Tony returns to work, and things seem to be going fine. Within a week, he is back at the top of his game. However, on an extra patrol call a mile from his previous incident, he begins to feel funny. Going by that fateful intersection, he realizes that he is hyperventilating and white-knuckling the steering wheel. He can't seem to focus, and he senses severe indigestion, but much lower in his gut. There is a feeling of dread, of impending doom, but it passes. Tony learns to avoid the neighborhood as much as possible, and tries alternate routes when he has to respond to a call. Luckily for Tony, two weeks later there is a beat rotation, and he feels free.
Seventeen days later, Tony awakens in his bed three hours after a long shift. His eyes pop open, it is still dark. He is chilled, sweating profusely, with a familiar crushing pain in his chest. Nothing feels real, he senses he is detached from himself and is looking down at himself from the ceiling. He has no control over his body or thoughts, he is virtually paralyzed. He wonders if he should call 911; he wonders if he can. He waits, eventually the symptoms subside, and Tony secretly believes he has gone over the edge, and that he is in fact going crazy. Embarrassment prevents him from talking to his family, supervisors or friends. He takes some comp time to regroup. The mere thought of leaving the house stresses him out.
Panic Disorder and Agoraphobia
A panic disorder is diagnosed when an individual suffers at least two unexpected panic attacks, followed by at least a month of concern over having another attack, as well as avoidance of places that may trigger an attack. A person with a panic disorder increasingly senses an intense feeling of foreboding, followed by raw fear, he/she knows that something terrible is about to happen. When another attack does come, the individual naturally begins to search for a cause. They may suffer phobic avoidance. He/she will begin to avoid situations or places where episodes have occurred. If the panic attack occurred at a mobbed concert, the sufferer makes sure to avoid crowds (enochlophobia). If the attack was during an airline flight, he/she will now drive everywhere and exclude distant locations they still may want to visit (pteromerhanophobia or acrophobia). The individual may even become reclusive. It's better to suffer alone than to endure the attacks in the public, where there's no escape from the fear and humiliation. However the attacks continue, making normal work or home life virtually impossible.
Agoraphobia, an intense and irrational fear of being in public places, often occurs in people who have a panic disorder. People who have agoraphobia are afraid of being in any place or situation which may trigger a panic attack, or from which it might be hard for them to escape--crowds, standing in line, shopping malls, public transportation, etc. Individuals with severe agoraphobia may never leave their homes.
Sometimes, panic attacks just go away. Some people have one and never have another, while others are plagued for years or a lifetime. Some sufferers learn coping strategies; others rearrange their lives and may eventually become totally isolated and alienated.
Treatments for panic attacks and panic disorder are very effective and include both medications and counseling. The most commonly prescribed medication for a panic disorder is an SSRI antidepressant, such as Zoloft, Prozac, Paxil or Luvox. Trials have shown that these medications reduce the frequency of panic attacks by up to 75-85%. Unfortunately, it takes from three to six weeks for a SSRI to be effective in treating a panic disorder. Benzodiazepines or diazepam (Xanax, Klonopin, Ativan, and Valium) can decrease panic attacks by up to 70-75% almost immediately, but these tranquilizers have some major drawbacks, including sedation, memory loss, decreased reaction times, increased tolerance, the possibility of addiction, and withdrawal symptoms.
Therapy for panic attacks includes education about the disorder, as well as learning how to differentiate a panic attack from life-threatening disorders such as a heart attack or stroke. Therapy can help an individual realize the first signs of a panic disorder, to initiate muscle relaxation and breathing techniques. Sufferers are taught to calm their thoughts and reactions by reminding themselves that the attack will be time-limited. Behavioral therapy may be another component of the treatment plan, related to gradual exposure to feared situations. A panic attack sufferer will tend to avoid perceived trigger situations at all costs. With behavior therapy, an individual practices being in a trigger situation while she/she is in a safer environment. The goal is to make small strides towards confronting and overcoming a trigger. For example, if your trigger situation is shopping at the grocery store, all you may be able to at first is make a shopping list. The next goal may be to sit in your car in the driveway and think about shopping for five minutes. Eventually you may drive a block, then perhaps two, then drive and park in the parking lot, followed by making a one-item purchase on your next attempt.