particularly given its genetic and neurobiological basis, but risk and severity can be reduced: • Managing chronic stress through regular exercise, adequate sleep, and healthy coping strategies • Limiting caffeine, alcohol, and stimulant use, all of which can trigger or worsen panic symptoms • Seeking treatment early after the first few attacks, before avoidance behaviours and agoraphobia have time to develop, significantly improves long-term outcomes Treatment: Cognitive Behavioural Therapy (CBT), which teaches skills to interrupt the panic cycle, is highly effective; SSRIs are the first-line medication option for moderate-to-severe cases; and a combination of therapy and medication typically produces the best results.